Why blaming undocumented immigrants for draining social services?.

TWO AREA PHYSICIANS AMONG FOUR DEFENDANTS CHARGED IN THREE SEPARATE FEDERAL HEALTH CARE FRAUD SCHEMES.


CHICAGO – Two Chicago area physicians are among four defendants who have been charged recently in three separate, unrelated federal healthcare fraud cases, federal law enforcement officials announced today. Each of the physicians, who were charged in separate cases, allegedly defrauded either Medicare and/or private health care insurers – in one case for more than $13 million – by either billing for services they never provided or inflating the services they did provide to patients. In the third case, the operator and manager of two former suburban Chicago durable medical equipment providers allegedly defrauded Medicare and Medicaid by providing power wheelchair or orthotic devices that were not prescribed or medically necessary and the recipients were not qualified to receive.

“Health care fraud remains an important priority of federal law enforcement. We will use all of our resources to ensure that dishonest physicians and other medical providers do not profit from cheating Medicare and private insurers,” said Patrick J. Fitzgerald, United States Attorney for the Northern District of Illinois.

Mr. Fitzgerald announced the cases, all three of which were charged or unsealed this week in U.S. District Court, with Robert D. Grant, Special Agent-in-Charge of the Chicago Office of Federal Bureau of Investigation; Lamont Pugh, Special Agent-in-Charge of the U.S. Department of Health and Human Services Office of Inspector General in Chicago; and James Vanderberg, Special Agent-in-Charge of the U.S. Department of Labor Office of Inspector General in Chicago. The Office of Personnel Management Office of Inspector General also participated in the investigations.

The defendants in all three cases were charged with one or more counts each of health care fraud. If convicted, each count carries a maximum penalty of 10 years in prison and a $250,000 fine.

The Court, however, would determine the appropriate sentence to be imposed under the advisory United States Sentencing Guidelines.

In each case, the public is reminded that charges are not evidence of guilt. The defendants are presumed innocent and are entitled to a fair trial at which the government has the burden of proving guilt beyond a reasonable doubt. The details of each case follow:

United States v. Sushil Sheth

Dr. Sushil Sheth, a cardiologist with privileges at three unnamed Chicago area hospitals, was charged with health care fraud in a criminal information filed Wednesday in U.S. District Court.

Between January 2002 and July 2007, he allegedly received approximately $13.4 million – $8.3 million from Medicare and $5.1 million from other health care insurers – in fraudulent reimbursement for the highest level of cardiac care when those services were not performed, and then used the proceeds for his own benefit.

Sheth, 47, of Burr Ridge and whose business office is in Flossmoor, will be arraigned at a later date in U.S. District Court.

According to the charges, Sheth used his hospital privileges to access and obtain information about patients without their knowledge or consent. He then hired individuals to bill Medicare and other insurance providers for medical services that he purportedly rendered to patients whom he knew he never treated. Typically waiting almost a year after the treatment was purportedly provided, Sheth submitted false claims for reimbursement for providing the highest level of cardiac care – requiring hands-on treatment in an intensive care unit – on multiple days during patients’ hospital stays.

The charges seek forfeiture of approximately $13.4 million and two parcels of real estate in Scottsdale , Ariz. The Government has seized or restrained approximately $11.3 million in various bank and investment accounts held by Sheth and his wife.

The government is being represented by Assistant U.S. Attorney Steven J. Dollear. The case was investigated by the FBI and the Inspector General’s offices of the Department of Health and Human Services and the Labor Department.

United States v. Otto Garcia Montenegro

Dr. Otto Garcia Montenegro, a general practice physician who owned and operated a private medical clinic, Montenegro Clinic, Inc., in Elmwood Park, where he treated dozens of patients each week, was charged with health care fraud in a criminal information filed yesterday in U.S. District Court. Between early 2003 and May 2007, he allegedly submitted false health insurance claims totaling approximately $500,000 to Blue Cross Blue Shield of Illinois and other private medical insurance providers. The insurers paid Montenegro approximately $373,000 based on the false claims, the charges allege.

Montenegro , 47, of Elmwood Park , will be arraigned at a later date in U.S. District Court.

According to the charges, Montenegro did not collect deductibles and co-payments from patients and, instead, submitted hundreds of fraudulent insurance claims to insurers for services and treatments that he knew he did not actually provide in order to exhaust patients’ deductibles and copays and obtain money for himself. As part of the scheme, he allegedly created hundreds of bogus bills falsely identifying visits and treatments that never occurred.

The government is being represented by Assistant U.S. Attorney Jacqueline Stern. The case was investigated by the FBI and the Labor Department’s Office of Inspector General.

United States v. Stephen Anthony Pam and Shavon Keyona Williams

Stephen Anthony Pam, who controlled and operated two former durable medical equipment companies in suburban Chicago that supplied motorized wheelchairs, scooters, reclining lift chairs and orthotic devices, and Shavon Keyona Williams, who at various times worked as office manager or salesperson for both business, were each indicted on 34 counts of health care fraud for allegedly fraudulently billing millions of dollars to Medicare and Medicaid and other health care benefit programs.

Pam, 47, of Sugarland , Tex. , was arrested on January 23 in Houston after returning from a foreign trip. He remains in federal custody while being transferred to Chicago to face prosecution.

Williams, 30, of Chicago , will be arraigned at a later date in U.S. District Court. They were indicted by a federal grand jury on December 11 and the indictment was unsealed following Pam’s arrest.

Pam controlled and operated the former Alliance Healthcare Services & Medical Equipment, Inc., in Glen Ellyn , and the former Medlinc Concepts, Inc., in Oak Brook.

Between 2004 and 2008, the defendants allegedly falsely claimed to Medicare and Medicaid that power wheelchairs or orthotic devices were medically necessary for beneficiaries when they knew that physicians had not ordered or prescribed such equipment and that beneficiaries did not qualify to receive them under Medicare and Medicaid rules. As part of the fraud scheme, Pam and Williams allegedly submitted hundreds of claims for reimbursement to Medicare and Medicaid totaling more than $5 million, falsely stating that Alliance and Medlinc had delivered equipment to beneficiaries when they knew that either no equipment was actually delivered; beneficiaries received less expensive scooters or reclining lift chairs instead of more expensive power wheelchairs; or beneficiaries received orthotic devices that were less in quantity or Medicare-approved quality than what was billed.

In one aspect of the fraud scheme, the indictment alleges that between February 2005 and May 2006, approximately 99 percent of the Alliance claims submitted to Medicare and Medicaid were for power wheelchairs and accessories that were never supplied. These claims totaled approximately $4.7 million. Pam, through Alliance , allegedly received reimbursements from these claims totaling more than $1.8 million, and the indictment seeks forfeiture of that amount.

The government is being represented by Assistant U.S. Attorneys Felicia Manno Alesia and Ryan Hedges. The case was investigated by the Department of Health and Human Service’s Office of Inspector General and the FBI.

Undocumented Immigrants draining Welfare system? A lie or a Lie.

Again is beyond belief the Anti Immigrants group are narrow minded towards facts and myths regarding draining social services like Welfare, Medicare, and Medicaid. Just a few facts for them; Are you there Lou Dobbs? Glenn Beck, Minuteman Groups? Read these facts:

A former Alabama Department of Human Resources employee from Prichard pleaded guilty this week to using her position to steal hundreds of dollars in food stamps, the attorney general's office announced Tuesday.

Three other Mobile County women also were convicted this week on charges of welfare fraud, according to a news release from Attorney General Troy King.

Elanda Stallworth, 57, admitted to charges of second-
degree theft of food stamp benefits or money from DHR and that she intentionally used her position for unlawful personal gain, the release states. She pleaded guilty in Mobile County Circuit Court on Monday. Stallworth apparently used her own computer to steal six checks worth $149, or a total of $894, King said. Source:


Attorney General Troy King today announced the convictions of three women in Mobile County Circuit Court for charges of welfare fraud.
“When people lie to receive welfare benefits to which they are not entitled, they are committing a crime against the State, the taxpaying public, and those who are truly deserving of welfare benefits,” said Attorney General King. “I take seriously my responsibility as Attorney General to protect public funds on behalf of the people of Alabama and pledge to prosecute those who break the law by abusing the welfare system.”

Chantell Robinson, 33, of Mobile, pleaded guilty today to third-degree theft of property in the amount of $1,401. She was sentenced to one year, which was suspended, and placed on probation for two years. The court ordered her to pay full restitution to the State of Alabama.

