Health care fraud no longer a faceless crime

Ricardo Alonso-Zaldivar

WASHINGTON  —  Health care fraud used to be a faceless crime  —  until now.

Medicare and Medicaid scams cost taxpayers more than $60 billion a year, but the average bank holdup is likely to get more attention. Seeking the public’s help to catch more than 170 fugitive fraudsters, the government has launched a new health care most-wanted list, with its own website.

Among those featured is Leonard Nwafor, convicted a couple of years ago in Los Angeles of billing Medicare more than $1 million for motorized wheelchairs that beneficiaries didn’t need. One of those who got a wheelchair was a blind man who later testified he couldn’t see to operate it.

Facing time in federal prison, Nwafor disappeared before his sentencing.

“We’re looking for new ways to press the issue of catching fugitives,” said Gerald Roy, deputy inspector general for investigations at the Health and Human Services Department. “If someone walks into a bank and steals $3,000 or $4,000, it would be all over the newspaper. These people manage to do it from a less high profile position, but they still have a tremendous impact.”

Even though motorized wheelchairs can run from under $1,000 to $7,000 apiece, Nawfor’s scam was on the low end when compared to others who made the most-wanted list.

Sisters Clara and Caridad Guilarte allegedly submitted $9 million to Medicare in false and fraudulent claims for pricey infusion drugs that were never provided to patients. They are accused of offering cash and other rewards for beneficiaries to visit their clinic in Dearborn, Mich., and sign forms that said they received services that they never got.

An alleged accomplice was arrested in the Dominican Republic recently, but the sisters remain at large.

Scammers “often utilize their ties to a particular community,” said Roy. “They take advantage of ethnic communities based on language barriers or lack of knowledge about how the Medicare system works. These folks are exploiting low-income communities.”

Another fugitive, Susan Bendigo, is accused of billing California’s Medicaid program for $17 million in nursing care, much of which was performed by staffers who weren’t licensed. A registered nurse herself, Bendigo was the nursing director for a company that provided personnel for home health agencies. Allegedly, she was fully aware that she was required to send licensed nurses to care for patients.

Topping the list are Miami brothers Carlos, Luis and Jose Benitez. Owners of a string of medical clinics, they allegedly scammed Medicare out of $119 million by billing for costly HIV drugs that patients never received or did not need. Authorities say they bought hotels, helicopters and boats before fleeing to Cuba.

The FBI has the marquee most-wanted list, but the Environmental Protection Agency and other federal agencies also maintain their own. Roy said he hopes this newest list will raise awareness about the importance of combating health care fraud. Medicare and Medicaid, which provide care for about 100 million Americans, are in serious financial trouble and can’t afford to be hemorrhaging tens of billions a year because of fraud.

Most fraudsters go to elaborate lengths to avoid being detected. But there is often some telltale sign.

To document his transactions, wheelchair purveyor Nwafor assembled elaborate paper files, complete with bogus prescriptions and photos of beneficiaries in their wheelchairs. But investigators had a hunch they were on to something when they discovered that most of his customers lived nearly 200 miles away from his Los Angeles-area store front.

Associated Press