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Problem Solvers Uncover Possible Medicare Fraud

POSTED: Friday, September 22, 2006

Imagine receiving a statement from Medicare saying the federal government paid nearly $18,000 for services you never received. And then when you try to report the apparent fraud, you have trouble filing a report.

That's what 80-year-old Marvin Sokolow said happened to him. And his story has prompted a Problem Solvers alert involving possible Medicare fraud and a West Miami medical center.

Sokolow said he was stunned after receiving monthly statements for May and June from the Rivera Rehab and Medical Center at 6346 S.W. Eighth St. He said he's never been to that medical center.

But Sokolow's statements showed the Rivera Center billed Medicare $24,653 and was paid $17,956 for services Sokolow said were never rendered.

Medicare was billed 15 times for office visits, medical services and $1,000 injections containing steroids and medications for HIV and AIDS patients, neither of which Sokolow said he needed.

"I would think that, with every other day, with such heavy bills, that it rings a red flag, where someone could just take two seconds and make that call to a recipient such as myself, saying this is what's being done to you," said Sokolow.

Sokolow said he thought Medicare had been billed for expensive infusion drugs, which cost $500 to $2,000 a shot.

Federal investigators have said that's the most expensive and widespread Medicare fraud in South Florida---infusion therapy for persons with HIV and AIDS.

A recent report in The Miami Herald said infusion therapy has become a big business, even though doctors said it is rarely needed as part of HIV-AIDS treatment.

The newspaper said, "According to the Governor's Office, Medicare paid out more than $1 billion in 2004 for infusion treatments in Florida -- more than 10 percent of all Medicare claims paid in the state."

Medicare officials have said they are trying to curb this problem.

Sokolow said Medicare never called him. But he called the Medicare fraud hot line three times with no results.

"I was waiting, waiting, waiting, 27 minutes, 32 minutes, people saying they don't handle it -- somebody else handles it. Then I was calling back and calling back again," Sokolow said.

Sokolow said he did not know how his personal information was obtained by the medical center.

"I don't understand what Medicare is doing or the people that represent Medicare that gets a fortune managing billions of dollars, not millions, billions of dollars," said Sokolow.

When Local 10 visited the Rivera Rehab and Medical Center, it was closed. Neighbors said the business had been closed for at least two months.

Neighbor Orlando Lopez, who has run a bicycle shop next to the medical center since July, said no one had been to the medical center since he'd been there.

"And I've seen a lot of people here complaining about it," said Lopez.

The owner of a nearby restaurant said the medical center had been unoccupied for four months.

Sokolow said he would keep trying to reach someone at Medicare to take his report about the possible fraud.

Every three months, Medicare recipients receive a Medicare summary notice with the lists of services and goods that the government has paid for.

Local 10 contacted a Medicare spokesman who said if you suspect fraud, the best telephone number to call is 1-877-772-3379. Sokolow said he would try that number because he did not have any success at the other numbers he called.

Sokolow said he called the other numbers recommended by the government. They are 1-800-MEDICARE (1-800-633-4227) and the Medicare Fraud Hotline at 1-800-HHS-TIPS (1-800-447-8477).

You can also call your local law enforcement agency. But Local 10 discovered that most police departments would refer you to the Miami-Dade headquarters of the FBI, which has a special unit that investigates Medicare fraud.

You can also e-mail your complaint about Medicare fraud to HHSTips@oig.hhs.gov. By fax, the number is 1-800-223-2164.

Or you can mail your complaint to: Office of the Inspector General, HHS Tips Hotline, P.O. Box 23489, Washington, D.C., 20026.

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