Healthcare, as with every other industry, has sought out ways to outsource and to ship jobs to overseas providers. So I am not suspected of jingoistic or “U.S.–first” behavior with this post, I am merely pointing out that Medicare has become an international piggy-bank that is all too easily in the cross hairs of fraud. Unfortunately, the world has learned that the system can and does get overwhelmed with unethical providers and behavior. It is long-past time to tighten billing ethics and to initiate greater ethical training programs,
Home Health Care Consulting
Case in point to my observation is an organization that goes by the name of Home Health Care Consulting, an impressive enough, solid-sounding entity that, according to the Department of Justice and FBI Field Headquarters in the Chicago-area, “controlled Medicare billing and maintenance of electronic medical records for over 20 home health agencies located in Illinois, Indiana, Nevada and Texas.”
However, the organization is not located in the Midwest, but rather Islamabad, Pakistan. There, a Pakistani national, Muhammad Ateeq (all of 33-years old) and an employee of the company, allegedly used several false identities to acquire and then manage smaller home health agencies in the U.S.
With inside information as to how the Medicare system works, once Ateeq controlled the home healthcare services, he billed the government more than $40 million for services that none of the services provided.
To be sure, he had U.S. accomplices. He engaged these partners-in-crime “to deposit checks of fraud proceeds into U.S. bank accounts designated by overseas customers of overseas money transmitting businesses. The money transmitting businesses then issued cash payments to Ateeq in Pakistan”
As Medicare dealt with several aliases of Ateeq, the system was undoubtedly confused as to the fact that the money was being laundered.
Here is where the scam took on a rather “elegant” aspect. In addition to the laundered money in Ateeq’s accounts, he “also directed U.S. employees to use fraud proceeds to purchase expensive watches and other luxury items in the United States and then deliver the items to Ateeq’s associates in Dubai.”
There is a huge luxury jewelry market at this time that many use as a hedge against inflation. Undoubtedly, Ateeq’s associates put an upcharge on these items. It was pure profit on top of pure profit.
Whistleblowers and Examiners
The patterns in Ateeq’s greed eventually caught up with him. The FBI in addition to the U.S. Department of Health and Human Services Office of Inspector General could find no justification for the $40 million in Medicare billings, nor could they trace the aliases that were claimed.
When the accomplices were caught, the focus got kicked up the ladder until Ateeq was found. For his fraud, the young man has been sentenced to 12 years in jail and $48 million in restitution. Auditors also found a $2.4 million cashier’s check in Ateeq’s possession and over $1 million in cash.
What is particularly troubling about this long-distance healthcare fraud, is not only that the system was abused, but I question the (lack of-) care the patients received in the efforts to bilk the system. How did a 30-something fraudster gain access to the system? How could he assume three aliases and bill Medicare to the tune of $40 million?
In our heavy reliance on outsourcing, what controls, financially and ethically have we given up? We will be told that such outsourcing will keep medical costs down, but how much did this fraud and its subsequent investigation cost all of us? How much in the way of taxpayer dollars was ultimately lost forever? It only took one unethical 33-year-old to cost us $40 million. How much more fraud is there, “out there?”
LEAVE YOUR COMMENTS!
