Brigido and Quintina Pullan, both 81, have no use for the pair of power wheelchairs and the two semielectric hospital beds sitting in unopened boxes at their tiny South of Market rental unit. Yet the federal government's Medicare program was billed more than $15,000 for them. Bagtolome Gorero, 80, and his wife Estelita, 79, each received a crisp $100 bill for taking a van ride to a sleep clinic in San Jose, where they were asked to lie on beds for four hours with wires attached to their bodies and watch movies. In turn, the clinic operators billed Medicare $7,950 for sleep studies on the two, who say they have no sleep problems whatsoever. These and two dozen other San Francisco seniors interviewed by The Chronicle say their Medicare accounts were purloined by medical con artists, who induced them -- and perhaps hundreds of others -- to give their Medicare numbers for health services and equipment they didn't need.
Their stories are evidence of a series of scams that may have cost the government health plan millions of dollars in the Bay Area. The schemes -- which have resulted in FBI raids that shut down two clinics -- shed light on how fraud, abuse and error cost Medicare tens of billions of dollars a year. The Chronicle's investigation shows how senior citizens and immigrants are used to defraud the giant health care system for the elderly. In San Francisco, the Medicare scammers targeted Filipino seniors -- many of them veterans who served with U.S. forces in World War II. Hundreds of people have reportedly received investigative letters from the FBI, questioning their Medicare usage. No charges have been filed in the investigation. The U.S. attorney's office in San Francisco refused to confirm or deny the existence of any investigation. FBI spokeswoman LaRae Quy said only: "We have not yet arrested anyone in this matter."
Records obtained from the seniors by The Chronicle show Medicare billings coming from a half-dozen doctors, four medical clinics in San Francisco and San Jose, and 11 medical distribution firms from the Los Angeles region. For example:
Apolonio Ladia, 81, is physically fit and has no major medical complaints. Yet recruiters paid him to go to three Bay Area clinics where he underwent 46 medical and laboratory tests -- for which clinic operators billed Medicare more than $8,500. Gonzalo Esnero, 80, is not diabetic nor does he require tube feeding. Yet his Medicare records show the insurance program for the elderly was billed $4,806 for diabetes and tube feeding supplies that he says he never ordered.
The federal government is struggling to find money to pay for such basics as prescription drugs for the elderly. At the same time, government reports estimate that $1 in every $10 spent by the $300 billion Medicare system goes to erroneous, abusive or fraudulent payments. In California, an incomplete accounting identified $553 million in improper payments last year, according to a December Medicare report. "We're seeing California as a hotspot of fraudulent activity," said Ted Doyle, who heads a new Centers for Medicare and Medicaid Services unit designed to root out fraud in the Los Angeles area.
The network of scams targeting Bay Area seniors appears to mirror medical fraud rings that have been investigated and prosecuted in Los Angeles and dozens of other cities. Many of the schemes have involved organized crime. "In the past six years, we've seen increasing amounts of criminal activity from several well-established organized crime groups, including the Russian mafia and Southeast Asian gangs," said Collin Wong, who heads California's Medi-Cal fraud unit. The Bay Area schemes now under federal investigation involved a network of clinics that employed recruiters to round up patients from immigrant communities. One recruiter, Lolita Ramos, 77, of San Francisco, told The Chronicle she was paid $50 for every Medicare beneficiary she brought to three clinics in San Jose and San Francisco.
Three doctors employed by these clinics said they accepted jobs in the facilities only to find out later that their names, medical certificates and bank accounts were being used in scams they knew nothing about. In San Francisco, the fraud involved a clinic that rented space at the West Bay Pilipino Multi-Service Center, a 30-year-old South of Market nonprofit. This clinic, which West Bay Director Edwin Jocson said has been closed since a December search by FBI agents, was housed in a space at the Seventh Street center rented by a mysterious man named Harut (Harry) Kirakossian. Jocson said the center was exploited by the clinic operators. Dozens of seniors said they were recruited to go to that clinic, where they lined up to apply for wheelchairs or to take van rides to San Jose clinics. Many said they were paid $100 each to join vanloads of other Medicare recipients who were driven to clinics in San Jose and San Francisco to undergo long batteries of unnecessary medical tests on Medicare's tab.
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ANYBODY CAN BE A SPECIALIST IN AT LEAST ONE AUSTRALIAN PUBLIC HEALTH SYSTEM
Your government will see that you get the
Queensland's health scandal has snowballed, with claims that hundreds of Government-sanctioned overseas-trained doctors are risking lives by working well above their qualifications. Opposition health spokesman Bruce Flegg said leaked Queensland Health documents proved doctors, often from developing countries, were working as specialists with the blessing of the state, but without accreditation. His comments come as Premier Peter Beattie said the Government would pursue the Indian-trained doctor Jayant Patel if an investigation proved he was criminally negligent, and the Government braced itself for a wave of legal action.
Dr Patel, dubbed Dr Death by colleagues at Bundaberg Base Hospital, has been linked with the serious injury or death of at least 14 patients. The 55-year-old doctor, who had also faced accusations of negligence in the US state of Oregon, is believed to have gone to India after leaving Australia at Easter. Because of his Bundaberg stint, the Oregon Board of Medical Examiners cancelled his licence for not telling it he was moving his practice.
Mr Beattie, who returned yesterday from a trade visit to Japan, said the Government would pursue Dr Patel if an investigation into his treatment of patients proved he was negligent. Although Queensland had no extradition treaty with India, there was an existing arrangement that might hold sway. Mr Beattie said: "If the legal case justifies that, which it would seem on the surface to me that it does, and that's the determination by [the police] then yes, absolutely [we will seek extradition]. "I think the people of Bundaberg, who have gone to hell and back and have suffered this pain, would expect nothing less of the Government than to pursue this if the legal case stands up to scrutiny in a court."
Mr Beattie conceded the Government had braced itself for a wave of legal action, as law firm Shine Roche McGowan said it would pursue personal injury compensation claims for Dr Patel's victims. Lawyers Simon Morrison said his firm had been approached by at least 11 people so far.
Dr Flegg said yesterday leaked Queensland Health documents proved it had been State Government policy since 2002 to employ inadequately trained overseas doctors, a policy which had led to the "Dr Death" tragedy. "What these documents show for the first time is the Queensland Government, as a matter of policy over the past 2 years, has been using overseas-trained doctors as specialists despite the fact that they do not have the qualifications to be registered in this state," Dr Flegg said. "The exact number is unknown . . . but, anecdotally, we're probably dealing with hundreds of doctors." He said the documents went a long way towards explaining the havoc wreaked by Dr Patel during his two-year stint as director of surgical services at Bundaberg Base Hospital.
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
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