A raid in Oxford County last week was apparently the latest in a string of search-and-seizures targeting Medicare/Medicaid fraud in the U.S.
Although federal officials are frustratingly tight-lipped about their investigations, the raid fits a profile: A variety of federal agencies suddenly show up in force, close the place up and begin loading out boxes of records and computers.
While we have no idea of what this particular investigation will show, it is all apparently part of a larger fraud crackdown that is not only welcome but long overdue.
In June, an Auburn man and a Portland woman were convicted of defrauding the federal government of tens of thousands of dollars in Medicaid money, according to the U.S. Attorney in Maine.
Their scheme was likely linked to a raid at a Lewiston office building in June of 2009 where federal agents spent hours hauling out boxloads of records.
Ahmed Yusuf Guled, 75, of Auburn and Dahabo Abdulle Osman, 59, of Portland were found guilty after a nine-day jury trial in U.S. District Court in Portland.
Three of the counts against them carry maximum 10-year prison sentences.
The siblings conspired to obtain Medicaid money through MaineCare Home and Community-Based Care Program.
Under the program, MaineCare recipients who are assessed for nursing home level care can get that care at home rather than a nursing home.
The evidence showed the Guled deceived nurse assessors into believing he was eligible for the care. His sister was then paid wages as his personal care assistant, which were reimbursed by Medicaid.
The evidence showed the services were not necessary and were never provided.
An indictment showed that MaineCare paid out more than $61,000, much of which was deposited into Guled’s bank accounts.
In other words, the money was stolen.
And it’s a nationwide problem with Miami and parts of Florida as its epicenter.
Some estimate that $60 billion a year is siphoned away from the Medicare program alone each year out of a total half-trillion spent on benefits.
So far, this has been a high-profit business for thieves with little risk of getting caught.
The same thieves who used to carry guns and burglary tools have figured out that a laptop computer, a phony address and a few government billing codes can draw down hundreds of thousands of dollars in loot.
The crackdown will be expensive — the Obama administration has allocated $500 million for new federal inspectors and FBI agents.
But the payoff could be huge — tens of billions saved.
The U.S. Office of Inspector General provides an anonymous hotline for anyone who suspects Medicare, Medicaid fraud or Social Security fraud, 1-800-HHS-TIPS (800-447-8477) or online at http://oig.hhs.gov/report_fraud/OIGFraudForm.asp.
Medical fraud does happen in Maine, as the recent raids have shown, and we can all have a hand in correcting the problem.
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