GAO: "Actions That Could Help Combat Fraud Incomplete"
In an unprecedented case, federal prosecutors say that a massive money-laundering operation moved up to $63 million in money from Medicare schemes to Cuban banks. The case is the first that directly traces money allegedly received through defrauding Medicare to the Cuban banking system.
The case highlights what the U.S. Government Accountability Office (GAO) describes as "persistent weaknesses" in Medicare's healthcare provider enrollment procedures. Lax procedures increase the risk of allowing in entities intent on defrauding the tax - payer funded program.
Since 2004 the GAO has made numerous recommendations for more stringent enrollment procedures of healthcare providers. But during that time, while the GAO was pleading with lawmakers that more needed to be done, a Cuban immigrant who allegedly conspired with a "syndicate of international money launderers" sent money fleeced from Medicare through a complex web of shell companies into Cuba's banking system to hide it. The case is part of a broader investigation involving 70 Florida companies. The Miami Herald reported that since the mid-1990's "waves of Cuban migrants have learned myriad ways to fleece the taxpayer-funded healthcare program for the elderly and disabled. Meanwhile, about 150 suspects have fled back to Cuba and other parts of Latin American to evade prosecution, according to FBI and court records."
Federal prosecutors said they have no proof that the Castro regime is behind the multimillion-dollar scheme and a Cuban official has defended the nation's banks. But experts have raised doubts that that much cash could wind up in Cuban bank accounts without the Castro government knowing about it.
The 2010 Affordable Care Act authorized a number of actions to strengthen healthcare provider enrollment, but, according to the GAO, The Centers for Medicare and Medicaid Services (CMS) has not completed implementing key new enrollment protections that require providers to post surety bonds, as well as fingerprint-based criminal background checks, among other things.
"Seniors and taxpayers have a right to know why," says TSCL Chairman Larry Hyland. TSCL strongly supports the GAO recommendations that CMS:
- Strengthen provider enrollment screening to avoid enrolling those intent on committing fraud.
- Increase and improve pre-and post-payment claims review to identify and respond to patterns of suspicious billing activity.
- Address identified vulnerabilities with timely corrective action to prevent improper payments.
"With Congress debating plans that would require seniors to pay more for their Medicare benefits, let's tell Congress and the candidates that stopping Medicare fraud is their first priority," Hyland says.
Send an email to your Member of Congress, or, for help with the name and address, call 1-800-333-TSCL (1-800-333-8725).
Sources: Medicare: Important Steps Have Been Taken, More Could Be Done To Deter Fraud, King, GAO, April 24, 2012. "Miami Money-Laundering Case Spotlights Link Between Medicare Fraud And Cuba’s National Bank," Weaver, Whitefield, Charles, The Miami Herald, June 30, 2012. "Cuba Defends Its Banks Amid Medicare Fraud Case," Peter Orsi, The Associated Press, June 21, 2012. "Miami Prosecutors: No Proof That Cuba Is Involved In Medicare Money Laundering Case," Robles, The Miami Herald, June 19, 2012.