Policy-ish

Crooks Use Doctors' Identities To Commit Medicare Fraud

A homeless guy in Florida supposedly got rent money and food to be the front man for a discount pharmacy that defrauded Medicare.

Map of South Florida. i i
iStockphoto.com
Map of South Florida.
iStockphoto.com

Former Cuban military officer Renier Vicente Rodriguez Fleitas, 60, pleaded guilty to a federal fraud conspiracy charge last fall and in January was sentenced to 37 months in prison.

The feds say Pirifer Pharmacy and Discount, which he owned according to the government, submitted about $1.8 million in fraudulent claims under Medicare Part D, which covers prescription drugs.

Medicare paid the Hialeah, Fla. pharmacy $135,930. The pharmacy then cut checks to three other people.

What made the claims a fraud?

The doctors whose names were on the bills never wrote the prescriptions. One doctor, a dermatologist, lived in Portland, Ore. Two others were dead and another had been in federal custody since June 2009, the plea agreement says.

The Center for Public Integrity, whose story tipped us to the Florida case, says the real worry here is that it's pretty darned easy for crooks to swipe doctors' special ID numbers for prescriptions and use them to perpetrate Medicare fraud.

Indeed, the Office of the Inspector General over at Health and Human Services put out a report last week saying Medicare should do a better job of making sure the prescribers identified in claims are legit — especially for narcotics, the focus of the inquiry.

HHS' Center for Medicare and Medicaid Services disagreed, saying that it was premature to reject claims that don't have a valid prescriber ID number. The Medicare bunch said it has "to balance our dual interests in monitoring program vulnerabilities with ensuring that Medicare beneficiaries have access to critical medications."

Comments

 

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.