Anti-Fraud Campaign Has Local Ties; Jacksonville Firms Review Claims for Medicare, Catching Bogus Bills in a Million-Dollar Racket

By Patterson, Steve | The Florida Times Union, December 19, 2007 | Go to article overview

Anti-Fraud Campaign Has Local Ties; Jacksonville Firms Review Claims for Medicare, Catching Bogus Bills in a Million-Dollar Racket


Patterson, Steve, The Florida Times Union


Byline: STEVE PATTERSON

Cheating Medicare made some Florida con artists rich.

Now it could leave them broke or in prison.

Federal agencies are trying to clamp down on fraud rackets that are thought to bill Medicare more than $620 million a year in Florida alone.

"That money should not be going to the pockets of health-care fraudsters. The more we are able to eradicate that ... the more money is available to help the people it was really intended for," said Eric Bustillo, a federal prosecutor in Miami.

"We're going after people who deliberately and knowingly cheat," he said.

A Jacksonville company, First Coast Service Options, reviews and manages Medicare claims from across the state under a federal contract. Medicare doesn't fault them for the fraud problem.

Two other companies, SafeGuard Services LLC and IntegriGuard LLC, run offices in Jacksonville and South Florida that Medicare pays to analyze claims for fraud and help investigators build cases against con men.

The extra scrutiny they're putting on claims is part of an anti-fraud campaign that Medicare officials say catches almost $200 in bogus bills for every dollar spent on claims review.

Prosecutors filed criminal or civil cases against at least 235 people and companies statewide during the last federal budget year, accusing them of cheating the country's senior citizen insurance system. Some of those cases started with the work done by SafeGuard and IntergriGuard.

The U.S. Attorney's Office for Southern Florida says it files one-quarter of all the health-care fraud cases in the country. The amount of fraud South Florida prosecutors claimed to have uncovered in one year was more than four times what they found a year earlier.

With more than 43 million people enrolled nationally, Medicare's giant reach make it an easy target for ripoffs. A single scam can be copied and tweaked by one thief after another pretending to file legitimate bills as a clinic owner, pharmacy operator or company selling medical equipment.

Phony billing for intravenous drugs, especially AIDS medicine and chemotherapy, is a hot area for fraud. …

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