Medicare Fraud Operations Expand in Northern California
Medicare fraud scams "are rapidly spreading" from Southern to Northern California as "shady doctors and clinic operators" have opened businesses in the Bay Area, health experts say, the San Jose Mercury News reports.
Ioana Petrou, a federal prosecutor and coordinator of health care fraud cases for the U.S. attorney's office in San Francisco, said, "There are a number of schemes that are being run or have been run in the Bay Area. And a lot of these cases are people coming up from Southern California."
Elderly patients eligible for Medicare or other insurance programs often hear about offers to visit clinics through friends, relatives and strangers who distribute fliers at senior centers. In one case, operators of a Milpitas clinic allegedly collected more than $900,000 in three months from billing Medicare for unnecessary or never performed diagnostic tests. Patients were offered a free checkup, ride to the clinic and a case of the nutritional supplement Ensure. Meanwhile, the clinic allegedly billed Medicare for repeated diagnostic tests for incontinence and nerve function.
Some experts suspect the fraud cases, which have increased in Northern California over the last three years, are linked to organized crime, but others say those engaging in fraud are "loosely affiliated individuals."
Although Medicare auditors can block payments for an unusual volume or pattern of billings, clinics making fraudulent claims "avoid detection by frequently switching tactics -- by charging for different kinds of medical procedures, or for medical supplies," the Mercury News reports (Bailey/Ha, San Jose Mercury News, 10/16).