Miami Herald - September 17, 2006
John Dorschner, jdorschner@MiamiHerald.com

Her story, reported in The Miami Herald last month, has sparked a wave of responses from seniors with similar stories about their identities being used for widespread fraud that FBI officials estimates runs $1 billion a year in South Florida alone.

Because their comments were so numerous and so intense, The Miami Herald has decided to open a forum on its website dedicated to healthcare fraud. (Go to MiamiHerald.com and click on Health).

The forum will consist of comments of seniors and others whose identities have been used, announcements from law enforcement and news reports. It will be updated frequently as developments occur.

"After I read this wonderful article, I went immediately to my summary notices, and I saw I too was a victim," wrote A. Friedman of North Dade in one of several dozen responses. 'I'm very irate. I've already called Medicare . . . I got the phone number of the service that did the billing and I called. I got a recording in Spanish. I told them: 'I'm reporting you to the FBI and the Herald! You better stop this.' "

Phil Wall of Kendall had a suggestion: "Has anyone yet realized that Muriel Sherman, and thousands more seniors who are just as irked by what's going on, represent an untapped mass of unlimited resources that would gladly get busy and identify dozens of frauds every hour if their efforts were productive of anything but yawns on the part of the folks who take the reports?. . .

'My own experience in reporting 25 or 30 obvious frauds has told me plainly that all the protections presently in place amount to a very bad joke. Never before has there been such an immediate need for 'whistle-blowers' by hundreds of thousands!! Might a small reward be workable?"

Timothy J. Delaney, assistant special agent in charge of the FBI's Miami Division, warned seniors not to do investigations on their own. "I would leave that up to the professionals."

Delaney, who previously was the FBI's national case manager for healthcare fraud cases, acknowledged that healthcare fraud is a huge issue here, particularly in durable medical equipment, a long-standing concern, and in expensive HIV/AIDS infusion treatments, which was first revealed as a massive problem in a Miami Herald report last year.

"It is a huge problem, but there are many people trying to do something about it," Delaney said. Thirty of the Miami division's 390 case agents are dedicated to healthcare fraud.

Seniors can help by taking a careful look at their explanations of benefits that arrive periodically in the mail from Medicare. If they spot something odd on their bills -- particularly charges for clinics or doctors they've never been to -- they should start by calling the 1-800 number on their EOB form. They can also call

the Medicare fraud hot line at 1-800-447-8477.

"I don't encourage calling the FBI," said Delaney. "Any single complaint is not enough" to launch an investigation. "Every citizen has the right to call the FBI," but in healthcare fraud cases, the agents generally fill out a form and forward the information to investigators.

Several seniors have told The Miami Herald that when they called Medicare to complain about fraud, they were told that an investigation is not launched until $1 million in claims has been built up.

Delaney acknowledged there was a threshold for investigations, but he refused to say what it was. Healthcare fraud cases tend to be complicated, he said, with agents having to gather records from several different sources -- meaning it can take months to bring a case to an indictment.

Meanwhile, many persons are irate. "If a person walked into a bank with a note demanding $1,000, the FBI would be on the case in seconds, and they would be arrested and prosecuted. We have people stealing millions and nothing is happening," Jim Nolan wrote to The Miami Herald. "Every American taxpayer and the business community is paying for this fraud. Does it take 80-year-old woman and her husband to go to a phony store front to get some attention?"

As for Muriel Sherman, now 81, she said that since the report was published, she received a copy of a two-page letter the FBI sent Medicare fraud investigators about her case. But she's received no word about anything action against the clinic that billed her for visits she never made.

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