Fla. Medicare fraud dispute targets patients

Authorities disagree over whether prosecutors should go after the patients who get the phony treatments.

MIAMI (AP) — Three days a week Philip Audette sat in a cushy white chair at the St. Jude Rehab Center, a needle pumping HIV drugs into his arm. He talked and laughed with a dozen other patients, all in good health, all receiving drugs they didn’t need. All for the money.

Audette says he made $100 to $200 every visit, nearly $10,000 over several months, selling his Medicare number to the clinic’s three owners, the Benitez brothers, who were later indicted on charges of bilking $119 million from Medicare.

Authorities say there are thousands in South Florida like Audette, and federal officials say they play a large role in the fraud overwhelming the national Medicare system. While authorities are successfully cracking down on clinic owners, they disagree over whether prosecutors should go after the patients who get the phony treatments in addition to the clinics that provide them.

“Unless patients are prosecuted, we will not have a true long-term impact,” says Kirk Ogrosky, deputy chief of the U.S. Justice Department’s criminal fraud section and an advocate for arresting patients, something that rarely happens in Miami and Los Angeles, the two cities where federal health care fraud task forces are based.

Medicare spent $2.5 billion on AIDS treatment in Florida, mostly in Miami, compared with $978 million for the other 49 states combined, according to the federal government.

About 8 percent of the nation’s HIV/AIDS patients live here, but Florida is responsible for 72 percent of Medicare spending on the disease — mostly for dubious infusion therapies like Audette received.

“It was very easy — the worst part was getting the needle,” said Audette, 48, who says he is HIV-positive. Audette, who was not prosecuted, testified in court against a clinic operator and agreed to describe the scam to The Associated Press.

Federal officials have campaigned aggressively against clinic operators like the Benitez brothers.

But the unspoken thousands who keep these mills churning — the patients — remain free to move from clinic to clinic, scam to scam, from durable medical equipment and HIV infusion therapy to home health care. Another year, another disease. One patient was responsible for claims of $1.1 million for HIV infusion drugs and other services. Within a few years, that patient had claims filed for $1.4 million for medical equipment, records show.

“To look at health care fraud and not look at the fact that the beneficiaries are somehow involved is to be blind to the problem,” said Peggy Sposato, a former emergency room nurse who recently joined the Justice Department as an investigator after working for the Miami U.S. Attorney’s Office. “We’ve got people out there who brag about the fact that they are making large amounts of money abusing Medicare.”

But Miami U.S. Attorney R. Alexander Acosta believes it’s better to spend his prosecutors’ limited time and resources going after the providers — juries are often sympathetic to elderly and terminally ill defendants, even if they are guilty.