Home Health & Hospice Week

A recent FBI bust of a health care fraud ring run by organized crime elements has providers asking whether home care may have become a lucrative new stomping ground for the Mob.

Attorney Robert Markette Jr. says he has, in fact, been claiming for the past couple of years that health care fraud perpetrated by organized crime is on the rise.

"What we're seeing in Houston, Miami, and Louisiana is outright criminal conduct where witnesses, etc., are ending up dead," says Markette, with Gilliland & Markette in Indianapolis. "It's like 1920 Mafia stuff."

In the recent bust, individuals allegedly related to an Armenian-American crime syndicate stole the identities of doctors and thousands of Medicare beneficiaries and operated at least 118 different  phony physician clinics in 25 states (see Eli's HCW, Vol. XIX, No. 37, p. 296 for more details). Seventy-three defendants were charged in indictments.

But does the organized crime action extend even to the home care market? Markette's heard anecdotal accounts about foreign Mob elements opening up a home health agency to bill for non-existent services by using stolen identifiers from Medicare patients.

As a result of such actions, "law-abiding health care providers are being hammered and portrayed unfavorably in the press," Markette says.

"There are more 'evil doers' purposefully defrauding Medicare" who set up storefronts and bill for services they didn't render, agrees attorney Michael Cassidy, in Pittsburgh. "Because Medicare pays within 30 days, the government doesn't figure out there's anything wrong until it's too late," he observes.

"The system is easy to manipulate" in that way. But Cassidy doesn't believe "there are as many haphazard or negligent violations by providers." And that's due to the available amount of education on compliance issues, he says.