America’s Newest ‘Most Wanted’ List

by Diane Dimond on March 12, 2012

Original 10 Most Wanted Captivated Me

In the unlikely event they make a movie of my life story a good place for the opening scene would be the post office in Albuquerque where my Mother used to take me as a child.

Scene one, act one, would be me leaving my mother in line and making a bee-line to the bulletin board displaying the FBI’s 10 most wanted list. The future crime writer transfixed.

“So that’s what a murderer looks like,” I always thought to myself, leaning in to the grainy black and white photos. I would peer deep into the eyes of the fugitive bank robber or kidnapper to try to find a clue as to what made these men turn so bad. (Back then, the list was all men) I admit it – I was a strange child.

Most Wanted Health Care Criminals

Today, another fugitive list has caught my attention. Its complied by the Office of the Inspector General at Health and Human Services and it highlights those involved with one of the fastest growing crime sectors in America: Health care fraud.

As our population ages and government programs literally pour money into elder care this type fraud has become a multi-million dollar a year problem.

Looking at the O.I.G. web site brings back memories of my post office visits. The site has photos (in color!) of the 10 Most Wanted health care fugitives. Two are women. And because this is the digital age it is accompanied by a videotaped message from the Deputy Inspector General for Investigations, Gerald Roy, who says the feds are currently looking for 170 criminals who’ve defrauded at least 400 million dollars from our health care programs. But Roy only hints at who these people are.

HHS Dep’ty Inspector General, Gerald Roy

“Some criminals may be hiding overseas,” he says. “But fleeing the country is not a get out of jail free card. We have a global reach. We regularly work with domestic and foreign law enforcement agencies to bring these fugitives to justice in the U.S.”

Here’s what Roy didn’t say and what I glean from studying this Most Wanted web site: A vast majority of suspects facing fraud charges hail from foreign countries. Many of them are now suspected of fleeing to India, Russia, Nigeria, Mexico, Cuba, the Dominican Republic and Columbia. They have names like Gautam Gupta and Anupal Gayen. Others have Hispanic surnames like Gonzales, Velazquez and Lopez. One of the women on the Most Wanted List is Ekaterina Shlykova.

Fugitive Ekaterina Shlykova

All of them have been charged with various schemes to bilk Medicare or insurance companies for goods and services that were not needed, not prescribed or never even delivered to the patient. They preyed on people in states with large elderly populations like Florida and Arizona. They also operated in California, Michigan, Illinois, Rhode Island, Texas and New York.

I don’t bring this up as a way to bash foreigners. In fact, among those on the “Also Wanted” Inspector General’s list is a brazen American psychotherapist from Hawaii who the feds say fraudulently billed about $1 million to his state’s Medicaid program and various insurance companies for therapy sessions he shortchanged or didn’t bother to conduct. He did the same thing in Colorado in the early 80’s. Dr. Carlos Warter was found hiding in Argentina last year and is now fighting extradition back to the States.

Dr. Warter Defrauded Before

No. This isn’t about condemning the actions of all non-citizens but facts are facts. One of the highest rates of health care fraud in the country is in the Brighton Beach section of Brooklyn, New York where a majority of residents are immigrants from Russia. In a recent story about a $250 million dollar fraud scheme in Brighton Beach the New York Times reported, “The city’s Russian-speaking immigrant population, many of whom grew up under a Communist system that bred disdain for the rules (has) … a willingness to cheat to get around them.”

The Benetiz Brothers Are At Large

In Miami, Florida, the nation’s other hot-spot for health care fraud, a trio called the Benitez Brothers and twenty co-conspirators allegedly pocketed $110 million in ill-gotten Medicare payments. Most defendants have pleaded guilty but the brothers – Carlos, Luis and Jose – are still at large.

The point in bringing this problem to light is to remind folks that crime fighting can start with you. If a health care provider asks you to sign a form for a service or a medical item you never got – physical therapy, a wheelchair, a scooter, a hospital bed or elbow or knee braces – report it to the O.I.G. Hotline at 1-800-HHS-TIPS.