Tosha Lee, 32, of Chickasaw, pleaded guilty today to third-degree theft of property in the amount of $4,867. She was sentenced to one year, which was suspended, and placed on probation for two years. The court directed her to pay full restitution to the State of Alabama.

Shirley Ann Blackmon, 44, of Mobile, pleaded guilty yesterday to second-degree theft of property in the amount of $4,617. She was sentenced to three years, which was suspended, and placed on probation for three years. The court ordered her to pay full restitution to the State of Alabama.

The Attorney General commended Assistant Attorney General Noel Barnes and Senior Special Agent Assie Webb for their work in handling these cases. Attorney General King also thanked the Department of Human Resources in Mobile County for its assistance in preparing information and referring the matter to the Attorney General’s Office for review and appropriate action, noting in particular Rose Johnson, director of Mobile County Department of Human Resources; Avis Buford, caseworker, Mobile County DHR; Leon Kennedy, claims worker, Mobile County DHR; and Geraldine W. Turner, claims supervisor, Mobile County DHR.

Johnson stated, “We work to have our Food Stamp program deliver timely benefits to eligible individual’s and appreciate the Attorney General prosecuting those who illegally receive benefits. Every dollar given fraudulently takes away from those truly in need. We want the public to have confidence in the administering of these programs and appreciate prosecution when appropriate.”

The Mobile County cases are part of a continuing statewide effort by Attorney General King to aggressively investigate and prosecute welfare fraud. Prosecutions are pending in approximately 38 counties, including Baldwin, Clarke, Monroe, Escambia and Conecuh counties. Source:


Couple plead guilty to welfare fraud

A Shingletown couple have pleaded guilty to welfare fraud and are due to be sentenced March 24, a prosecutor said Tuesday.

William Wallner, 34, pleaded guilty Monday to welfare fraud and perjury in two separate cases, and is to be sentenced to three years in prison, Deputy District Attorney Michael Hemker said.

Teresa Wallner, 34, pleaded guilty to two counts of welfare fraud and is to be sentenced to 180 days in jail, he said.

Between 2004 and 2008, the couple were overpaid nearly $30,000 in welfare benefits for failing to report job and unemployment income, Hemker said. Source:

Polygamous Sect are the largest funded groups from Medicare and Medical.

If you are going to have three wives and 15 children, you need to figure out a way to support three wives and 15 children. Source:

California will recover 112 million for Medi Cal Program fraud.

Attorney General Edmund G. Brown Jr. today announced that California will recover $112 million for its Medi-Cal program as part of a national settlement with Eli Lilly and Company for the unlawful off-label marketing of its anti-psychotic drug Zyprexa, which the company aggressively marketed for such unapproved uses such as treatment for depression, anxiety, irritability, disrupted sleep, nausea and gambling.

“This settlement means that Eli Lilly can no longer reap massive profits by aggressively marketing this drug for unapproved uses at the expense of state health care programs for seniors and the infirm,” Attorney General Brown said. “California’s Medi-Cal program will receive almost $112 million, which is more than welcome at a time when the state faces massive budget deficits.”

Eighteen percent of the $112 million recovered for the Medi-Cal program will go to relators (whistleblowers) – the remainder will be split between the State, which will receive $54 million and the federal government, which will receive $41 million.

Beginning in 2001, Eli Lilly launched a marketing campaign called “Viva Zyprexa!” which encouraged physicians to prescribe Zyprexa for children, adolescents, and dementia patients.

In October 2008, the California Attorney General entered a settlement with Eli Lilly over the Zyprexa marketing campaign. In his original complaint, Attorney General Brown alleged that Eli Lilly engaged in unfair and deceptive practices when it marketed Zyprexa for off-label uses and failed to adequately disclose the drug’s potential side effects (including diabetes and hyperglycemia) to healthcare providers.

Under this settlement, Eli Lilly agreed to change its marketing practices and to cease promotion of its off-label uses. Off-label uses are those not approved by the FDA when it approves the sale and use of a particular drug. Physicians are allowed to prescribe drugs for off-label uses, but federal law prohibits pharmaceutical manufacturers from marketing products for off-label uses.

The total settlement is $1.415 billion—the largest recovery in a health care fraud investigation in U.S. history. The settlement includes $800 million in civil damages to be paid to the States and $615 million as a result of criminal charges brought against the company for illegal marketing.

Although both California and the U.S. contribute 50% to the funding of the Medi-Cal program, California’s share is larger than the federal share due to the federal Deficit Reduction Act, which provides monetary incentives to states to use False Claims Acts to pursue Medicaid fraud.

Cardiologist Convicted of 51 counts of Healthcare Fraud. Ethic? Moral?

United States Attorney Donald W. Washington, along with Health & Human Services Office of Inspector General Special Agent in Charge, Mike Fields, and FBI, New Orleans Division, Special Agent in Charge, David Welker, announced the conviction of DR. MEHMOOD M. PATEL, 64, of Lafayette, by a federal jury of healthcare fraud After a three-month trial which began on October 1, 2008, and six days of deliberation, a jury returned a guilty verdict on 51 counts of healthcare fraud in United States District Court in Lafayette.

After the verdict Tuesday evening, Judge Tucker Melancon denied the government’s motion for detention before sentencing, but increased Patel’s release bond obligation to $500,000.00. The court also ordered the defendant to surrender all medical licenses, including those allowing him to practice medicine
in Louisiana, Canada, India and elsewhere by 9:00 a.m. on December 31, 2008. A date for sentencing is expected to be set soon.

PATEL was indicted in February 2006 stemming from a complaint made to the Department of Health & Human Services that the defendant was placing stents in people who did not need them. A search warrant was executed on Patel’s office in November 2003, at which time patient files were seized. Beginning on or about September 2003, Our Lady of Lourdes (OLOL) Hospital in Lafayette, LA conducted an internal investigation leading to the suspension of DR. PATEL’S privileges at OLOL. A similar process was undertaken by Lafayette General Medical Center (LGMC) in late 2003 and early 2004 which also led to DR. PATEL being suspended from practicing at LGMC. After the hospitals suspended the defendant’s privileges, the Louisiana State Medical Board restricted DR. PATEL’S license to practice interventional cardiology, leaving him the ability to practice internal medicine pending the results of the criminal trial.

Testimony at trial revealed that MEHMOOD M. PATEL, M.D., who has been practicing interventional cardiology in Lafayette, Louisiana and surrounding areas for more than 25 years, was falsifying patient symptoms in medical records, falsifying findings on medical tests, and performing unnecessary coronary procedures such as deploying angioplasty balloons and stents. Testimony from experts in cardiology specialties revealed that the defendant deployed stents, balloons and radiation in coronary arteries that had little or insignificant disease. Testifying medical experts included doctors from Emory University in Atlanta, GA, the University of Pennsylvania Medical School in Philadelphia, PA, Mt. Sinai Hospital in New York City, and the University of California at Los Angeles, CA, as well as cardiologists practicing in Louisiana. Each expert testified about only a small number of the thousands of procedures performed annually for many years by DR. PATEL. The indictment in the case contained 91 counts involving only 75 patients chosen by the government with the help of these experts.

Additionally, the jury heard testimony from dozens of other government witnesses including medical technicians, nurses, and patients who painted the defendant as one who lacked concern for patient care and safety. Many of the nurses and technicians indicated their concerns and made complaints to their supervisors after witnessing unnecessary angioplasty procedures performed by the defendant doctor. Testimony also revealed that DR. PATEL was performing unnecessary medical procedures and billing both Medicare and private insurance companies, which added up to millions of dollars paid to DR. PATEL and the hospitals where many of the procedures were performed. During the years 1999-2003, DR. PATEL was the number one biller in cardiology services for the State of Louisiana. During the approximately three-year period covered by the indictment, DR. PATEL billed Medicare and private insurance companies more than $3 million, of which he received $541,745.00 from this scheme. The indicted charges included less than $90,000.00 of the amount received by the defendant.

DR. PATEL performed procedures at both Our Lady of Lourdes Hospital and Lafayette General Medical Center, as well as a leased mobile catheterization lab located outside his practice, Acadiana Cardiology, before he opened his own catheterization lab in mid-2002 on the second floor of his office on St. Julien Street in Lafayette, Louisiana.

