Cabinet officials commenting on this week's trio of Medicare fraud crackdowns in Miami and other cities pushed an emerging two-pronged approach, focusing on fraud prevention as well as prosecutions.
The latest indictments -- exposing almost $200 million in Medicare scams involving HIV treatments, physical therapy and diabetic services -- follow a recently announced partnership between the Justice and Health and Human Services departments.
The agencies have expanded criminal ''strike forces'' that existed under the Bush administration, most recently to Detroit, but also have committed about half a billion dollars to fraud prevention efforts this year. They are working on sharing suspicious billing information with Medicare -- an agency notorious for paying claims fast without verifying them -- to help stop fraud and waste.
Experts estimate the huge entitlement program loses at least $60 billion to fraud every year, with Miami-Dade County at the center of the national crisis.
''The Obama administration is committed to turning up the heat on Medicare fraud and employing all the weapons in the federal government's arsenal to target those who are defrauding the American taxpayer,'' HHS Secretary Kathleen Sebelius said during a news conference at the Justice Department with Attorney General Eric Holder.
''But our joint efforts don't just stop at the jailhouse door,'' she said. ``Every dollar we can save by stopping fraud can be used to strengthen the long-term fiscal health of Medicare, bring down costs and deliver better service to Medicare beneficiaries.''
The government's job will be anything but easy.
During the past five years, thousands of Medicare fraud offenders have shown that they can outsmart the vulnerable healthcare system for the elderly and disabled. Their weapons: cash kickbacks to Medicare patients, manipulation of medical records to justify bogus charges, and use of different billing codes to get around Medicare's technology to block false claims.
Consider the series of eye-opening criminal cases this week.
On Friday, FBI agents arrested eight Miami-Dade residents on charges of bilking Medicare for $22 million by charging for nurses to treat mostly homebound diabetic patients -- many of whom didn't have the disease or didn't receive the services.
FBI and HHS agents raided the suspects' two Miami-Dade businesses, ABC Home Health Care and Florida Home Health Care Providers, while prosecutors froze their bank accounts.
The prosecutions follow Medicare's suspension of billing privileges for 10 Miami-Dade home healthcare agencies that charged more than $100 million for suspicious services to treat homebound diabetic patients -- including false claims for nurses injecting their insulin shots twice a day.
Medicare issued the suspensions in October after finding that $1 of every $15 it spends on home healthcare nationwide is spent in one county: Miami-Dade. Medicare's total budget: $16.5 billion.
The situation in Miami-Dade has spun so out of control that Medicare's cost per home healthcare patient runs as high as $19,230, according to agency records. That's 30 times the average cost per homebound patient in Chicago: $635.
According to the indictment unsealed Friday, Gladys Zambrana, Enrique Perez and Alejandro Hernandez Quiros operated ABC Home Health Care, 8360 W. Flagler St., listing Javier Zambrana as the owner.
They submitted false claims for $17 million from January 2006 until December, with Medicare paying them $11.3 million -- mostly for treating homebound diabetic patients, authorities said.
Gladys Zambrana and Carlos Castaneda also operated Florida Home Health Care Providers, 4150 NW Seventh St., listing Vicenta Tellechea as the owner. They filed bogus charges for $5.5 million from October 2007 until March, authorities said. Medicare paid them $4 million -- again, mostly for homebound diabetic services.
The alleged racket ''would provide cash kickbacks to Medicare beneficiaries in exchange for [their] signing documents stating that they had received the home healthcare services,'' according to the indictment.
The indictment further alleges one medical assistant, Modesto Hidalgo, ``falsified blood tests and medical records to make it appear that legitimate home healthcare services were being provided.''
The eighth defendant, Vanessa Estrada, handled billing for the group's two home care agencies.
Earlier in the week, federal agents took down 53 Medicare fraud suspects in Miami, Detroit and other cities in a roundup of doctors, clinic owners and patients on charges of conspiring to defraud the government program of $56 million.
Multiple indictments, returned by a federal grand jury in Michigan, spotlighted HIV infusion and physical therapy that have been widespread in Miami and were transported to Detroit, the latest Medicare fraud hot spot.
The severity of the problem in Detroit prompted Holder, Sebelius and FBI Director Robert Mueller to hold the news conference Wednesday at the Justice Department.
And the previous day, agents broke up a Miami-based ring that allegedly schemed to defraud Medicare of $100 million by filing false claims for obsolete HIV therapy across five states. Two of the eight suspects have fled to Cuba.
The organization, which was paid $30 million by the federal health insurance program, exported a fraudulent local business enterprise to Georgia, Louisiana, North Carolina and South Carolina by using empty storefronts and post office boxes, authorities said.
The alleged conspiracy exploited not only Medicare but also private insurers that administered the federal program under the Medicare Advantage plan.
''We will strike back against those whose fraudulent schemes not only undermine a program upon which 45 million aged and disabled Americans depend, but which also contribute directly to rising healthcare costs that all Americans must bear,'' Holder said.
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