Day after day, the delivery trucks arrived at the building on Chicago's North Side, bringing walkers, hospital beds and wheelchairs to residents.
But there was a problem: Most of the older men and women getting the equipment were healthy and didn't need it, according to Jessica Moon, resident coordinator at the apartment complex.
The elderly residents, immigrants from Japan, Korea and China, had agreed to accept the deliveries after smooth-talking marketers went door to door, getting their Medicare numbers and telling them they might need the items if they got sick, Moon reported.
Then, the equipment supplier persuaded doctors — it's not clear how many — to sign the orders, completing the deception.
It was an all-too-typical scam targeting vulnerable seniors, according to Erin Weir, coordinator of Illinois Senior Medicare Patrol, who got involved in the case and helped stop the deliveries. Older adults were manipulated, a duplicitous company raked in money from Medicare, and taxpayers paid a bundle for unnecessary services, she said.
Weir declined to name the company, saying authorities were looking into the case.
With wrongful payments consuming more than $70 billion in Medicare and Medicaid funds each year, the government has intensified efforts to crack down on fraud, including closer scrutiny of medical databases, better coordination between law enforcement agencies and tighter standards for medical providers participating in government health programs.
Identified as a fraud "hot spot" earlier this year, Chicago has become the latest city to join the government's recently launched Medicare Fraud Strike Force operations. The designation brings new fraud-fighting resources into the city, so "it's likely we'll see an increase in the number of cases pursued," said Lamont Pugh, special agent in the Chicago regional office of the Inspector General for the U.S. Department of Health and Human Services.
Several alleged local scams were spotlighted in February, when the government charged 14 Chicago-area residents as part of the largest national health care fraud crackdown on record. Most of the cases filed in U.S. District Court in the Northern District of Illinois targeted older adults, who are the biggest consumers of health care services by virtue of their susceptibility to illness. Some examples:
•Dr. Jaswinder Rai Chhibber, owner of Chicago's Cottage Grove Community Medical Clinic, was charged in a criminal indictment with ordering unnecessary diagnostic tests for seniors and other patients in an effort to boost revenues from Medicare and Medicaid. Tests included echocardiograms, electrocardiograms and lung function tests, among others. His lawyer, Walter Jones Jr., did not respond to requests for comment.
•Marilyn Maravilla, a Chicago nurse, and four others were charged in a criminal complaint with paying kickbacks to various health care providers in exchange for referrals to her agency, Goodwill Home Healthcare Inc. of Lincolnwood. Maravilla allegedly made illegal cash payments of $600 for each patient referred. Her attorney, Leigh Roadman, did not respond to requests for comment.
•The owners of Chicago's Chalice Home Healthcare Services Inc., Virgilio Orillo and Merigrace Orillo, were charged in a criminal indictment with falsifying documents in an effort to boost Medicare payments. The alleged scam, according to the government: Patients were listed as being homebound and in need of skilled assistance when it wasn't true. (Medicare pays for home health care only for patients who meet these criteria.) Mark Olson, attorney for the Orillos, said he could not comment on the case because discovery was ongoing.
Deceptive individuals or organizations can make money off of Medicare by submitting invoices for services never rendered; by billing for more complex, expensive levels of service than those actually delivered; or through various schemes to expand their customer base, maximizing the opportunity to earn revenues and make profits. As long as it appears that a legitimate doctor signed off on the bills, Medicare pays.
Illinois Senior Medicare Patrol, a government-funded group that helps seniors identify and deal with medical fraud, offers this common example: Someone will approach an elderly person offering free blood pressure checks a couple of times a week. Then, they'll pay a short visit, sit and talk, maybe take a blood pressure reading, and bill the government for skilled nursing care.
In other cases, criminals steal doctors' identities and use them to forge approval for equipment or services. Sham companies and unscrupulous providers may set out to dupe consumers — then quickly fold when suspicions are raised. Or legitimate companies file illegitimate invoices, hoping they'll slip through without scrutiny as 4.5 million payment claims for Medicare are processed every workday.