United States Attorney Donald W. Washington stated: “Patient care and safety are the primary duty of all healthcare providers. Doctors are never privileged to perform medically unnecessary procedures on any person for any reasons whatsoever. I hope that this matter sends a strong message to those good and honorable medical professionals to police their ranks and be faithful to their credo of doing no harm to any patient. Healthcare providers like Dr. Patel are not entitled to payment by federal and/or private health plans for medically unnecessary procedures. Physicians must be held accountable when they fail in their primary mission to care for their patients appropriately, ethically and respectfully. Healthcare fraud will continue to remain a priority for this office, and we will aggressively investigate and devote our full attention and resources to matters of this magnitude.”


Special Agent in Charge for Health & Human Services Office of Inspector General, Mike Fields, stated: “Yesterday, Dr. Patel heard from this jury what healthcare providers who defraud Medicare are hearing from juries all over America - you will be held accountable for your greed. HHS-OIG agents will
continue to work closely with our state and federal law enforcement partners to protect the Medicare Trust Fund.”

Special Agent in Charge of the FBI’s New Orleans Division, David Welker, stated: “It is reprehensible to think that a medial professional would put patients at significant risk and conduct medically unnecessary procedures simply to fill their personal coffers. Hopefully, as U.S. Attorney Donald Washington notes, this conviction should send a powerful message to healthcare providers of the perils of deviating from their oath. It should also send a message to patients to be personally involved in their own care. We will continue to aggressively investigate healthcare fraud to ensure the safety of the public.”
PATEL faces a maximum of ten years imprisonment, a fine not more than $250,000.00, and a term of not more than three years of supervised release following confinement.

Sentencing in federal court is determined by the discretion of federal judges and the governing statutes. Parole has been abolished in the federal system. This case was investigated by Special Agent Barbara Alleman of Health & Human Services and Special Agents Troy Chenevert and Greg Harbourt of the Federal Bureau of Investigation. The case was prosecuted by United States Attorney Donald W. Washington and Assistant United States Attorney Kelly
Uebinger

your hard earned tax dollars at Illegals hands.

Can you believe this? Well, of course you can. After all, it's the strange and sour marriage between Medicare and phony equipment suppliers.

Medicare shut down more than 200 medical equipment companies last year. Why? Because they either were operating out of their hats, with no actual business addresses, or because they had been implicated in fraud or even indicted for fraud.

Now, get this: Advance your clock to 2008. Medicare allowed 90 percent of these fake companies to go back into business because of "flawed appeals processes." Great balls of fire! If a private enterprise operated that way, it would be out of business within two days. And the merry-go-round continues, because after allowing these scam artists to go back to their scams, Medicare decided to shut them down again. And meanwhile, a number of them had the opportunity to send out spurious bills again.

The sad but undeniable evidence is that federal agents visited, unannounced, some 1,581 Medicare suppliers in South Florida. Of that number, a solid one-third — 491 to be exact — had no business operation or just weren't open because they had no employees. Nice deal, isn't it? So Medicare revoked their billing privileges again, but so what since about half of them appealed, and based on nothing but an invalidated appeal, Medicare reinstated just about all the ones who appealed. An Inspector General's report is unsurprising: Medicare's hearing officers applied "no criteria" for accepting anything offered as evidence. An electric bill or a simple statement would do it.

One lawyer — Miami-Dade not Broward, thank goodness — represented fifteen so-called Medicare providers. Seem familiar? The whole charade has been a comedy of errors.

Comedy, all right, but when these counterfeit claims hit us taxpayers in the pocketbook it isn't funny.

Every now and then, the law actually clamps down on a couple of flimflams. One of them was ordered to pay $11 million in restitution. That's a hefty amount and it gives us an inkling of the number of dollars Medicare fraud represents.

Here we are, about to enter 2009. Medicare costs are about to increase again, and anyone who deludes himself or herself that fraudulent claims (yes, by people on Medicare, too) aren't partly responsible has been living on Mars.

We should be outraged that our public servants are so casual in accepting non-evidence as evidence. But every one of us is so used to "business as usual," we've long since substituted acceptance for outrage.

The phrase, "your tax dollars at work," never has been as derogatory and uncomplimentary as it is today. Will a new administration actually do something about these suppliers who treat Medicare officials as suckers? Will exposure such as this make any difference?

Don't count on it because corruption are at the tip of the Iceberg and of course the people without Voice and Political support are always being blame for it.

These are the comments from the Nativist and Anti Immigrants Jim Gilchrist and Jerome Corsi:

The large numbers of illegal immigrants already living in the country have put an enormous fiscal strain on government-funded social service programs because many of the illegal immigrants who arrive here are impoverished and undereducated. They are then forced to supplement their low-paying incomes with social welfare benefits, including those fraudulently obtained, to make ends meet. Moreover, the willingness of these illegal immigrants to commit fraud—both tax fraud and social service fraud—compounds the problem, as they work the system to get the maximum benefit from government-funded social services….

Why we as American citizens do not speak out loudly enough against these generous Social fraudulently beneficiaries(Hospital CEO's, CFO's, Doctors, and the list goes on and on) on behalf of U.S. Taxpayers?.

Blessing of caregiving elderly love ones and their cost.

Repairing that broken heart is one of those chores in life that requires you to find your own way. You have to wander around and find your own path.
Michael Vargas.

The burden is compounded by ignorance, which found that most Americans have no idea how much long-term care costs and believe that Medicare pays for it, when it does not. Hispanic Families have always looked after their elderly loved ones. Instead, across the income spectrum, Hispanics are sacrificing to care for their parents to the limit of their means and sometimes beyond.
We should encourageing Young Hispanics and other ethnicities that Elderly love ones are from different cultural backgrounds and may have differing from their beliefs and values but the question is how can we learn their language and how we should speak to them? Well; Elderly Love ones can communicates depends on his or her culture. Thus we should expect that cultural differences should be reflected whether they are developing or typically have a disability. We should support, listen, observe, value, encourage, talk to, interact and expand as a way to develop and build their language skills. Longevity is not a problem, but a life stage for which we must be prepared physically and emotionally, thus achieving a productive old age, useful and active. Throughout history we can see that the role of the elderly within the family and society has changed. The modern world does not tolerate the revocation, is trying to combat the time and deny old age. Currently, the society we live insists on using the chronological age for many purposes social and labor, preferring to young people and relegating the elderly. The problem of "age" denotes a form of discrimination before the old man because of his age, which turns out to be so dangerous and unfounded as racism and sensismo. Lastima que ya no estas conmigo Mi Viejito, Mi Padre. Qpd.

Recenlty study released from UnitedHealth Group's Evercare organization and the National Alliance for Caregiving (NAC) finds that more than one third of Hispanic households (36 percent) have at least one family member caring for an older loved one -a larger percentage than all U.S. caregiving households which is 21 percent (one in five), according to the Evercare Study of Hispanic Caregiving in the U.S. The study, the largest comprehensive look at Hispanic caregivers, also revealed that caregiving caused a major change to the working situation of Hispanics, which could have dramatic personal implications as the current fiscal crisis continues to unfold in the United States. Additionally, the emotional and physical tolls of caregiving might also impact the local and national economies, given that more than eight million Hispanics provide care to older loved ones nationwide.

The participants of the study indicated that additional resources and tools-in Spanish-are necessary to help them care for their loved ones. Seventy-three percent of Hispanic caregivers think it is very or somewhat important that caregiving information be provided in Spanish, with 56 percent who say it is very important. Eighty percent of Hispanic caregivers indicated training sessions that teach caregiving skills would be helpful, while more than seven in 10 would find online training in caregiving skills to be helpful.

Evercare, a leader in the fight against chronic illness, is dedicated to providing health care management and preventive care for the millions of Americans suffering with advanced or long-term illnesses such as diabetes, heart disease, and Alzheimer's disease. Through Evercare health plans, family caregivers are part of the primary care team led by Evercare Nurse Practitioners and Care Managers who help coordinate care and guide members to improve their health outcomes, remain independent, and live at home as long as possible. In addition, more than 500,000 working caregivers have access to Evercare™ Solutions for Caregivers, a caregiver services and support program provided through employers nationwide or on a private-pay basis.

"Family caregivers are an essential part of our health care system yet very often they need additional training and support for the critical role they play," says Ana T. Fuentevilla, M.D., Medical Director for Evercare/ Ovations National Support Team. "Understanding the specific cultural needs and issues of caregivers in the Hispanic community is an important part of how we design our specific health plans and services for our members. Through programs such as Evercare Solutions for Caregivers, we can help these caregivers maintain their own health and stay on the job."

