Medicare Fraud arrests might expose ties to medical identity theft and organized crime

Ever wonder why our social services are going bankrupt? Here is a story, from a FBI press release, showing how $101 million was paid out in fraudulent health care claims.

Reading the release also made me wonder, where all the names to claim services, came from?

From the FBI release:

On May 22, 2007, a Miami federal grand jury returned a 46-count indictment against eight defendants in United States v. Mabel Diaz, et al., No. 07-20398-Cr-Ungaro. The indictment charges Mabel and Banner Diaz, wife and husband, with operating All-Med Billing Corp. (All-Med), a Miami medical billing company, and executing a scheme to submit tens of millions of dollars in fraudulent claims to Medicare from 1998 to 2004 for reimbursement for durable medical equipment (DME) and related services. The indictment alleges that All-Med submitted approximately $80 million in false claims on behalf of 29 DME companies. The claims were allegedly fraudulent in that the equipment had not been ordered by a physician and/or had never been delivered to a Medicare patient. As a result of the submission of the fraudulent claims, Medicare paid the DME companies approximately $56 million. The indictment also seeks forfeiture of the fraud proceeds and here substitute assets, including real estate of the Diazes. The Diazes were additionally charged with conspiracy to launder the proceeds of the alleged All-Med billing fraud scheme. Also charged in the All-Med billing fraud scheme was All-Med employee Suleidy Cano.

If you read down further on the release, the names of all the people being charged are Hispanic.

While I suppose, not all criminals with Hispanic names, cater to illegal aliens, a large number of them seem to. Despite this, there seems to be no information, whether or not; this activity had any ties to illegal immigrant activity, or if people’s identities were stolen to facilitate these crimes.

There is also very little information as to exactly how these crimes were committed. It would make sense that they would have to use names and other personal information to claim the “services,” paid for with taxpayer money.

Digging a little deeper, I found another press release dated the day before from the FBI describing a similar health care fraud scheme – where the employees involved were described as illegal aliens.

This case occurred on the other side of the country (Southern California). Please note that all the names listed on this press release were of Hispanic origin, also.

In the Los Angeles case, the taxpayers were only ripped off for a little more than $9 million. Small potatoes compared the amount in the Miami case. Of course, I wonder how much more of this is going on, where no one has been caught?

Some of these illegal aliens were posing as nurses, which could be pretty scary, if they were dispensing any real medical services. Even scarier, is the very real harm bogus information in a medical record can cause. If you think about it, bogus information in a medical history could be life-threatening.

The World Privacy Forum has studied this subject (in detail) and stated in a 56 page report:

This report discusses the issue of medical identity theft and outlines how it can cause great harm to its victims. The report finds that one of the significant harms a victim may experience is a false entry made to his or her medical history due to the activities of an imposter. Erroneous information in health files can lead and has led to a number of negative consequences for victims. Victims do not have the same recourse and help for recovery from medical identity theft as do victims of financial identity theft. This report analyzes statistics in health care and identity theft, and estimates that approximately a quarter million to a half million individuals have been victims of this crime.

The report also states:

Medical identity theft is deeply entrenched in the health cares system. Identity theft may be done by criminals, doctors, nurses, hospital employees, and increasingly, by highly sophisticated crime rings.

If the FBI is issuing two press releases about this activity, one could deduct that they might have been investigating some of these “highly sophisticated crime rings.”

Not sure if the impending immigration bill is the reason some of the surrounding issues aren't being talked about, but a lot of criminal activity is tied to the trade in human flesh.

On a personal note, I want to see honest immigrants find a better life, and continue the American tradition of adding value to the most diverse society in the world. The problem is that a lot of organized criminal groups have profited in the illegal immigrant trade for years, and no one has come up with a way to weed out this hidden activity, very effectively (my opinion).

Of note, the honest and hard working illegal immigrants are often victimized in this process, which is largely controlled by organized crime.

With millions of identities compromised, it isn’t going to be easy. Assuming someone else's identity has become too easy, especially for those with criminal connections.

FBI press release on Florida arrests, here.

FBI press release on Southern California arrests, here.

World Privacy Forum report on medical identity theft, here.

QuackWatch has a good site, which covers this type of fraud in great detail, here.

In case you wanted to learn more, the U.S. District Court of Southern Florida is happy to sell you the information, here.

The Virginia WatchDog goes after government sites that post too much personal information. A lot of great information about this subject, and examples of effective action taken by the Watchdog herself, BJ Ostergren can be found, here.

BJ and I had about an hour long conversation recently, where she demonstrated how easy personal information can be data-mined from these sites. I found BJ to be a fascinating person, but more of that, later.

This site and their important work will be the subject of some future posts.

My previous rants about organized crime controlling the traffic in human flesh can be read, here.

Organized groups with Hispanic names aren't the only immigrant groups ripping off the taxpayers. Here is a recent post, I did about another immigrant group that seems to focus on stealing public funds:

Eurasian organized crime loots public coffers

Medical Identity Theft Could Kill

Recently, I've seen a lot written about Medical Identity Theft. There seems to be a lot of people getting bills for medical procedures they never received and subsequently going through a lot of "pain and suffering" to clear their good names.

And (it seems) organized criminal are getting involved in the activity, probably because it's a "profitable" enterprise with little danger of getting caught.

BusinessWeek online did an interesting article about this, where they said:

Yet the thief isn't always an individual desperately needing medical care. In some instances, the perpetrator can be a doctor hoping to pad his or her income by filing fraudulent claims. Even worse, law enforcement authorities say that more and more frauds are being perpetrated by organized crime rings who steal dozens, and sometimes thousands, of medical records, as well as the billing codes for doctors. The rings then set up fake medical clinics—offering free health screenings as a ruse to draw in patients—that submit bogus bills to insurers, collect payments for a few months, and then disappear before the insurers realize they've been had. (Dixon notes that health records now fetch $50 to $60 each on the black market, vs. a mere 7 cents for stolen résumés.)

BusinessWeek online article, here.

The BusinessWeek article quotes Pam Dixon, executive director of the World Privacy Forum, and rightfully so. The World Privacy Forum (to the best of my knowledge) was the first to call out this growing problem and has done quite a bit of work to determine the extent of it.

They have an entire page devoted to it on their site, here. I highly recommend it for anyone, who is, or might become a victim of this growing trend.

Based on their research, they have presented some key recommendations:

• Individuals’ rights to correct errors in their medical histories and files need to be expanded to allow them to remove false information from their files.
  
• Victims of medical identity theft should have the right to receive one free copy of their medical file.
  
• Individuals should have expanded rights to obtain an accounting of disclosures of health information.
  
• Notification of medical data breaches to consumers has the potential to save lives, protect health, and prevent losses.
  
• All working prototypes for the National Health Information Network need comprehensive risk assessments focused on preventing medical identity theft while protecting patient privacy.

The World Privacy Forum has also presented their finding to several government agencies, including the FTC.

This problem goes beyond the financial implications of identity fraud because it could cause great harm to victims, who have had erroneous medical information put in their medical histories. People could be improperly diagnosed, which might (in an extreme case) lead to their demise.

I did a previous post:

Tell it to the Identity Theft Task Force

Since the Federal Identity Theft Task Force is soliciting information from the public - this would be an appropriate place for someone to voice their thoughts (recommendations) about medical identity theft.