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‘We’ve got to change the culture,’ health-fraud prosecutor says

Miami may be the nation's epicenter for Medicare and Medicaid fraud, but the United States Attorney's Office has upped its game and its prosecutions, said the U.S Attorney for the Southern District of Florida at a conference in Miami on Thursday.

In front of about 150 lawyers from around the country, Wilfredo Ferrer said that his office has prosecuted more than 1,000 people in healthcare fraud cases that cost the system more than $3 billion dollars.

“The results have been spectacular and they've been sad because it portrays a sad situation,” he said.

He ticked down a list of some of the district's most outrageous fraud cases.

In one, a grandma was the ringleader, bilking hundreds of thousands from Medicare. She bought four yachts and then fled with her family to the Dominican Republic.

“The grandmother came into court and did the whole thing like, 'I can't believe the big, bad U.S. Attorney's Office is going after me.' After I told the judge she had purchased four yachts with our money, I started hearing 'burn the witch, 'burn the witch.'”

Sometimes fraud cases are obvious, such as when a doctor bills two prosthetic left arms. But often the operations are more sophisticated, involving doctors, nurses, patients and other healthcare workers.

This month, for example, leaders of two home healthcare companies pled guilty after billing Medicare $200 million for supposed therapy on elderly people with dementia. In fact, workers at the company did nothing more than go to assisted-living facilities, move the patients to isolated rooms, and put them in front of the television.

Ferrer, who was nominated by President Barack Obama and sworn in by the U.S. Senate in April 2010, stressed the importance of working with the the Department of Justice, the Centers for Medicare and Medicaid Services, and the Health and Human Services Office of the Inspector General.

“We all need to work together," he said. “Healthcare fraud is always evolving; the people who are doing this adjust.”

As the prosecutors cracked down in Miami-Dade, for example, criminals moved north to Palm Beach County. And as it became more dangerous for people to bilk Medicare and Medicaid, they shifted to private insurance companies, he said.

The problem is rampant, and the consequences are serious, he said. Legitimate suppliers can't compete with fraudulent companies, patients can get the wrong treatment or no treatment at all, and healthcare costs are soaring, he said.

“This is going to sound weird because I'm a prosecutor, but prosecutions really aren't the answer to this,” he said. “We've got to change the culture that makes this acceptable.”