Caregiving has also caused a major change to the working situation of many Hispanics. The study found that more than four in 10 Hispanic caregivers (41 percent) have changed their work situation either by cutting back on hours, changing jobs, stopping work entirely, or taking a leave of absence. This is compared to 29 percent among non-Hispanic caregivers.

In fact, two-thirds of Hispanics were employed at some point while they were caregiving (66 percent), whereas only 52 percent are currently working, a decline of 14 percentage points. Although the notable proportion of Hispanic caregivers who made major employment-related changes while caregiving might lead one to believe that they would be less satisfied with the balance between caregiving and work, they are actually more highly satisfied than non-Hispanic caregivers. Nearly half of Hispanic caregivers (47 percent) report being very satisfied with their home/work balance, compared to 36 percent of non-Hispanic caregivers.

The Evercare/NAC Study revealed that Hispanics spend 17 percent more time on caregiving than non-Hispanics do - 37 hours a week compared to 31 hours a week for non-Hispanics. Hispanic caregivers also perform more strenuous activities for their loved ones than non-Hispanic caregivers. In fact, Hispanic caregivers perform 17 percent more Activities of Daily Living (ADLs) including bathing, feeding, and other personal care tasks - than non-Hispanic caregivers.

However, while Hispanic caregivers provide more care, more than half reported little or no stress from caregiving. In fact, a significant number (35 percent) indicated that caregiving is not at all stressful - compared to 22 percent of non-Hispanic caregivers who reported the same. This is an important cultural finding given that more than four out of 10 Hispanic caregivers reported living with their loved one (compared to more than three out of 10 non-Hispanics who are co-residents) - a situation that in previous studies has typically increased caregiver stress levels.
See report:

Major Part of the equation problem of Medicare, Medicaid is Fraud and Overbilling. Why Nativist and Anti Immigrants blamed undocumented Immigrants?





only Medtronic unit will pay $75 million to settle whistleblower Medicare fraud case


Spinal medical device company Kyphon misled hospitals

May 22, 2008 -- Medtronic Spine LLC, formerly known as Kyphon Inc., has agreed to pay $75,000,000 to the federal government to settle a whistleblower lawsuit that exposed the spinal medical device company's sales and pricing strategy to increase its profits by defrauding Medicare.

The "qui tam" (whistleblower) lawsuit, which the government joined, was kept under seal and so was not publicly known until today, when the settlement was announced.

Kyphon, based in Sunnyvale, Calif., and recently acquired by Medtronic Inc., sells costly equipment and medical devices, including bone cement, for use in spinal procedures known as "kyphoplasty."

Kyphon's phenomenal sales growth was funded, in large part, by its successful efforts to sell kyphoplasty as an inpatient procedure. The minimally invasive procedure can be performed safely in about an hour on an outpatient basis. But Kyphon persuaded doctors and hospitals to keep patients overnight -- which allowed hospitals to charge Medicare up to $10,000 per procedure -- even though the patients typically had fully recovered within a few hours.

Because Kyphon was able to convince healthcare providers to perform kyphoplasty as an inpatient procedure, the company was able to price its products so that its profit margin exceeded 80 percent.

"A big, inpatient price tag allowed Kyphon to make thousands of dollars each time it sold a kyphoplasty kit," said Mary Louise Cohen, a Washington, D.C., attorney whose firm, Phillips & Cohen LLP, represented the whistleblowers in their qui tam case. "Because of the company's scheme, the Medicare program paid many millions of dollars more than it needed to pay."

Tens of thousands of kyphoplasty procedures were done as one-day inpatient stays as a result of Kyphon's marketing and sales strategy.

"The government was unaware of the fraud until Craig Patrick and Chuck Bates courageously came forward," said attorney Matthew Smith of Phillips & Cohen. "They also provided crucial assistance to the government in its investigation and pursuit of the case."

Kyphoplasty is performed to treat vertebral compression fractures, which commonly occur in the thoracic (middle) and lumbar (lower) spine. A balloon device attempts to pump up the compressed vertebra to restore the spine's original height. Then it is removed and bone cement is injected into the cavity that the balloon created.

Elderly women are susceptible to vertebral fractures due to osteoporosis, a disease that causes bones to become brittle and break. If left untreated, a compression fracture can lead to many other health problems.

Phillips & Cohen filed the qui tam lawsuit in 2005 in federal district court in Buffalo on behalf of Patrick and Bates. Patrick, of Hudson, Wis., was a reimbursement manager for Kyphon, and Bates was a regional sales manager in Birmingham, Ala. Patrick left Kyphon after complaints he made about its sales strategy went unheeded.

The U.S. Attorney's Office (USAO) in Buffalo took the lead for the government on the case. "The successful outcome was due in large part to the work of the U.S. Attorney's Office and investigators from the Department of Health and Human Services," said attorney Cohen. "They did an impressive job in all aspects of the case."

In particular, Cohen recognized the work of Assistant U.S. Attorney Robert Trusiak, USAO investigator Peggy McFarland, USAO auditor Theresa Tetlow as well as Cindy Pangallo and Peggy Glynn, who are Department of Health and Human Services special agents.

Phillips & Cohen specializes in representing whistleblowers in qui tam lawsuits. Under the False Claims Act, private individuals can sue companies defrauding the government and recover funds on the government's behalf. Whistleblowers, known as "relators," are entitled to 15 percent to 25 percent of the amount recovered as a result of the lawsuit. For more information about Phillips & Cohen and qui tam lawsuits

Walgreens Pays $35 Million, Settles Medicaid Fraud Allegations.


Walgreens shoppers Statement. Thank you for trusting Walgreens with your more valuable asset: Your Health. Failed to compliance with.

By paying $35 million, Walgreens, the self-proclaimed "Pharmacy America Trusts®" settled allegations by a pharmacist whistleblower that it unlawfully defrauded Medicaid by switching prescriptions for ranitidine, the generic form of the brand-name drug Zantac®, and fluoxetine, the generic form of Prozac®.

The United States, Puerto Rico, 42 states, and qui tam Relator Bernard Lisitza claimed that Walgreens improperly caused its pharmacies to switch Medicaid patients' prescriptions from ranitidine tablets to ranitidine capsules, and from fluoxetine capsules to fluoxetine tablets.

The alleged Medicaid fraud covered by the settlement lasted for more than four years, from July 16, 2001 through at least December 31, 2005. The Complaint was brought by the Relator in 2003, under "qui tam" provisions of federal and state False Claims Acts, after he uncovered the conduct and reported the problem to the government. The investigation and prosecution was led by the Attorneys General offices in Florida, Illinois, Ohio, Texas and several other states, and by the United States Attorney's Office in Chicago. Relator Lisitza pursued the case with the assistance of his attorneys, Michael I. Behn and Linda Wyetzner, of Behn & Wyetzner, Chartered, in Chicago.

According to the government, Walgreens switched drugs because the United States and various individual states had imposed price limits for the amounts that Medicaid would pay for the tablet form of ranitidine, and for the capsule form of fluoxetine. By substituting a drug dosage form with a Medicaid price ceiling for another form with no ceiling, Walgreens received substantially higher reimbursement amounts from various state Medicaid programs. For example, the Complaint states that the switches resulted in the government paying Walgreens as much as four times more for ranitidine capsules than for tablets.

Ranitidine tablets were the standard form of the medication. Capsules were rarely prescribed. Likewise, fluoxetine capsules were the standard forms of the drug. Legally, tablets and capsules are different drugs, and state pharmacy laws generally prohibit substituting tablets for capsules or capsules for tablets.

As different drugs, tablets and capsules also have different prices. State Medicaid regulations determine how much a pharmacy is paid for a particular prescription. States follow federal Medicaid reimbursement limits when they are set by the federal government for certain popular generic drugs. The United States, through the Centers for Medicare & Medicaid Services ("CMS") sets a Federal Upper Limit price for ranitidine tablets and fluoxetine capsules. State Medicaid programs followed these federal price limits. There were no price limits for ranitidine capsules or fluoxetine tablets, as they were virtually never prescribed.

The case alleges that Walgreens' ranitidine drug switching violated federal and state False Claims Acts. False Claims Acts prohibit submitting false or fraudulent claims to the government. Here, the United States, individual states and Relator Lisitza alleged that Walgreens violated federal and state False Claims Acts by claiming Medicaid reimbursements for the form of the drug with the higher price when the lower-priced ranitidine tablets should have been provided.

