Medicare & Medicaid Fraud: Health Care’s Most Wanted Fugitives

For first time ever,  the Office of the Inspector General (OIG) for the U.S. Dept. of Health and Human Services (HHS) is publishing a list, complete with the mug shots below, of HealthCare’s “10 Most Wanted Fugitives,”   individuals who have allegedly defrauded taxpayers of more than $126.6 million.   These are just 10 of the more than 170 fugitives on OIG’s list, and it is asking the public to help:  “For OIG, tracking more than 170 health care fugitives is a challenge. If you have a tip about a featured most-wanted fugitive, send the information our way.”

If you go to the webpage of mug shots  and click on the photos, you’ll find a brief bio and details  of the fugitive’s crime.

For instance, consider Tarek Wehbe: Between January 2002 and January 2007, Wehbe, a physician, allegedly submitted fraudulent claims to Medicare, Medicaid, and private health insurance carriers in order to obtain reimbursement for services that were either not provided, medically unnecessary, and/or over-charged.

“Wehbe allegedly perpetrated this fraud through the Renaissance Medical Group (RMG), based in Providence, Rhode Island, of which Wehbe was the president and owner. Health insurance carriers reimbursed RMG over $1.8 million by either depositing payments into RMG's bank account or sending reimbursement checks to RMG through the mail .

“These funds were deposited into and transferred between Wehbe's personal bank accounts and those of RMG, which he controlled. Wehbe allegedly laundered money through an account in a foreign country.

“Also, on more than 100 occasions, Wehbe allegedly issued prescriptions for controlled substances, such as Oxycodone and Hydrocodone, without medical justification.”

Then there are the sisters–who managed to scoop up more than $4 million while running an infusion therapy clinic.

Clara and Caridad Guilarte were captured in Colombia on March 13, 2011.Along with previously captured co-conspirator Reynel Betancourt, the Guilartes allegedly defrauded Medicare of nearly $4.3 million (and submitted $9.1 million in false and fraudulent claims), according to a Federal indictment.

“The Guilartes operated the Dearborn Medical and Rehabilitation Center (DMRC), an infusion therapy clinic in Michigan, where Betancourt was an employee.

“All three fugitives allegedly committed health care fraud, conspiracy, and money laundering. The trio allegedly recruited and paid cash and other inducements to Medicare beneficiaries to visit DMRC and sign forms indicating that they received legitimate medical services, including injections and infusions of expensive medications, although the services allegedly were never provided.

“All three are originally from Cuba: Clara Guilarte is a U.S. citizen, and Caridad Guilarte and Betancourt are permanent U.S. residents.”

Office of Inspector General: U.S. Department of Health and Human Services

This Web page contains information about OIG's most-wanted health care fugitives. In all, we are seeking more than 170 fugitives on charges related to health care fraud and abuse.Click any of the photos below for more information about the fugitives or view captured fugitives.

 

Image002

Etienne Allonce
DOB: 06-28-1965
Height: UNK
Weight: UNK

WANTED

Image003

Tarek Wehbe
DOB: 11-29-1964
Height: 5'8"
Weight: 214 lbs.

WANTED

Image004

Image005

Image006

Carlos Benitez
DOB: 08-03-1961
Height: 5'9"
Weight: 180 lbs.

WANTED

Image007

Luis Benitez
DOB: 06-06-1966
Height: 5'11"
Weight: 195 lbs.

WANTED

Image008

Jose Benitez
DOB: 02-29-1964
Height: 5'11"
Weight: 163 lbs.

WANTED

Image009

Caridad Guilarte
DOB: 02-20-1957
Height: 5'5"
Weight: UNK
Image010

Image011

Clara Guilarte
DOB: 06-22-1954
Height: 5'7"
Weight: UNK
Image010

Image012

Susan Bendigo
DOB: 09-26-1970
Height: 5'4"
Weight: 130 lbs.

WANTED

Image013

Leonard Nwafor
DOB: 11-04-1965
Height: 6'
Weight: 195 lbs.

WANTED

Image014

Eduardo Moreno
DOB: 02-19-1969
Height: 5' 9"
Weight: 180 lbs.

