FORT WORTH, Texas — When federal agents arrived, the scooter was still covered in plastic.
It should have been a fancy $5,000 power wheelchair for someone who needed it. That’s what Medicare paid for.
Instead, the little red scooter was delivered to an unsuspecting patient who didn’t need it, through the work of a North Texas medical supplier who eventually pleaded guilty with five others in a $2 million fraud scheme.
“It all boils down to somebody getting something for nothing,” said Mike Fields, special agent in charge of the Dallas Regional Office of the Health and Human Services Department’s office of inspector general.
“It’s amazing how quickly these schemes spread.”
The conviction in the scooter case, which stretched from North Texas to Houston and Tennessee, was among about 300 in cases that led to the recovery of nearly $1 billion in fiscal 2009 under the Health Care Fraud Prevention and Enforcement Action Teams, known as HEAT. It’s part of a nationwide crackdown on Medicare and Medicaid fraud that experts say costs taxpayers as much as $60 billion a year.
This problem has drawn increased interest as the debate on overhauling health care rages in Congress, which wants to cover some of the costs with savings from Medicare and Medicaid. And the problem appears to be growing: Recent cases show a new sophistication among the scam artists, and authorities say organized crime and street gangs are becoming involved.
“It obviously is something that’s huge,” said Bill Mateja, a Dallas attorney who was special counsel on health care fraud in the Justice Department. “Anytime you dole out billions of dollars in a federal program, there’s going to be fraud and abuse that takes place.”
Evidence mounts
The evidence lists for local fraud cases read like a Medicare supply and service list.
In addition to payment for unnecessary wheelchairs and scooters, cases have involved expensive trips in ambulances for patients who could drive themselves to treatment, home-health nurses who never showed up, over-the-counter medical supplies sold as high-tech specialty kits, and kickbacks to those who stole patient identities or agreed to sign paperwork deeming the equipment a medical necessity.
The local task force, based in Dallas, is working with strike forces set up in targeted locations nationwide, including one in Houston, and with the Texas attorney general’s office.
“They’re preying upon the elderly and our vulnerable citizens,” said Assistant U.S. Attorney Sean McKenna, who handles civil fraud cases from the Dallas office. “They’re stealing money they’re not entitled to.”
Assistant U.S. Attorney Katherine Miller, who handles criminal cases from the Dallas office, said most of the scam artists are using the proceeds to line their own pockets.
In the scooter case, prosecutors say Walter Sanders of Mesquite, owner of Waltco Medical Equipment and Supplies, paid his ex-wife to provide him with Medicare patient identification that she obtained from a Tennessee hospital where she worked in the emergency room.
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