False Claims Acts are designed to deter fraud against the government and provide substantial remedies against those who lie, cheat and steal from the public treasury. The government can collect up to three times the amount it was defrauded in addition to civil penalties of $5,500 to $11,000 per false claim.

Major recoveries have been achieved through incentives and protections in the laws designed to encourage whistleblowers to come forward with information about fraud against the government. Whistleblowers can receive a substantial percentage of the recovery, ranging from 15 to 25 percent when the government pursues the case with the whistleblower. Pharmacists like the Relator in this case have brought numerous successful actions, resulting in taxpayers recovering hundreds of millions of dollars in improper government payments

WOMAN ARRESTED ON FEDERAL FRAUD CHARGES FOR DEFRAUDING MEDICARE OUT OF $12 MILLION




This morning, special agents with the FBI and IRS-Criminal Investigation arrested the operator of Wescove Home Health Services at her home in Covina on health care fraud and money laundering charges stemming from her participation in a scheme that defrauded Medicare out of more than $12 million.
Felcoranenda “Nenda” Estudillo, 50, a registered nurse, ran Wescove, which was based in the city of West Covina. Estudillo was Wescove’s administrator, responsible for the home health agency’s day-to-day operations and Medicare billing activity. In a 36-count indictment returned earlier this week and unsealed today, Estudillo is charged with conspiracy, health care fraud, money laundering, the structuring of cash transactions and falsifying records to maintain Wescove’s participation in the Medicare program.
According to the indictment, Estudillo paid marketers to recruit Medicare beneficiaries to receive benefits they were not eligible to receive. The marketers recruited and referred Medicare patients to Wescove, even though the beneficiaries were not confined to the home and did not need skilled nursing or therapy services. According to the indictment, Wescove billed Medicare for home health services provided to beneficiaries who were not confined to their homes, did not qualify for or need those types of services, or never received any services.
Estudillo allegedly paid marketers fees ranging from $300 to $4,800, based upon the amount that Wescove was able to fraudulently bill to Medicare. Estudillo would pay marketers higher fees for patient referrals that resulted in increased Medicare billings. She also allegedly paid referral fees that she booked as “skilled nursing” payments to conceal the payment of kickbacks.
According to the indictment, some Medicare beneficiaries were paid cash to sign up for home health services after being recruited by the marketers to receive services they did not need or did not receive. Estudillo allegedly paid more than $3.1 million to at least six marketers for the referral of Medicare beneficiaries.
The indictment charges Estudillo with 11 money laundering counts and 12 cash-structuring violations. These result from allegations that Estudillo laundered the proceeds of her Medicare billing scheme to promote the scheme, conceal the source of payments made to marketers and to herself, and avoid the payment of taxes . According to the indictment, Estudillo paid cash to some of the marketers who referred patients. To facilitate this, Estudillo devised a check-cashing scheme involving the marketers and Wescover employees in which they negotiated Wescove checks, obtained cash, and Estudillo used some of the cash to pay the marketers and patients. Estudillo allegedly wrote checks to marketers and employees in amounts less than $10,000 in an effort to avoid the currency transaction reporting requirements that banks are required to follow.
Estudillo is expected to make her initial court appearance this afternoon in United States District Court in Los Angeles.
If convicted of all counts in the indictment, Estudillo faces a statutory maximum penalty of 430 years in federal prison.
The investigation of Estudillo was conducted by IRS-Criminal Investigation and the Federal Bureau of Investigation

BILLIONS OF DOLLARS ARE STOLEN FROM MEDICARE AND ULTIMATELY FROM U.S. TAXPAYERS BUT THEY ARE NOT UNDOCUMENTED IMMIGRANTS !!!!!!!






TWO MEN SENTENCED IN MILLIONAIRE MEDICARE FRAUD SCHEME. WHRN THE ANTI IMMIGRANTS WILL START TO ACTING MORE RATIONAL AND USED A COMMON SENSE RATHER THAN BEING BIGOTRY, IGNORANCE AND LACK OF KNOWLEDGE.


R. Alexander Acosta, United States Attorney for the Southern District of Florida, and Jonathan I. Solomon, Special Agent in Charge, Federal Bureau of Investigation, Miami Field Office, announced today that on April 2, 2008 the Honorable Adalberto Jordan sentenced defendant Michael Labrada, 27, of Miami to a 97 month prison term and Miguel Castillo, 42, of Miami, to a 57 month prison term for their participation in a multi-million dollar health care fraud and money laundering scheme.

Labrada was sentenced in connection with two criminal cases. In the first case, Labrada was convicted of conspiring with Angel Castillo, Jr. to commit health care fraud by serving as a straw owner of a medical equipment company known as JJ & D Medical Equipment, Inc. The company submitted more than $6.8 million dollars in bogus claims and received approximately $1.6 million in payments. In the second case, Labrada was convicted of money laundering charges in connection with a $2.3 million laundering scheme orchestrated by his co-defendant, Angel Castillo, Jr.

Miguel Castillo was also convicted of related health care fraud and money laundering conspiracy charges. In addition to serving as a straw owner of a medical equipment company, Miguel Castillo collected hundreds of thousands of dollars in fraud proceeds from check cashers at the direction of his cousin and co-conspirator, Angel Castillo, Jr.

Last month, Angel Castillo, Jr. was sentenced to a 235 month term in connection with his ownership of more than eight durable medical equipment companies in Miami during 2005 and 2006. The companies collectively submitted in excess of $48,000,000 in false claims by way of two Miami based medical billing companies. In reality, the companies never provided any Medicare patients with any type of equipment or service. Angel Castillo Jr. used a series of straw owners to conduct banking transactions and conceal his ownership of the companies.

After receiving more than $7,000,000 from the Medicare program, Angel Castillo, Jr. then laundered the proceeds of the scheme by using friends, family and other associates, including various bank employees, to cash hundreds of checks. In some cases, Castillo’s associates needed duffel bags to carry the cash out of local banks.

Co-conspirators, Giovanni Guerrero, Javier Roberto More, Angel Hernandez, Juan A. Zaragoza have all pled guilty to related health care fraud and money laundering offenses in the past months. The case is being prosecuted by Special Assistant United States Attorney William J. Parente Jr. of the Federal Bureau of Investigation

BILLIONS OF DOLLARS ARE STOLEN FROM MEDICARE AND ULTIMATELY FROM U.S. TAXPAYERS BUT THEY ARE NOT UNDOCUMENTED IMMIGRANTS !!!!!!!





MIAMI-DADE DME AND CLINIC OWNERS INDICTED FOR USING STOLEN PATIENT INFORMATION IN MULTI-MILLION DOLLAR MEDICARE FRAUD SCHEME. ANTI IMMIGRANTS ARE NOT YOU GLAD TO KNOW THIS INFORMATION YOU NEED TO STOP BLAMING UNDOCUMENTED IMMIGRANTS FOR YOUR IGNORANCE AND PARANOIA.

R. Alexander Acosta, United States Attorney for the Southern District of Florida, and Jonathan I. Solomon, Special Agent in Charge, Federal Bureau of Investigation, Miami Field Office, announced today the unsealing of eight separate Indictments charging six Miami Dade residents with health care fraud in connection with their use of patient information previously stolen from the Cleveland Clinic in Weston, Florida. The Indictments allege that the defendants used the stolen patient information to submit fraudulent claims to Medicare.

Specifically, the defendants are each charged with ten counts of health care fraud, in violation of 18 U.S.C. § 1347. If convicted of these charges, the defendants, owners of various clinics and DME companies, face up to ten years’ imprisonment on each count.

The Indictments unsealed today are the culmination of an investigation into the theft of computerized patient files from the Cleveland Clinic’s Weston Office from May 2005 to June 2006. In September 2006, defendant Isis Machado, an employee at the Cleveland Clinic’s Weston Office with access to computerized patient information, wrongfully accessed the Cleveland Clinic’s computerized patient files and downloaded the personal identification information of approximately 1,500 patients.

This information included patients’ names, dates of birth, Social Security numbers, Medicare numbers, and home addresses. Machado then sold the patient information to her cousin, co-defendant Fernando Ferrer, for $5 to $10 per Medicare number or other individual identifying information. Co-defendant Ferrer, in turn, caused the stolen patient information to be used by DME’s and clinics for the submission of false claims to Medicare.

