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Physician Sentenced to 20 Years for Medicare Fraud
New American ^ | 8-6-11 | Bob Adelmann

Posted on 08/06/2011 11:37:24 AM PDT by Mikey_1962

The case brought by the Department of Justice against Dr. Rene de los Rios of Miami, Florida, succeeded not only in sending the physician to jail for 20 years for systematically defrauding Medicare, but also in exposing the dark underside of the entire Medicare system itself. The sentence meted out by U.S. District Judge Joan Lenard was the second most severe sentence handed out to any doctor in South Florida, known as the “epicenter” of Medicare fraud. The dubious honor of the most severe sentence is held by Dr. Ana Alvarez-Jacinto, who was convicted of Medicare fraud in 2008 and is now serving 30 years behind bars.

Dr. de los Rios learned the Medicare scam from the owner of Metro Med, a medical clinic that specialized in HIV therapy. The owner, Damaris Oliva, who is serving his own seven-year sentence, learned the trade from three brothers — Carlos, Luis, and Jose Benitez — who owned 11 HIV clinics in the Miami-Dade area that specialized in HIV treatments and injections. The brothers billed Medicare $119 million and were reimbursed $84 million. To avoid prosecution, the brothers fled to the Dominican Republic and then to Cuba where, according to the FBI, they are in jail on immigration violations.

The scam was simple, and consisted of three coordinated strategies: phantom billing (billing for procedures that either never performed or were unnecessary), patient billing (a patient receives a kickback for allowing use of his Medicare card and then testifying that the procedure was performed), and upcoding (where bills are inflated by using a billing code that maximizes reimbursement from Medicare). The good doctor signed off on treatments that were never performed, ordered tests that were unnecessary, and ordered injections of expensive drugs — for which he was paid $3,000 a week by Oliva.

(Excerpt) Read more at thenewamerican.com ...


TOPICS: Crime/Corruption
KEYWORDS:
Part of the problem is that when Medicare was set up, payment was based on the “honor system” and claims were paid automatically because the goal was to pay claims “quickly and smoothly.”

Yes that is "part" of the problem. The biggest problem is "its not my money, what do I care?"

1 posted on 08/06/2011 11:37:31 AM PDT by Mikey_1962
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To: Mikey_1962

To truly expose the fraud in the medicare - and any other federal program giving away goodies - check the unreported accounts of all the congressmembers involved in establishing or funding the program. This guy probably represents just a drop in the bucket compared to kickbacks and payoffs involved.


2 posted on 08/06/2011 11:42:30 AM PDT by DPMD (~)
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To: Mikey_1962

This is the same attitude the public servants have about food stamps and other government freebies. They just throw the money out there and really don’t care who gets it. It’s not their money.


3 posted on 08/06/2011 11:43:03 AM PDT by FlingWingFlyer (Americans need to wean their government off of its dependence on foreign money.)
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To: Mikey_1962; Mr. K; All

nationwide, this costs hundreds of BILLIONS !!!
IBM offered to save 900 billion, for FREE!

http://www.freerepublic.com/focus/f-bloggers/2750239/posts

Obama Turns Down IBM Offer To Cut Medicare Fraud By $900 Billion Dollars
(Feb 11) Washington Examiner ^


4 posted on 08/06/2011 11:48:05 AM PDT by Elendur (It is incumbent on every generation to pay its own debts as it goes. - Thomas Jefferson)
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To: Mikey_1962

Two years ago, my wife stepped off our boat while mooring and fell on her shoulder. She went to her doctor who referred her to a specialist. She’s on medicare and the doctor looked at her for less than 5 minutes, no x-rays, and gave her two shots; one for pain and one a steroid plus a steroid prescription. She got a copy of the bill from medicare which was over $600 and which was documented by the doctor as surgery. She never saw the ripoff guy again. These doctors are just getting ready for the big paydays around the corner.


5 posted on 08/06/2011 11:59:31 AM PDT by sanjuanbob (Festina Lente)
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To: Mikey_1962

Meanwhile, try and find a doctor accepting new Medicare patients these days.

Alaska, Massachusetts, and Manhattan are devoid of Medicare providers.

In Alaska, you have to go to third rate public clinics once your reach 65 years of age.


6 posted on 08/06/2011 12:01:50 PM PDT by FormerACLUmember (When the past no longer illuminates the future, the spirit walks in darkness.)
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To: sanjuanbob

Injections are classified as surgery by CMS and every other insurance carrier.


7 posted on 08/06/2011 12:05:39 PM PDT by Cyman
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To: Mikey_1962

I in no way condone the fraud perpetrated, but the sentence meted out exceeds many sentences handed out for murder. When economic crimes are more harshly treated then crimes of violence, our society is rushing headlong into dictatorial socialism.


