DAYTON, Ohio (AP) -- Scammers have used the stolen identities of doctors and made up businesses to bill Medicare for millions of dollars of nonexistent services, a newspaper investigation has found.
Dozens of so-called medical providers in Ohio have registered with the Centers for Medicare and Medicaid Services by using nothing more than a mailbox as their address even though investigators know it's part of a common scheme used to steal from the government, The Dayton Daily News reported (http://bit.ly/Ve6NXz).
Medicare fraud and abuse costs taxpayers up to $98 billion.
"Schemes that involve the use of medical identity theft can have a devastating impact not only on the Medicare program itself, but the lives of the people who depend on the services Medicare provides," federal agent Lamont Pugh III said at a sentencing hearing in Cleveland last May.
The leaders of that fraud ring were sent to prison after they used fake storefronts and UPS Store boxes to bill Medicare for $48 million in Ohio and across the country.
This type of scheme has been around for years, said Louis Saccoccio, CEO of the National Healthcare Anti-Fraud Association.
The ruse involves setting up a mailbox as an address and stealing the identities of doctors and patients to bill the government for made up medical services. Addresses for mailboxes at UPS Stores appear as real businesses on documents because they have a street address and suite number.
The newspaper reviewed a database maintained by the Centers for Medicare and Medicaid and found 29 medical providers in Ohio that claimed to provide medical care out of a mailbox.
One man was discovered with three different medical supply businesses licensed to three different UPS stores in the Toledo area. Calls to the listed phone numbers for the businesses either went unanswered, were disconnected or answered by someone claiming it was a wrong number.
Federal officials told the newspaper they were aware of loopholes with private mailboxes and have been making strides to close them.
"In order to bill Medicare, providers must list a physical address," CMS officials said in a statement. "If a provider tries to enroll with a P.O. Box as their physical location, their enrollment will be automatically denied."
Saccoccio also said the federal agency has beefed up its data analysis to screen for fraud. And officials have increased site visits to make sure medical businesses are not empty storefronts or UPS stores -- particularly in cases involving companies such as home health agencies or medical equipment suppliers.
Saccoccio said it's too early to see the effectiveness of these efforts, which have just gotten started.
"It's really important that CMS really screens folks coming in the program," Saccoccio said. "They're doing a better job of that, but I think it's going to take a little time before the effects of that are as apparent as they should be. The extent you can get to this stuff earlier rather than later is better."
Information from: Dayton Daily News, http://www.daytondailynews.com