WANTED

The  Obama administration has begun to make significant progress in fighting healthcare fraud.  In fiscal year 2009, anti-fraud efforts resulted in $2.51 billion being deposited to the Medicare Trust Fund, a $569 million, or 29 percent, increase over FY 2008.  In addition, over $441 million in federal Medicaid money was returned to the Treasury, a 28 percent increase from FY 2008.  Then, in 2010 fraud-fighters set a  record, recovering more than $4 billion in stolen taxpayer dollars

Meanwhile, the Affordable Care Act provides new resources and tools that HHS says “will build on innovative strategies to fight fraud, such as Project HEAT, the joint operation between DOJ, CMS and the HHS Office of Inspector General  that has unleashed special strike forces in six states to target  health care fraud hot spots like South Florida, New York, Texas, California, Louisiana and Michigan.”  

16 thoughts on “Medicare & Medicaid Fraud: Health Care’s Most Wanted Fugitives

  1. It is good to see this effort. However, I wonder how these people managed to defraud Medicare for many years (and many millions of dollars) before being detected?
    Also, when are they going to go after the fraud of overpriced ineffective diagnosis and treatment such as digital mamography, cardiac stents, elective induction of labor, robotic surgery, unnecessary MRI and CT scans, and proton beam radiation therapy? There is a lot more potential for savings in controlling these procedures ($ billions for ineffective procedures vs. $ millions for outright fraud).

  2. I think Mark’s correct: fraud is the low-hanging fruit — important, but not where the big savings are to be found. Reining in payment for unnecessary treatments is probably the next level, but the big savings are in figuring out a way to stop paying for treatments that just don’t work.

  3. Mark–
    The Centers for Medicare and Medicaid has not had the funding it needs to go after fraud …
    In general, conservative administrations believe in small government, and that means “starving the beast”– giving Medicare, the FDA, etc. less than they need to do their job.
    Also some involved in Medicare fraud are also quite powerful–here I think of Rick Scott, and companies owning for-profit hospitals that, over the years, have stolen billions from taxpayers. (See Money-Driven Medicine for the sorry history of for-profit hosptials. Wall Street expects more $$$ than they can deliver, so they have a history of resorting to fraud in order ot make up the difference.
    Regarding the waste involved in over-treatment, the Affordable Care Act does give the Secretary of HHS the power to reduce fees for “over-valued services”–without going through Congress– and I’m sure we’ll see that happening.
    Already Medicare–and many private insurers– have reduced fees for diagnostic imaging.
    Medicare is also going to refuse to pay hospitals that report a high number of preventable readmissions.
    And both hospitals and doctors who, in the past made money on “volume” are now going to find that if they want bonsues, they will need to show that they are offering better value–i.e. better outcomes at a lower price.
    Unncessary C-sections, inductions, robotic surgery and proton beam radiation therapy don’t lead to bettter outcomes for less. (They don’t even lead to better outcomes.)
    Palliative care, chronic disease management that keeps patients out of the hosptial, shared decision-making do.
    Hospitals and doctors that emphasize these strategies will be getting the bonuses.
    And just as the Secretary of HHS can lower fees for overvalued services, she can raise fees for undervalued services. And I expect she will.
    Since over-valued services are so very expensive, net net we’ll see savings.

  4. Chris–
    I agree that outright fraud is a smaller problme than overtreatment that has become an accepted part of the system.
    But fraud probably costs more than we think. (Both private insurers and CMS adknowledge that they just don’t know how big the problem is. But some major cases (HCA, for instance) suggest that it can be huge–and succeed for many years.
    Also, fraud does represent “low-haning fruit” in that one can fight fraud without attracting too much resistance from Congress.
    It’s hard to rally popular support for fraud. It’s relatively easy to rally popular support for over treatment.
    As I say in my reply to Mark, the ACA does begin to tackle over-treatment–though this will take years.
    In the meantime we should pick whatever low-hanging fruit we can and save billions, not to mention the suffering of people who think they are getting infusions–but aren’t.