8 posted on 08/06/2011 12:13:33 PM PDT by monocle
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To: Mikey_1962

Goldman Sacks, Fannie and Freddy, Moody,s, S&P, Elite politicians defraud investors and nobody goes to jail. Nixon didn’t go to jail but when to china. Bill Clinton Lied in federal court and didn’t go to jail and becomes well respected statesman and didn’t go to jail. Amazing, simply amazing. And you wonder why the rest of the world has a low opinion of our Constitution and Government. Lady Justice took off her blindfold.


9 posted on 08/06/2011 12:16:43 PM PDT by steveab (When was the last time someone tried to sell you a CO2 induced climate control system for your home?)
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To: Cyman

Thanks Cyman. It always bugged me and now I can drop it.


10 posted on 08/06/2011 12:26:09 PM PDT by sanjuanbob (Festina Lente)
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To: Mikey_1962

Looking forward to a day when the biggest moral fraudsters of all, those in the federal government, get sent up the river for a long, long stretch. The trouble is their fraud is deemed “legal” as they have entrusted themselves to make the laws that enables their theft.


11 posted on 08/06/2011 12:33:26 PM PDT by steelyourfaith (If it's "green" ... it's crap !!!)
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To: Mikey_1962
Dr. Rene de los Rios

Dr. Ana Alvarez-Jacinto

Carlos, Luis, and Jose Benitez

Gee, if I was not so concerned as being labeled a "Racist" or "Bigot," I might be inclined to make some comment about what all 3 of these scammers have in common.

Never mind; nutting to see here, just move along!

12 posted on 08/06/2011 12:34:24 PM PDT by Conservative Vermont Vet (l)
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To: Elendur

There was a scandal in Newark, NJ a few years back. Medicare and Medicaid were routinely billed twice for everything. The double billing was part of the billing programming! This type of fraud would have been extraordinarily easy to prevent!


13 posted on 08/06/2011 12:43:43 PM PDT by algernonpj (He who pays the piper . . .)
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To: Conservative Vermont Vet

More U.S. Government approved immigrants.


14 posted on 08/06/2011 12:44:56 PM PDT by dragnet2 (Diversion and evasion are tools of deceit)
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To: dragnet2; Conservative Vermont Vet
More U.S. Government approved immigrants.

Here committing fraud Americans can't/won't commit /sarc
15 posted on 08/06/2011 12:47:50 PM PDT by algernonpj (He who pays the piper . . .)
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To: algernonpj

We don’t have enough crime, so importing more, only makes sense.


16 posted on 08/06/2011 12:55:53 PM PDT by dragnet2 (Diversion and evasion are tools of deceit)
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To: Mikey_1962

That is an impressive sentence handed down.
I wonder what the real $$$ figure is on Medicare fraud.
It’s a problem -— the main problem with the system -— that has gone on way too long.
Needless to say.


17 posted on 08/06/2011 1:02:59 PM PDT by La Enchiladita (I said it, I meant it and I represent it.)
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To: monocle
When economic crimes are more harshly treated then crimes of violence, our society is rushing headlong into dictatorial socialism.

Dictorial socialism has total control of the economy, not necessarily of violence. The opposite of your statement might be more valid. (Not that I think that violent crime should be dealt with leniently, mind you.)

18 posted on 08/06/2011 1:06:08 PM PDT by Moltke (Always retaliate first.)
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To: Moltke

Note that I said heading not there where are there yet.


19 posted on 08/06/2011 1:14:44 PM PDT by monocle
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To: Mikey_1962

Check the Date. Cuba’s been selling refuge for a percentage for some time already.

http://www.fiercehealthfinance.com/story/medicare-fraudsters-seeking-refuge-cuba/2011-07-19

Here’s the Feds latest Big Bust, 107 perps for $452 Million
http://www.justice.gov/opa/medicare-fraud-docs-2012.html
That’s against at Least $90 Billion a year in Fraud.

“it’s not my money, what do I care?”
http://www.fiercehealthcare.com/story/gao-cms-must-take-stronger-stand-medicare-fraud-overpayments/2012-05-11

It’s worse than that. CMS is nothing but a Piggy Bank for crooked Senators and House Members to raid for votes through pork.

It could be Stopped, but it Won’t be, because Senator FogHorn doesn’t Want it stopped.

http://www.fiercehealthcare.com/story/medicare-fraud-detection-system-disappoints/2012-02-24

“A computer initiative to stop fraudulent Medicare billing at the point of claims submission has so far been a disappointment, reported the Associated Press.

To date, the $77 million computer system, which went online in mid-2011, had prevented exactly one bad claim by late last year. That totaled $7,591.”

$77 Million worth of Fraud Checker Computers and it stopped 1 Claim for $7,591. Does Anybody want to tell me that’s not intentional?


20 posted on 06/19/2012 1:07:11 PM PDT by To-Whose-Benefit? (It is Error alone which needs the support of Government. The Truth can stand by itself.)
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To: To-Whose-Benefit?

Wow I posted this about a year ago. Thanks for reminding me.


21 posted on 06/19/2012 3:58:09 PM PDT by Mikey_1962 (Obama: The Affirmative Action President.)
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