These are not victimless crimes, said John C. Allen, inspector general of the Illinois Department of Healthcare and Family Services, which runs Medicaid.
"The money spent on fraud is money that can't be used on (health care) for you or your children," and all taxpayers foot the bill, he said.
Older adults also can be harmed when strangers enter their homes without a valid medical purpose. A false diagnosis can lead to inaccuracies in medical records, unneeded tests carry the risk of complications, and quality of care can be compromised if services are delivered by agencies eager to lift profits and perhaps cut corners, Weir said.
Antiquinetta Davis, of Chicago, learned about the consequences of fraud when her grandfather, Rudolph, suffered two strokes in 2009 and couldn't walk without assistance.
"When we tried to get him a wheelchair, Medicare sent information indicating that he already had gotten a wheelchair back in 2006 and refused our request," Davis said.
Someone had used the man's Medicare number to submit an invoice for an expensive wheelchair and cashed in when Medicare paid $4,487, according to records that Davis subsequently obtained. It's not clear who that individual was or whether the equipment was ever delivered.
Without a wheelchair, Rudolph Davis was confined to bed and unable to get to medical appointments or sit with the family at meals. It wasn't until the elderly man's doctor and Weir got involved that Medicare staff agreed to change course and approve the equipment.
Chicagoan Muriel Wein, 87, had a similar experience after her most recent heart attack in January left her weak and in need of a walker.
"I was quite shocked when the people over at Medicare said, 'No, you've already got one,'" said the elderly woman, who lives in a North Side apartment.
Wein eventually asked Weir's office for help, but not before she dished out $100 for a walker she felt she couldn't live without.
Seniors who are ordinarily vigilant can fall prey to scams when caught unaware. This happened to Dorothy Light, 82, of East Moline, when she answered the phone last November and found a professional-sounding woman named Sandy on the line, offering diabetic supplies by mail order.
As it turned out, the older woman was tired of going to Osco for supplies, and when "Sandy" said she'd qualify for a free glucose monitor, Light found herself giving out her doctor's name and her Social Security number. It wasn't until the caller asked "what is your favorite color?" — a frequent password used for personal accounts — that Light said "I knew I had been taken."
The following day, Light contacted her financial adviser, her credit union, the Illinois attorney general's office, a local alderman and Medicare, which promised to put a red flag on her account. Her quick response kept any wrongful charges from being billed, but the older woman was chastened nonetheless.
"I'll never give out this kind of information over the phone again," she said. "There are just too many people who want to take advantage out there."
Protect against Medicare fraud
Don't give out your Medicare or Social Security numbers to strangers.
•Be wary of anyone who offers free medical services or equipment.
•Don't let anyone borrow or use your Medicare card.
•Don't do business with someone who shows up at your door or calls you unexpectedly.
•If you lose your Medicare card, report it immediately, just like you would with a lost credit card.
•Check account notices from Medicare and your Medicare drug plan. Look out for double billing and charges for items you didn't receive or your doctor didn't order. Notify Medicare if questionable charges appear.
•If you want to check whether a health care company or provider is approved by Medicare, call 1-800-633-4227.
•If you want help dealing with suspected Medicare fraud, call Erin Weir, coordinator of Illinois Senior Medicare Patrol, at 1-800-699-9043 (email: email@example.com). For more information, go to illinoissmp.org.
•To report potential fraud to federal authorities, call 1-800-HHS-TIPS (800-447-8477).
•Low-income seniors can get coverage from Medicaid as well as Medicare. To report possible fraud in Illinois' Medicaid program, call 1-800-843-6154 or 1-800-368-1463. Online reports can be filed at state.il.us/agency/oig/reportfraud.asp.
SOURCES: stopmedicarefraud.gov, Illinois Senior Medicare Patrol