  5. Maggie –
    I think tinkering with fees for various services, tests and procedures is just that – tinkering. Just yesterday, for example, Medicare announced that it will pay $93,000 for Provenge, the new treatment for prostrate cancer made by Dendreon which extends life by about four months, on average. Even assuming no other care is needed or provided, that equates to $279,000 per QALY. That’s too much and, if it were up to me, I wouldn’t pay for it. Personally, I think a limit of $150K per QALY, which implicitly values a life at $12 million (roundly 80 years life expectancy x $150K per year) is more than reasonable. Under current law, Medicare is specifically precluded from taking cost into account in deciding what to cover and pay for. That needs to change.
    Regarding fraud, I think we could get a lot more bang for the buck if physician opposition to making the vast Medicare claims database available to private analysts could be overcome. The AMA won a court case about 30 years ago that prohibits disclosure of aggregate payments to individual physicians on privacy grounds. Legislators can and should fix this. Also, I think it would be helpful if all providers with the authority to bill Medicare and Medicaid were required to have an ID card with a name, address, account number, picture and fingerprint or other biometric identifier. I also support a national ID card like the 9/11 Commission recommended. Huge advances in technology and data processing over the last 30-40 years have occurred. We need to take full advantage of them. The AMA and other interest groups that stand in the way of needed reforms in this area should be ashamed.

  6. I recall seeing this list of faces before; same folks exactly on some government web site. Is this really new or is it just another retred?
    I really think going after folk who break the law is great! The fraud that large companies pertetrate is probably something that should be better addressed. It doesn’t seem like these million dollar fines are doing much to disincent large company fraud. The fine is just a cost of doing business to them and the folks who do the crimes seem to get off pretty easy.
    So I guess there is a difference between saying we are going after fraudsters and actually doing it.

  7. Joe Says, Barry
    This is really new. And people aren’t just paying fines. They are (and have been) going to jail–long sentences.
    Barry– I, too, am shocked about Provenge.
    As you may recall I wrote about it a long time ago . . .

  8. How did these people manage to defraud Medicare for many years before being detected? It wasn’t just the funding. According to government documents back in 2001, the previous administration, through Thomas A. Scully, then administrator of CMS, wanted to ease regulatory requirements, reducing the frequency of inspections and lessening or eliminating some penalties (meaning deregulation). That administration wanted to move away from adversarial enforcement toward a more collaborative one, in which regulators would work with industry. You can see where that got us in the market meltdown and economic crisis.

  9. Few interesting things here:
    1. Out of the top 10 most wanted, only one of them is a doctor.
    2. Every single person on this list is someone I would consider from an “immigrant” background even though one is a US citizen and a couple are permanent residents.

  10. Let me tell you a story.
    A large hospital chain organizes a mast chain of fraud, encouraging fraudulent overbilling. This continues unabated for 10 years. The hospital chain makes, say 10 billion in frauduluent profits.
    CMS finally catches on to the overbilling and begins its case investigation. They charge the company has fraudulently billed for approx 10 billion.
    The hospital CEO/mgmt comes out and says it is “shocked/appalled” by the fraud and vows to change. However, they claim that if they are forced to pay back the entire 10 billion they STOLE FROM TAXPAYERS, that the poor hospital will go broke and the poor community residents will have no friendly neighborhood hospital to go to.
    Sounds ridiculous, right? I mean, who would let these guys off the hook when they STOLE 10 BILLION DOLLARS FROM THE US TAXPAYERS.
    But guess what, the joke is on us, guys. CMS ROUTINELY agrees to fine these hospitals only a small fraction of what they stole. So lets say you steal 10 billion dollars over a 10 year period, you get away clean and free when you make a small payment of 5-10% to the US government. For that bargain price, you get to continue STEALING FROM US TAXPAYERS.
    The bottom line is that CMS is scared/intimidated of the hospitals and their local cronie politicians. They make these scoundrels pay only a small portion of what they owe.
    So guess what happens next year when the hospital CEO pays the 5% he stole? He goes back to the hospital board and says “OK guys, we are back in business. Lets steal another 10 billion dollars and then in 10 years from now we’ll pay a few hundred million. Thats a pure profit margin of 90%.”
    And thats EXACTLY what happens. CMS ensures that stealing money from Medicaid/Medicare is simply good business for hospitals.
    HCA was estimated to have stolen over 20 billion dollars from taxpayers, and the “fine” CMS levies against them amounts to only 700 million dollars. And for that price, the entire hospital management/CEO remains intact and they keep every single hospital open to steal even more money again.
    Running a large hospital that is “too big to fail” is a license to steal money from US taxpayers. CMS is a toothless pansy.
    Its time to start sending these scumbags to jail and shutting down these hospitals. Local politicians can go screw themselves.