According to the Indictments, the fraudulently obtained Medicare numbers and identifying patient information were subsequently used by medical providers in Miami Dade-County to fraudulently bill Medicare for medical services not rendered and medical equipment not supplied.

Case Summaries:

1. United States v. Remberto Sarmiento Perez, 08-20262-Cr-Seitz.

This Indictment charges Sarmiento Perez, age 45, of Miami, with using the Medicare numbers and identifying patient information stolen from the Cleveland Clinic to fraudulently bill Medicare between May and October 2006 for approximately $1,237,509 through Super Medical Supply, Inc., one of two DME companies he owned.

2. United States v. Remberto Sarmiento Perez, 08-20258-Cr-Ungaro.

In a separate case, Sarmiento Perez is charged with using the Medicare numbers and identifying patient information stolen from the Cleveland Clinic to fraudulently bill Medicare between May and October 2006 for approximately $313,684 through another DME company he owned, APR Medical Equipment, Inc.

3. United States v. Michell Gonzalez Benitez, 08-20260-Cr-Huck.

Michell Gonzalez Benitez, age 28, of Hialeah, owned a clinic named Premium Medical Care, Inc. Between May and October 2006, Gonzalez Benitez is alleged to have used the Medicare numbers and identifying patient information stolen from the Cleveland Clinic to fraudulently bill Medicare for approximately $1,291,267.

4. United States v. Julio Perez Ramos, 08-20261-Cr-Moreno.

Julio A. Perez Ramos, age 33, of Miami, was the owner of one clinic and one DME company, and is charged in two separate cases. In this case, Perez Ramos is charged with using the Medicare numbers and identifying patient information stolen from the Cleveland Clinic to fraudulently bill Medicare between May and October 2006 for approximately $538,416 through his clinic, Benefica Rehabilitation Center, Inc.

5. United States v. Julio Perez Ramos, 08-20257-Cr-Cooke.

In a separate case, Perez Ramos is charged with using the Medicare numbers and identifying patient information stolen from the Cleveland Clinic to fraudulently bill Medicare between May and October 2006 for approximately $1,331,715 through his DME company, RVM Medical Supply, Inc.

6. United States v. Yordano Ruviera Diaz, 08-20259-Cr-Seitz.

Yordano Ruviera Diaz, age 30, of Miami, is charged with using the Medicare numbers and identifying patient information stolen from the Cleveland Clinic to fraudulently bill Medicare between May and October 2006 for approximately $1,264,464 through his DME company, De La Torre Medical Equipment, Inc.

7. United States v. Lazaro Hernandez Hernandez,08-20256-Cr-Middlebrooks.

Lazaro Hernandez Hernandez, age 43, of Miami, is charged with using the Medicare numbers and identifying patient information stolen from the Cleveland Clinic to fraudulently bill Medicare between May and October 2006 for approximately $171,445 through his DME company, W.P. Medical Supply, Inc.

8. United States v. Ariel Gonzalez, 08-20263-Cr-Lenard.

Ariel Gonzalez, age 36, of Miami, is charged with using the Medicare numbers and identifying patient information stolen from the Cleveland Clinic to fraudulently bill Medicare between May and October 2006 for approximately $1,830,711 through his DME company, IMP Medical Equipment, Inc.

United States Attorney Alex Acosta stated, “I continue to be deeply dismayed by the ease and size of the frauds that we find in the Medicare system. Over the past two years, we have more than doubled our prosecutions. Prosecutions, however, are ultimately not the solution. We must take steps to prevent Medicare fraud.”

FBI Special Agent in Charge Jonathan Solomon stated, “Billions of dollars are stolen from Medicare – and ultimately from U.S. taxpayers – by criminals who use our money to fund their lavish lifestyles. Our message to those that defraud Medicare is that you will be caught and you will go to jail. The FBI and its partners have concentrated extensive resources towards combating health care fraud and will continue to develop new strategies and initiatives to put more criminals behind bars and save taxpayers money.”

Mr. Acosta commended the investigative efforts of the Federal Bureau of Investigation. In addition, Mr. Acosta commended the Cleveland Clinic for its quick response to the incident and for its cooperation with law enforcement throughout the federal investigation. These cases are being prosecuted by Assistant U.S. Attorney Luis M. Pérez.

Why blamed undocumented Immigrants for burden the medicare and Social Services programs? I had been exposed many cases of Medicare and social services frauds as well as the 47Millions of people uninsured that are part of the equation. Why???.




Another case Woman pleads guilty to conspiracy to defraud Medicare of aproximately $ 36.9 Millions.


(HOUSTON, Texas) - Khira Guillory, 27, has pleaded guilty to one count of conspiracy to defraud Medicare of approximately $36.9 million, United States Attorney Don DeGabrielle announced today. At the time of the criminal activity, Guillory was the owner of KJB Medical Billing, an authorized Medicare billing company.

At a hearing held yesterday before U.S. District Judge Gray H. Miller, Guillory admitted she participated in a 13-month conspiracy with several other individuals, including Rhonda Fleming, to defraud Medicare by repeatedly billing Medicare for Durable Medical Equipment (DME) which was never supplied to the Medicare beneficiaries as claimed. According to the indictment, at the time of the criminal activity, Fleming, 42, owned her own Medicare billing company, Advanced Medical Billing Specialists, as well as three DME supply companies, Medical Equipment and Supply Center (MESC), Hi-Tech Medical Supply & Delivery (Hi-Tech) and E&R Medical Supply (E&R).

During her plea, Guillory admitted to billing Medicare for approximately $7.4 million of DME which she knew had never been delivered to the Medicare beneficiaries. She also admitted that all but $12,600 of the claims she filed contained fictitious dates of service that were backdated to make it appear the DME had been delivered six to 23 months prior to the date she filed the claim. For example, Guillory admitted that on Nov. 17, 2004 , she filed claims totaling $1,054,000 on behalf of 111 Medicare Beneficiaries for an Infrared Heating Pad System and a Power Pressure Reducing Air Mattress with dates of service ranging from January to September 2003.

Based on Guillory's fraudulent billing, Medicare and Medicaid paid approximately $2,500,284 to DME companies owned by Fleming and other co-conspirators. Guillory also admitted to receiving $483,868.92 from Fleming for filing the false billings.

Guillory is scheduled to be sentenced April 25, 2008 , and faces a maximum penalty of five years imprisonment and a $250,000 fine for her conspiracy conviction. As part of her plea agreement, Guillory also agreed to pay restitution of $2,500,284 to Medicare.

Guillory and Fleming are charged in a 73-count indictment with four other individuals which alleges a scheme involving the filing of millions of dollars in claims with Medicare/Medicaid by DME companies for durable medical equipment, such as infrared heating systems, pressure reducing mattresses and lumbar supports, which they purportedly supplied to Medicare beneficiaries, but were never purchased by the DME company nor delivered to the beneficiary.

Also charged in that indictment with conspiracy to defraud Medicare are Bose Ebhamen, 41, Billy Perkins, 48, James Chaney, 44, and King Arthur, 53. Fleming, Ebhamen, Perkins, Chaney and Arthur are also charged with multiple counts of healthcare fraud and wire fraud. Three of the defendants, Fleming, Ebhamen and Chaney, are also charged with various counts of money laundering.

According to allegations in the indictment, Fleming purchased Medicare beneficiary information, including their names and Medicare numbers, from Chaney and others for use in the scheme. Perkins and other employees of Fleming created fictitious delivery tickets to give the appearance the DME had been delivered by Hi-Tech, First Advantage and E&R. Perkins allegedly also mislead Medicare by pretending to be the person Medicare thought was the owner of E&R Medical Supply, located in Lake Charles, La. Fleming and her five co-defendants' fraud scheme caused Medicare/Medicaid to pay out approximately $6.5 million in fraudulent claims.

During the Fall of 2005, the United States seized and forfeited approximately $1.8 million of the illegal Medicare/Medicaid proceeds obtained during the alleged conspiracy to defraud Medicare charged in this indictment. The indictment also seeks to forfeit the $6.5 million from the six defendants as proceeds of the fraudulent scheme.

Fleming and the remaining four defendants are scheduled for trial beginning Feb. 25, 2008 . The public is reminded that an indictment is a formal accusation of criminal conduct, not evidence. The defendants are presumed innocent unless convicted through due process of law.

