I don't think this guy will commit fraud again

 - 
08/21/2009

Something a little noir...

A provider e-mailed me this morning with the link to this story in the Miami Herald:

"Convicted killer to plead guilty to Medicare fraud, then face new murder charge"

Read the first paragraph then skip paragraphs two through 11 (unless you want the gruesome details of how Denis Gonzalez allegedly killed Sergio Quintero in 2008 and Eduardo Oses in 1991 in separate fights over money). The following paragraphs go something like this:

After his release, he eventually bought DG Medical for $18,000 in December 2006. The Miami company, incorporated six months earlier by Deborah Gomez, had already obtained a Medicare supplier license in September of that year, according to public records.

How does a guy fresh out of jail come up with $18,000, anyway? Was it buried in his back yard the 14 years he was in jail? And what did he get for $18,000? Some office space in Hialeah?

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In 2007, Gonzalez misappropriated physicians' names for prescriptions and Medicare patients' numbers, according to Assistant U.S. Attorney Christopher Clark.

Gonzalez is an example of Medicare's lax oversight of Medicare operators in South Florida. The agency claims it regularly conducts criminal background checks on Medicare operators and disqualifies convicted felons -- but Gonzalez fell through the cracks.

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Hey, at least they're putting some of the blame on Medicare, right?

Medicare, funded with taxpayer dollars, reimbursed Gonzalez's business $31,442 -- chump change by healthcare fraud standards in Miami-Dade.

OK, so he didn't get away with much.

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Gonzalez's case isn't that unusual in the underworld of Medicare fraud.

An underworld of Medicare fraud? That's fodder for an HME News cartoon.

After billing Medicare for a short period, equipment owners routinely sell their businesses to others or install straw owners -- without reporting ownership changes to the federal government. This enables them to collect big bucks over a few months without notice.

Critics both inside and outside Health and Human Services point to persistent flaws in Medicare's oversight: Until recently, almost anyone -- including convicted felons -- could qualify to become a Medicare provider because the agency's criminal background checks, though required by regulation in recent years, were spotty or nonexistent.

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Medicare officials said that in late 2008 the agency was going to start conducting full background checks on selected medical equipment suppliers in areas with ``high fraud potential'' such as Miami-Dade.

Death Becomes Her release Gonzalez was expected to plead guilty in federal court today to defrauding Medicare. Then he heads to state court to be prosecuted again on a first-degree murder charge for Quintero's murder.

The upside of all of this: I don't think this guy will commit fraud again.

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Liz Beaulieu