Associated Press - December 24, 2008

By 2005, Florida providers submitted $2.5 billion in AIDS treatment claims to Medicare, a government health insurance program that provides partial coverage to the elderly and indigent. The other 49 U.S. states combined submitted only $978 million, according to a 2007 report from the office of the inspector general.

Many of the patients recruited in the scams are Cuban immigrants who barely speak English.

About 8 percent of U.S. HIV/AIDS patients live in Florida but the state is responsible for 72 percent of Medicare spending on the disease - mostly for infusion therapies, that have long ago been replaced elsewhere by more effective antiretroviral drugs taken orally.

And yet because the treatments remained classified as "reasonable and necessary," the agency must cover them. Infusions are obsolete in most of the country where HIV experts say they are unnecessary, especially in the amounts given in Florida.

This loophole has spawned a lucrative industry of fraudulent medical care and many prosecutors feel the only way to shut it down is to go after patients.

"Unless patients are prosecuted, we will not have a true long-term impact," says Kirk Ogrosky, deputy chief of the U.S. Justice Department's criminal fraud section.

One Florida patient, Philip Audette, said he received $100 to $200 every time he went for an infusion treatment, nearly $10,000 over several months, selling his Medicare number to the clinic's three owners, the Benitez brothers, who were later indicted on charges of bilking $119 million from Medicare.

"It was very easy - the worst part was getting the needle," said Audette, 48, who was not prosecuted and testified in court against a clinic operator.

For years, federal officials have campaigned aggressively against clinic operators like the Benitez brothers.

But the unspoken thousands who keep these mills churning - the patients - remain free to move from clinic to clinic, scam to scam.

One patient alone was responsible for claims of $1.1 million for HIV infusion drugs and other services.

"To look at health care fraud and not look at the fact that the beneficiaries are somehow involved is to be blind to the problem," said Peggy Sposato, a former emergency room nurse who recently joined the Justice Department as an investigator. "We've got people out there who brag about the fact that they are making large amounts of money abusing Medicare."

But Miami U.S. Attorney R. Alexander Acosta believes it's better to spend his prosecutors' limited time and resources going after the providers - juries are often sympathetic to elderly and terminally ill defendants, even if they are guilty.

Connie Woodhead, the health care fraud coordinator in the Los Angeles office, agrees.

"It sounds great and I like the idea of getting the deterrent aspect," Woodhead said, but "you're not going to prosecute thousands of beneficiaries, so you're going to be making a sacrificial lamb in front of a jury of some poor person?"

The patients, mostly Cuban-Americans, are recruited by brokers who go door-to-door, offering hundreds of dollars for use of their Medicare numbers, a tactic The Miami Herald first reported. They often target new citizens and immigrants, sometimes entire families. Many barely speak English. Former professional patient Audette told the Associated Press a friend asked him if he wanted to make some quick money and introduced him to a broker named Oscar about five years ago.

After Oscar took Audette and his partner to get blood tests confirming they were HIV positive, then they were bused with about 18 other patients to the Miami clinic for three-times-weekly treatments.

The Benitez brothers, who owned St. Jude and 10 other clinics, bought hotels, helicopters, boats, even a water park with their spoils and allegedly fled to Cuba.

A doctor found guilty in the scam was sentenced to 30 years in prison last week, one of the stiffest penalties ever imposed for Medicare fraud. A physician's assistant received 14 years.

The Justice Department says Miami could significantly alarm bogus patients just by arresting one a month.

The fraud is not limited to HIV/AIDS.

Eighty one year old Ana Luisa Palacio made $125 every three months for about eight years going for bogus treatments for respiratory illness.

As part of a federal case against a clinic owner in Miami, she testified in February that she was in good health, though she accepted a host of medications and oxygen, which she never used and threw away. Several neighbors went with her.

Asked why she went to the doctor if she wasn't sick, Palacio said, "I went there because of the money problem ... well, I received money."

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