The criminal charges are the result of a joint investigation conducted by agents of the U.S. Department of Health and Human Services, Office of Inspector General, Office of Investigations, the Internal Revenue Service Criminal Investigation Division, the FBI and the Medicare Fraud Control Unit of the Texas Attorney General's Office. This case is being prosecuted by Assistant United States Attorney Al Balboni and Special Assistant United States Attorney Suzanne Bradley

How many immigrants, legal and Undocumented, get how much health coverage from where and what does it cost?

In response to that. This should be no surprise since 45 million AMERICANS are currently uninsured which restricts their access to fundamental preventative health care services. This has lead to the inefficient and expensive use of other services (i.e. ED) and has negatively impacted public health (regardless of immigration status). This is one of their assumptions that Many Undocumented immigrants are overwhelming the healthcare system and driving up the cost. is not true. "Vulnerable populations" such as "infants, youth, women, indigenous people, the very poor, the elderly and disabled do not have health care as well and are a part of the equation. In a recent poll that expressed that the majority thought that Undocumented immigrants were 50 percent responsible or more for the uninsured treated in hospitals leaves one with the question of its validity and wonder which portion of the population did this statistic come from.

The fact of the matter is that the most predictive factors in defining access to quality health care are income, zip code and race. White America for the most part have been the main part of the population who have lived in the better areas where health care has thrived at its peak. Depending on where you live will have a strong influence of the type of health services you will receive, anyway. When looking at the history of the United State concerning the availability of health care, it needs to be pointed out that undocumented immigrants have truly not been the first in line for anything. Income is a factor as well on the determination of who will receive health care, the statistics reveal blacks have the lowest median household income at 31.905, compared to the median for Latinos at 33,820, Asians at 47,631 and whites at 53,975. Although these household figures are not impressive the availability leans toward white America in being able to receive and have access to heath and all of its added benefits. The country with the most developed knowledge base is the US, and with all the advanced technology racial hidden biases exist influencing the choices made by scientist and industry as well. This has a trickle down affect to the front line of provided health care, lets look at some examples of this fact. On the front lines Whites are three times as likely to undergo bypass surgery that non-whites. Non-White patients seeking admission to nursing homes experience greater delays before placement that White patients. Doctors are less likely to do breast cancer screening for Hispanic women that for White women. Non-White pneumonia patients are seen less in hospitals that Whites, and finally, poor urban blacks and Hispanic neighborhoods have about 24 physicians per 100.000 compared to 69 physicians per 100.000 for poor white communities (Vernellia R.Randall, pg 1-8). It would appear that the cost of health care insurance is being driven up by the ones who are in line first and can afford it. The portion of the population that don't have access to adequate health care that provides the use of the most advanced technology in the world can't possibly be the cost drivers.

let's focus on the true problem at hand. Sadly the state of our failing healthcare system will place the blame on a minority with little to no political voice, despite their immense contributions to our economy. More concerning is the accusation that Undocumented immigrants are placing an undue burden on the U.S. health care system as a whole. An accusation that is largely unconfirmed, according to Mohanty, Assistant Professor of Medicine at UCLA. Cody so far has been the only one to solely address the issue of our failing health care system for what it is FAILING. Why is this? Employers, consumers and governments at every level are straining under the burden of a health care bill that is growing at a pace five or six times the rate of inflation. As the price tag for insurance increases employers pass the additional cost burden on to their employees; forcing workers to dig deeper into their pockets. The outcome is deleterious. Millions who can't continue to dig forgo coverage altogether and chance that their families will stay healthy.

the US spends nearly $5,000 per person on health care -- more than twice the amount of some other industrialized countries. But our life expectancies are horrible. Canada, for example, spends about 60 percent less per person than the United States but has longer life expectancies. Where is the return on investment? Why is the system failing us and our health? New medical technologies may be responsible for as much as 50 percent of U.S. medical cost growth. In addition, prescription drugs represent the fastest growing part of the health care bill, with Americans paying the world's highest prices for medication. While the industry says it needs to charge high prices to finance research and development, the largest pharmaceutical companies in 2002 spent 14 percent of their revenues on research and development while devoting 31 percent to marketing and administration.

The contributions of undocumented immigrants and the benefits they provide to the U.S. economy more than balance the health care resources they consume. In fact, the Social Security Administration has reported $56 billion in annual earnings from this population that help to generate almost $7 billion annually in Social Security tax revenue and an additional $1.5 billion annually in Medicare taxes. Also, undocumented immigrants contribute at least $300 billion to the U.S. gross national product annually.

How many times we heard the Anti Immigrants saying that Undocumented immigrants are the burden for Medicare cost!!!!! Almost everyday and they assured that is no way around it. Since when Ignorance became point of discussion? Well, let show them some numbers of Medicare fraud......

Nine Miami Defendants in strike force cases sentenced for $56.5 MILLION in Medicare Fraud.

Washington - Assistant Attorney General Alice S. Fisher of the Criminal Division and U.S. Attorney R. Alexander Acosta of the Southern District of Florida announced today that owners of nine separate Miami-based health care corporations have been sentenced to prison terms within the past two weeks. Collectively, the nine defendants filed fraudulent claims with Medicare for $56,599,832 worth of unnecessary durable medical equipment (DME) and infusion therapy.

The nine defendants sentenced in Miami are: (1) Luis Soto, 41, sentenced to 87 months in prison; (2) Noel Rodriguez, 50, sentenced to 51 months in prison; (3) Rosabel Gonzalez, 32, sentenced to 30 months in prison; (4) Christian Vasquez, 22, sentenced to 41 months in prison; (5) Maria De La Serna, 55, sentenced to 19 months in prison; (6) Ariel Betancourt, 35, sentenced to 24 months in prison; (7) Jose Prieto, 58, sentenced to 41 months in prison; (8) Armando Jorge Herrera, 27, sentenced to 36 months in prison; and (9) Reinaldo Lopez, 40, sentenced to 46 months in prison.

Soto was sentenced by U.S. District Judge Marcia G. Cooke on January 23, 2008. Soto owned and operated Ocean Medical Equipment, Adriana Medical Supply, Advance Medical Equipment, Family Health Medical Equipment, First AA Medical, KB Medical Services, Rossmary Medical Supplies, R&R Medical Equipment, Sagua Medical Supplies, Telimay Medical Service, West Side Medical, Future Medical Center, Siboney Medical Center, and Tampa Trauma that billed for items such as oxygen concentrators, nebulizers and wheelchairs that were never provided. Soto submitted claims to Medicare for unnecessary medical equipment and he caused the submission of false claims for pharmaceuticals. In total, Soto, through his companies, was responsible for over $47 million in false claims to Medicare. Soto pleaded guilty on October 16, 2007.

Rodriguez was sentenced by U.S. District Judge James Lawrence King on January 16, 2008. Rodriguez owned and operated OxyCare of Miami, a fraudulent DME company that had nothing to do with providing health care or necessary medical equipment. Between September of 2001 and June of 2003, OxyCare submitted claims to Medicare for medical equipment largely consisting of unnecessary oxygen concentrators, hospital beds and pressure reducing mattresses. Further, Rodriguez caused the submission of false claims for pharmaceuticals. In total, Rodriguez, through his companies, was responsible for over $1.2 million in false claims to Medicare. Rodriguez pleaded guilty on October 10, 2007.

Gonzalez, the owner and operator of Genesis Associates Group, Inc., was sentenced by U.S. District Judge Donald L. Graham on January 10, 2008. Genesis was a fraudulent DME company that had nothing to do with providing health care or necessary medical equipment. Gonzalez submitted over $1.5 million in false claims to Medicare largely consisting of unnecessary power pressure reducing mattresses and orthotics. Gonzalez pleaded guilty on November 2, 2007.

Vasquez, the named owner of Tamiami Medical Supply, Inc., was sentenced by U.S. District Judge Joan A. Lenard on January 16, 2008. Tamiami was a fraudulent DME company that had nothing to do with providing health care or necessary medical equipment. Tamiami submitted over $1.2 million in false claims to Medicare. The previous named owner of Tamiami, Justo Padron, 36, died in November of 2007 after an alligator attack at the Miccosukee Tribe Indian Reservation. Vasquez pleaded guilty on October 22, 2007.

De La Serna was sentenced by U.S. District Marcia G. Cooke on January 23, 2008. De La Serna owned and operated Respiratory One Equipment, Inc., a fraudulent DME company that had nothing to do with providing health care or necessary medical equipment. Between September of 2001 and June of 2003, Respiratory One submitted claims to Medicare for medical equipment largely consisting of unnecessary oxygen concentrators and nebulizers. Further, De La Serna caused the submission of false claims for pharmaceuticals. In total, De La Serna was responsible for over $345,000 in false claim to Medicare. De La Serna pleaded guilty on November 15, 2007.

