How pockets of fraud grow

Tuesday, September 30, 2003

YARMOUTH, Maine - With the huge wheelchair scam in Houston grabbing headlines all across the country, a particularly sensitive topic has surfaced in the HME industry: healthcare fraud and how it sometimes grows and blossoms in ethnic communities around the United States.

In Houston, providers contacted by HME News blamed the scam there on a particular ethnic group.

Investigators declined to confirm that allegation, but did say that pockets of ethnic fraud surface from time to time, adding that it is a small portion of the billions in healthcare fraud committed annually. Investigators typically shy away from pointing out examples of ethnic fraud because they don’t want to be perceived as “picking on” a particular group, said a federal official.

The reasons for such concentrated fraudulent behavior appear to be several, both intentional and unintentional, ranging from allegations of organized crime to problems with English that lead to misinterpretations of healthcare laws and regulations, say industry watchers.

“Many people come from different countries were it is commonplace to pay money to referral sources or have a cozy relationship with a physician or to be very caviler with documentation,” said a healthcare attorney. “I’m not passing judgement on those folks. In many countries, that is not unethical, it is not illegal, bad or immoral. That is the way to do business.”

Add to that the tight-knit nature of ethnic enclaves where immigrants settle. Unlike mainstream HME providers who loathe to share any business insights or best practices with their competition, providers in ethnic communities do so regularly. As a result, billing mistakes that result in inappropriate reimbursement can spread like wild fire, said a former healthcare investigator.

“These guys are saying, ‘We have an opportunity to flourish in a new country. Let’s help everybody that we can,”’ the former investigator said. “At times, that creates an abusive or fraudulent situation. I don’t know that it is malicious in intent. In come cases, it may just be ignorance.”

There is also an element of organized crime that flourishes in impoverished ethnic communities, said another healthcare attorney.

“If you don’t have a lot of money and someone offers you $100 to use your Medicare number and sign a document, which most of the time you don’t even know what you are signing, it is a pretty attractive offer,” the attorney said.

An unfortunate component of ethnic fraud is that it can taint the reputation of an entire group of immigrants, said a former investigator.

DME providers who complain their reputations have been sullied by a few bad apples committing most of the industry’s fraud can identify with that kind of stereotyping.

“It is a small population of the provider community, but they grab most of the attention,” said one industry watcher.