December 9, 2012

Mailbox: Only thing scammers need for Medicare fraud

A newspaper investigation shows that fraudsters can easily obtain ID numbers without having an office.

By M.B. Pell, The Atlanta Journal-Constitution

(Continued from page 1)

medical providers
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Dr. Harry Dorsey, an internist in Albany, Ga., had his medical license number stolen in 2010 by someone using a UPS Store mailbox to obtain a National Provider Identifier.

Brant Sanderlin/Atlanta Journal-Constitution/MCT

The AJC used an inexpensive software program and a list of UPS Store addresses found on the Internet. That turned up 131 CMS-registered medical providers across metro Atlanta claiming a UPS Store as their practice location.

Most likely filled out their paperwork incorrectly and are not committing fraud. Some were already under investigation, while others have been identified as fronts for fraud schemes and the perpetrators prosecuted and convicted.

But several physicians said they were stunned when the AJC told them a provider number was created using their name.

And two dozen of the 131 identified by the AJC are now under review by a federal contractor after the newspaper brought its findings to the attention of the U.S. Department of Health & Human Services Office of the Inspector General.

"If one company is defrauding the Medicare trust fund, that's one too many," said Kelly McCoy, assistant special agent in charge of the watchdog agency in Atlanta. "This agency will diligently pursue any evidence of fraud."

Accurate estimates of the cost of health care fraud do not exist, Sparrow said. But he told the U.S. Senate in 2009 that fraud could siphon off $100 billion to $500 billion a year.

The cost is borne by federal taxpayers who support Medicare, state taxpayers who support Medicaid and customers of private insurance companies.

Estimating the cost of specific fraud schemes, like a scam using UPS boxes, is even trickier. But the scheme can be lucrative.

More Than Ready Company, located at a UPS store on Peachtree Industrial Boulevard in Atlanta, was among a number of companies that billed Medicare for fraudulent injections of medication. The provider billed Medicare for $1.2 million. Eventually, several people were convicted of health care fraud as a result.

More Than Ready Company still has an active provider number, however. CMS says that's because even companies that commit health care fraud can still render services for private health insurance plans.

These suspicious organizations sprout up across the country. Outside of Atlanta, in spot checks the AJC identified potentially fraudulent providers in Louisiana, Florida, Kentucky, Ohio, Texas and Massachusetts.

Two years ago, a man calling himself Dulat Adilshin created IEDM Services Inc. The supposed obstetrics and gynecology office was located in a UPS Box Store mailbox in Baton Rouge.

According to CMS records, Dr. Edan Moran is the CEO. Moran is an obstetrician, but his practice is in Alexandria, La., more than 100 miles from the UPS Store in Baton Rouge.

Moran said he does not know Adilshin and he does not know IEDM Services.

Iin 2010, Adilshin incorporated Meadows Med Group Inc. in Georgia.

The fictitious family-medical practice is located in a UPS Store mailbox on Hugh Howell Road in Tucker, according to CMS. Agency records list Dr. David Derrer, a family physician at Georgia Highlands Medical Services in Atlanta, as the CEO.

But Derrer said he never heard of Meadows Med Group or Adilshin before receiving a phone call from the AJC.

Obtaining a fake provider number is much less difficult than canceling one. Scam artists can find almost all the information they need from a state medical licensing website. After that, they fill out a short application on the CMS website.

That's it.

CMS officials wouldn't discuss this issue on the record, but they said they know there are loopholes in the system.

"Over the last several years we have stepped up our efforts to fight Medicare fraud and we are continuing our work to crack down on anyone who tries to steal from seniors and taxpayers," CMS officials said in a prepared statement.


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