Betancourt, the named owner of Lincoln Medical Supply, was sentenced by U.S. District Judge James Lawrence King on January 16, 2008. Lincoln Medical was a fraudulent DME company that had nothing to do with providing health care or necessary medical equipment. Lincoln Medical submitted over $480,000 in false claims to Medicare for largely unnecessary equipment such as wound therapy pumps and expensive wound care items. Betancourt pleaded guilty on November 15, 2007.

Prieto and Herrera were sentenced by U.S. District Judge Jose A. Gonzalez for their involvement on January 18, 2008. Prieto and Herrera were owners and operators of Coral Way Medical, a fraudulent HIV infusion clinic that also billed for unnecessary procedures such as paravertebral joint injections. Prieto and Herrera used these two companies to submit over $900,000 in fraudulent Medicare claims. Prieto pleaded guilty on November 15, 2007. Herrera pleaded guilty on November 1, 2007.

Lopez, the owner and operator of Reny Medical Equipment, was sentenced by U.S. District Judge Marcia G. Cooke on January 23, 2008. Reny Medical was a fraudulent DME company that had nothing to do with providing health care or necessary medical equipment. Lopez submitted over $450,000 in false claims to Medicare for unnecessary items such as prosthetics and ostomy supplies. Lopez pleaded guilty on November 7, 2007.

“The Department of Justice places a high priority on investigating and prosecuting those who steal tax payer money intended to provide health care for the elderly and disabled,” said Assistant Attorney General Fisher. “We have dedicated a team of experienced prosecutors to focus on Medicare and other healthcare fraud around the country.”

“The fight against Health Care fraud in Miami is a top priority,” said U.S. Attorney Acosta. “With the help of the newly formed HHS-OIG Florida Region which will add federal agents to our efforts we expect to see a significant impact on reducing fraud.”

According to data from the Centers for Medicare and Medicaid Services (CMS), Miami-Dade County alone accounted for more paid DME claims than 44 other states. Only some of the most populous states in the country including California, Texas, New York, Michigan, and Ohio billed Medicare for more than Miami-Dade County. According to that same data, an average Medicare patient in Miami-Dade County allegedly receives $6,200 worth of DME every year based on paid amounts; whereas patients throughout the rest of the United States average approximately $1,200 per year.

The Soto and De La Serna cases were prosecuted by Deputy Chief Kirk Ogrosky from the Criminal Division’s Fraud Section in Washington, D.C., and Assistant U.S. Attorney Ryan Stumphauser of the Southern District of Florida. The Vasquez and Betancourt cases were prosecuted by Assistant U.S. Attorney Stumphauser. The Rodriguez case was prosecuted by Deputy Chief Ogrosky, and Assistant U.S. Attorney Randy Katz. The Gonzalez case was prosecuted by Trial Attorney John S. Darden of the Fraud Section, the Prieto and Herrera cases were prosecuted by Trial Attorney Jerrob Duffy and Deputy Chief Ogrosky of the Fraud Section; and the Lopez case was prosecuted by Trial Attorney John Cunningham of the Fraud Section

ANOTHER MILLIONAIRE MEDICARE FRAUD AFFECTING TAXPAYER POCKETS. WHY WE CONTINUE TO BLAMING UNDOCUMENTED IMMIGRANTS?

MIAMI DME OPERATORS CHARGED IN $11 MILLION MEDICARE FRAUD CASE
December 04, 2007

R. Alexander Acosta, United States Attorney for the Southern District of Florida, Jonathan I. Solomon, Special Agent in Charge, Federal Bureau of Investigation, and Melody Jackson, Special Agent in Charge, Department of Health and Human Services, Office of Inspector General, Atlanta Region, announced that defendants Alicia Rodriguez and Juan Viera were held without bond in connection with an Indictment unsealed last week charging them with Medicare fraud and money laundering. Defendants Rodriguez and Viera are both charged with five counts of mail fraud and four counts of money laundering. Defendant Rodriguez is also charged with one count of obstruction of a criminal health care fraud investigation. The charges stem from a multi-million dollar Medicare fraud case involving two Miami medical equipment companies, R&N (“R&N”) Medical Supplies, Inc. and A&S (“A&S”) Medical Services, Inc.

According to the Indictment and evidence proffered at the pretrial detention hearing, in early 2006, defendants Rodriguez and Viera purchased R&N and A&S for the purpose of submitting fraudulent Medicare claims. To conceal their ownership and control of these companies, they used a nominee owner on the corporate, Medicare, and banking documents for the two companies. Over the 5-week period between March 7, 2006 and April 13, 2006, the defendants used these two companies to submit more than $11 million in fraudulent Medicare claims. These claims sought reimbursement for medical equipment that had not been ordered by a physician, was not medically necessary, and was not delivered as claimed.

This fraud was uncovered when large cash withdrawals from the R&N bank account caught the attention of law enforcement in April 2006. Specifically, on April 7, 2006, $110,000 in cash was withdrawn from the R&N account. When the agents tracked down the purported owner and corporate officer of R&N, the individual was living in a small efficiency apartment without air conditioning or running water. When served with a subpoena requiring the production of R&N’s business records, the individual admitted that she was not the true owner of R&N. She explained that she had been recruited by defendant Alicia Rodriguez to pose as the owner of both R&N and A&S. In return for her services, she received occasional cash payments from defendant Rodriguez.
Thereafter, the individual agreed to cooperate and arranged a meeting with defendant Rodriguez to discuss the subpoena. This meeting was recorded. During this meeting, defendant Rodriguez directed the individual to provide false information to the federal agent and the grand jury concerning R&N. Defendant Rodriguez repeatedly warned the individual not to mention her name or “Juan’s” name to the government. At the conclusion of the meeting, defendant Rodriguez handed the individual an envelope containing $4600 in cash and suggested a trip to Puerto Rico.
Mr. Acosta commended the Federal Bureau of Investigation and the Department of Health and Human Services for their investigation of this matter. This case was prosecuted by Assistant United States Attorney Adrienne Rabinowitz.
A copy of this press release may be found on the website of the United States Attorney's Office for the Southern District of Florida at http://www.usdoj.gov/usao/fls. Related court documents and information may be found on the website of the District Court for the Southern District of Florida at http://www.flsd.uscourts.gov or on http://pacer.flsd.uscourts.gov

http://miami.fbi.gov/dojpressrel/pressrel07/mm20071204a.htm

ANOTHER MILLIONARIE SCHEME FRAUD TO MEDICARE AND TRICARE AFFECTING TAXPAYERS POCKETS.
WHEN THE XENOPHOBICS, EXTREMIST WILL BE TAKING OFF THE MASK OF IGNORANCE AND SEE'S WHO'S REALLY DRAINING THE SOCIAL SERVICES SYSTEM.

DIANON SYSTEMS AGREES TO PAY U.S. $1.5 MILLION TO RESOLVE CLAIMS OF MISCHARGING MEDICARE

WASHINGTON -- Dianon Systems Inc. has agreed to pay the United States $1.5 million to resolve claims under the False Claims Act that the company mischarged Medicare and TRICARE for certain tests it performed, the Justice Department announced today.

Dianon, a reference lab located in Stratford, Conn., specializes in conducting tests to detect and stage various types of cancer. Doctors obtain tissue or liquid specimens from patients and refer the specimens to Dianon to determine whether they contain cancer cells, and if so, the stage of the disease.

The original suit against Dianon was filed by Dr. James Tiesinga, a pathologist formerly employed by the company. He filed the complaint against the company on behalf of the United States under the qui tam or whistleblower provisions of the False Claims Act. Dr. Tiesinga will receive $300,000 as his share of the proceeds of the settlement.

The complaint alleged that Dianon billed for medically unnecessary tests in that it performed 26 flow cytometry tests on every sample sent to the company for diagnosis regardless of whether all 26 were medically necessary for a particular patient. Flow cytometry tests can be used to measure the amount of DNA in cells.

The investigation and settlement were jointly handled by the Office of the United States Attorney for the District of Connecticut and the Justice Department's Civil Division, with the assistance of the Office of Inspector General for the Department of Health and Human Services, the U.S. Defense Criminal Investigative Service, and the Federal Bureau of Investigation.