Skip to comments.Health Care Providers Make A Killing In Medicare Fraud Racket
Posted on 05/04/2012 1:36:16 PM PDT by AtlasStalled
The big rackets these days aren't limited to gambling and drugs, and the major players in the underworld aren't just the Italian Mafia and drug cartels.
A new breed of criminal masterminds is healthcare providers who are using their medical offices to make a killing by submitting fraudulent claims through the Medicare system.
Earlier this week the feds busted 107 individuals, including dozens of doctors, nurses and social workers, in seven cities across the nation for allegedly bilking Medicare of $452 million through false billings as reported by Richard A. Serrano for the Los Angeles Times.
The estimates for billing fraud under the Medicare and Medicaid programs range from $20 to $100 billion each year. Electronic processing of claims from providers has allowed fraud against the government programs on a massive scale because they "are adjudicated by computers using rule-based systems, with no human intervention at all" as reported by Malcolm Sparrow for the Los Angeles Times: "those committing fraud find it easy to get paid for fabricated claims because the government's systems check for billing correctness but not for truthfulness."
The scam's low-risk, high-reward even has attracted real mobsters to the lucrative racket. Of course, they just use phantom clinics through which to submit the phony claims.
In October 2010 the feds charged 73 defendants, including dozens of reputed members and associates of the transnational Armenian crime group known as the Mirzoyan-Terdjanian, for their alleged roles in a multi-state $163 million billing fraud scheme against Medicare according to an FBI press release:
"According to the indictments, the defendants allegedly stole the identities of doctors and thousands of Medicare beneficiaries and operated at least 118 different phony clinics in 25 states for the purposes of submitting Medicare reimbursements. "The emergence of international organized crime in domestic health care fraud schemes signals a dangerous expansion that poses a serious threat to consumers as these syndicates are willing to exploit almost any program, business or individual to earn an illegal profit," said Acting Deputy Attorney General Gary G. Grinder."
According to the allegations contained in the indictment the Mirzoyan-Terdjanian "is named for its principal leaders, Davit Mirzoyan and Robert Terdjanian." Its leadership "is based in Los Angeles and New York" although "its operations extend throughout the United States and internationally." Among those indicted was Armen Kazarian whom the FBI alleged was a "Vor" or "thief-in-law" which the G-men characterized as "a member of a select group of high-level criminals from Russia and the countries that has been part of the former Soviet Union, including Armenia."
Last summer federal prosecutors reached a plea deal with Armen Kazarian under which he would serve no more than three years in prison as then reported by Scott Shifrel for the Daily News, and last December Robert Terdjanian was sentenced yesterday to ten years in prison as then reported by Bruce Golding for the New York Post.
Zero’s trickle down chicago style criminal thug policy
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