  11. Jason, Melanie–
    Jason– I hope you didn’t mean to imply that immigrants are the main cause of Medicare fraud–or that physicians and businessmen born in this country are rarely involved.
    That just isn’t true.
    This post focused on the 10 fugitives who happen to be at the top of the current list. One cannot generalize from 10 people.
    I did a little research..
    But first, let me point out that people who manage to succesfully escape the law are more likely to be from other countries. They will
    readily leave the U.S. and have a place to go where they have friends and relatives who will protect them. They also are often in a better position to launder the money they have stolen.
    By contrast, consider the case of a white, well educated attorney who went to Yale law school with my first husband.
    We knew him quite well. He and his wife were pretty conservative — if memory serves, they voted Republican. And he was certainly someone who you would never expect to cross the law–not in a million years. A totally white-bread, straight guy–someone who wouldn’t Jawyalk, or speed on the highway. But he was very interested in money and becoming wealthy. For this reason, I always found him pretty boring. Not a bad person, just not at all interesting as he talked about what he had bought the antiques he was collecting, what they might be worth in the future . . .
    A few years ago, he was arrested for Medicare fraud– he ran a company that had been defrauding Medicare of a huge amount of money for years.
    He had a Yale law degree; his wife also was extremely well educated; she was an accountant at one of the top 5 firms in the country and became a partner. He didn’t need the money.
    As I recall, he wound up sentenced to prison for 8 years. The very sad part of the story is that he had one child–a son–who was only about 8 or 9 years old. He won’t see his son grow up.
    This is a person who would NOT become one of the “most wanted” fugitives because he would never leave the U.S., his wife and child. Where would he go? He wouldn’t know how to set up a life in Colombia.
    On the question of how many of the people who defraud Medicare are doctors–or immigrants– I went back to the website, clicked on “Archives” and saw who was on their radar screen
    last December (Ths is just a random sample.)
    Number 2 on the list: a trio of Arizona physicians that includes S. Klopfenstein, M.D.,Edward J. Quinn, M.D., and Ray A. Silao.
    My guess is that Klopfenstein & Quinn are not new immigrants. Very likelym Silao isn’t either.
    And this was what I found when I looked at just one month . . .
    Melanie–Thanks much for your comment.
    Let me add one piece to the puzzle: HCA was owned by the Frist family, as in Senator Bill Frist.
    Rick Scott was the CEO– Scott is now governor of Florida.
    There was no way anyone would go to jail–they knew too much about what appears to have been the Frist family involvement in setting up two sets of books–before Scott came on the scene.
    (I wrote about this in my book, Money-Driven Medicine)
    The problem is not that CMS is spineless. The order to settle with HCA, without deposing Scott–or anyone named Frists–came, I am quite sure, from the top of the Republican party.
    Finally– and this is what i find truly disturbing.
    The citizens of Florida knew all about Rick Scott’s background as CEO of a compnay that defrauded Medicare, and still elected him their governor last year.
    (Scott walked away from HCA with millions and spent an unprecedented amount of money on the campaign.)
    So we can’t just blame govt’ bureaucrats for being spineless; we have to blame ourselves (or our fellow Americans) for being willing to elect people like Scott.

  12. I agree with Maggie, we can’t just blame government bureaucrats for being spineless. We can’t just shift the blame to bureaucrats. We have to blame ourselves for being willing to elect those who con the electorate into believing there are some mystical forces that cause our problems and they have all the answers, so vote for them. Then there are forces that prevents these people from doing what they took an oath to uphold. Power tends to corrupt, and absolute power corrupts absolutely.

  13. Dr. Rick, Gregory
    Dr.Rick– I agree. When white collar criminals rob Medicare and Medicaid I think they should do jail time. Fines are not enough to deter them.
    Gregory–Yes, less regulation fewer inspectioins, smaller government means more fraud.
    And in a democracy, if we don’t trust and respect our elected officials, we have only ourselves to blame.
    Many intelligent people don’t vote–and then they complain about the quality of our government.
    Others vote based on whether they find a politician attractive or charming–someone they would like to have a beer with. . .

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