Special Agent Discusses 'The Largest Medicare Fraud Scheme in U.S. History'

Apr 18, 2019
Originally published on April 19, 2019 11:39 am

South Florida has long been a target for Medicare fraud. Last week, the U.S. Department of Justice announced 24 people had been charged in a $1.2 billion telemarketing Medicare fraud scheme. Two of the individuals charged in the case were from Boca Raton. 

And earlier this month, a Miami Beach man was found guilty for charging the federal government more than $1 billion in Medicare for services patients didn't need or never received.

Last year, the Office of Inspector General and U.S. Justice Department established the Medicare Fraud Strike Force, with an office based in Miami focused on these scams. Brian Martens is the Assistant Special Agent in charge of the telemarketing Medicare fraud scheme in Miami. He's been investigating cases in South Florida since the early 2000s. He spoke with Sundial's Luis Hernandez about the region's reputation for healthcare fraud and what consumers can do to be proactive and not fall victim to these schemes.

WLRN: Brian you've been working here for awhile. What are one or two other big cases that you've seen in your time, considering you've seen so much of it?

MARTENS: We had this DME (durable medical equipment) many years ago and it's kind of evolved into other types of fraud schemes as we've attacked them. That's the focus of the case we're talking about, which was the largest Medicare fraud case in U.S. history. But historically, one of those would be an HIV infusion fraud case, which was a big thing in the late 2000s. And there was a huge case with the Benítez brothers, which had assets going into the Dominican Republic. They were building a water park with their fraud proceeds down there. So that was a significantly big case that occurred here. And then more recently, just the other day, was a skilled nursing facility. After a long trial here in Miami, Phills Esformas was convicted in that matter and that was over a billion dollar related fraud scheme for skilled nursing facilities.  

Let's look at the most recent case, this again the largest in U.S. history. Let's start at the top. Who's running this operation? Is it one person a group of people, how did that work?

There's a lot of co-conspirators if you want to say that. Obviously we can't talk too much into the ongoing details outside of what's in the Department of Justice press release. But basically you had some people that were outlined there that were essentially establishing these call centers. And the call centers are in the process of basically making phone calls out to individuals, potentially cold calling, them to get information to solicit beneficiaries about the need for these braces. The other side, which is kind of unique and interesting, there were these television ads, radio ads and online ads. So people were seeing advertisements for back braces, knee braces, these things to help you, it was actually part of the scheme. So there is a possibility of them purchasing or obtaining leads lists, which leads lists are considered list of Medicare beneficiaries that they will get information on to call outside of the advertisement. Their target is a Medicare beneficiary.

Are the doctors that are writing these prescriptions for these Medicare braces operating fraudulently or do they not know what's happening?

We have to look at each one individually but I think in this case there were specifically two physicians that were charged in this matter. One out of New Jersey and one out of Pennsylvania for that very thing. So as we're working individual cases the assessment of whether or not they were complicit or involved will be addressed between the agents and working with the U.S. Attorney's Office and the Department of Justice whether or not we should charge them based upon the individual case.

Let's talk about how people can protect themselves because a lot of people were victim in this scheme. Something you said to me sounds simple but it's a challenge to get people to do it. Basically, don't answer your phone because scammers are still using the phone?

When somebody calls your house, the question is, 'Do you actually need to talk to that person?' And you know nowadays with so many robocalls that we all receive, the question becomes if you don't know the number why even answer? But if for some reason you do answer the phone, if they start to ask you about your Medicare number or knee or back braces or something that we can give you free or reduced, [ask yourself the question] 'Who should you be talking to about your medical situation, your diagnosis or what issues you have?' Usually we all have a doctor that we trust. And that's the person we should be talking to.

We also spoke with Palm Beach Post reporter Jane Musgrave earlier this week about the most recent Medicare fraud investigation. 


Copyright 2019 WLRN 91.3 FM. To see more, visit WLRN 91.3 FM.