DME con artist sings for lawmakers
WASHINGTON - A woman who participated in a scam that defrauded Medicare out of $25 million described the venture as a veritable cake walk.
“On the day of inspection for my storefront, the [NSC] surveyor telephoned me for an appointment,”Rebecca Lewan-dowski told the Senate Finance Committee April 28. “That call gave me ample opportunity to prepare for my surprise visit.”
Lewandowski is currently awaiting sentencing on multiple fraud charges. She got involved in the scam through her brother, Mark Lewandowski, who befriended Ani Edem and Nsikan Edem, who in the mid 1990s operated two DME companies in Nevada and California.
Unemployed and in her early 20s, she joined the operation in 1998 as a clerk in the operation’s Long Beach, Calif., headquarters. She began by forging doctors signatures on CMNs and completing delivery tickets and various insurance documents for several DME companies. The Edem brothers eventually set up Lewandowski in her own DME, Mercury Medical Supply in Klamath Falls, Ore. In all, the Edems oversaw 20 sham HME companies in California, Oregon, Nevada, Arizona, Utah and Missouri that fraudulently billed Medicare for $25 million.
Lewandowski’s part of the con billed Medicare $1,158,000 in just two years, she said. Of that, she received less than $200,000, with most of the profits going to the Edem brothers.
Some of the operation’s mistakes were so basic that Medicare should have stopped it sooner, Lewandowski said. For example, all locations used the same physicians, and less than 5% of the Edems’ “patients” ever visited a doctor or a clinic.
“In many instances, a simple telephone call to either a doctor or a patient could have prevented some of this fraudulent activity,” she said.
At the height of the operation, the Edems billed Medicare for approximately 100 power wheelchairs each month, but they delivered only a tiny fraction of that number. Lewandowski said she once received a letter from a Medicare fraud analyst inquiring why a Medicare beneficiary hadn’t received a power chair that the company had billed for.
“Offering no explanation, I mailed a refund check to Medicare and billed another $50,000 the following month,” she said.
In December 2001, federal agents raided the Long Beach office and several homes, where they discovered six supplier applications for new DMEs in the state of Washington.
Mark Lewandowski and the Edem brothers pleaded guilty in September 2003 to felony charges including conspiracy, health-care fraud, false claims and conspiracy to money-launder.
Tricks for trade
To reduce future HME scams, convicted con artist Rebecca Lewandowski suggests that Medicare:
- Screen new provider applicants for previous violations and/or convictions.
- Investigate more thoroughly beneficiary complaints of having been a fraud victim.
- Site inspections should always be a surprise and occur more frequently.
- Make random calls to doctors and patients to identify illegitimate claims.
- Restrict new DME companies to submitting paper claims. This would allow Medicare a closer inspection of a patient’s file and alert them to suspicious paperwork.