Suspect fraud if you get a notice from your insurance company that they paid for an un-delivered service. If you are one of America’s 25 million diabetics and you are getting too many lancets or test strips via those mail order pharmacies many insurance companies make us use these days, chances are someone is illegally profiting from it. Chances are good that if a health care provider is cheating you they’ve cheated others and investigators need to

Wanted: Ezechukwu “Dr. Joshua” Ohaka

know about it to build a case. And if you can, check out that spiffy web site I found and take a close look at the mug shots there. If you know something about one of the fugitives there – say something! It’s time we all became active in fighting this multi-million dollar crime. home

{ 7 comments… read them below or add one }

Good Job! March 12, 2012 at 8:51 pm

Di, You always do a good job capturing stories like this. Reminds me of an episode of American Greed. Keep on writing, there are many of us who will read it.

Reply

Diane Dimond March 12, 2012 at 9:24 pm

Facebook Friend Pat Melchionno writes:

“Real sorry to hear this. We always kind of know this goes on by this deeply effected so many who really need the supplies and can’t afford them, it’s a dam shame. I emailed this article to a friend of mine who is a drug rep specifically and exactly for diabetic supplies.”

Reply

Diane Dimond March 12, 2012 at 10:20 pm

Facebook Friend Joseph Luchetti writes:

“Nice piece Diane, maybe the FBI should make an alternate ten most wanted list for the bank heads and politicians who are attempting to collapse this country!”

Reply

Diane Dimond March 12, 2012 at 10:22 pm

Facebook Friend (and Radio Talk Show Host) Athena Phoenix writes:

“Thank you SOOOO much for writing this. I did my entire radio show on this topic yesterday. The reason being that GA recently passed a law requiring all welfare recipients to take drug tests. 90% of the people on welfare are women, and no one suggested testing TANF recipients enrolled in Fatherhood programs-who are recruited from prisons, so this is not about child safety. The stated reason for passing the law was allegedly “to ensure Federal money is not fueling the drug trade.” So I looked up the OIG reports and the #1 offenders fueling the drug trade with federal money are actually doctors engaged in false billing and kickback scams, #2 are pharmaceutical companies. Single mothers on food stamps who smoke weed (not condoning) do not even make the list. I study these HHS grant programs for a living, and I can tell you in my expert opinion that NO ONE in HHS is serious about cleaning up medicaid fraud. I mean, prime example is a doctor in Texas who stole identities and billed $347m on 11,000 patients, most of whom did not even know they were on medicaid or recieving services. How does HHS not notice that? How many other groups like this are out there?”

Reply

Diane Dimond March 20, 2012 at 4:55 pm

ABQ Journal Reader Patricia Iley writes:

“Dear Ms. Dimond,
I really enjoy your columns; they always have a different twist on the story. I particularly enjoyed your column on Medical System Fraud.

My personal story is that I have sleep apnea. With a small co-payment I receive a new mask/headgear every 3-4 months. I waited one year before I requested my 2nd one because it seemed like such a waste of money (even though it didn’t come out of my pocket). The egregious thing was each order would come with it’s own very nice briefcase type carrier and another smaller zippered bag. Even though I didn’t order as soon as recommended, I acquired a nice collection of these bags. The piece that really needs replacement often is the nose piece, but it is not available individually only with the mask & head gear & tubing, etc. The nose pieces come in 3 sizes, SML. Since my nose never grows, two of the pieces are never used. I appreciated the nice bag because it was a convenient way to travel with the gear, but one with the first order would have sufficed.

After a few years, my health care provider switched companies. I now get my mask & supplies in a little cardboard box which actually made me happy (how weird is that). However, I still cannot get a supply of the small nose piece. I still receive the three sizes.

The message in your column is very important because we don’t always know what to do when we see fraud in increments. This does not seem like a big deal, but I’m sure it adds up to a lot of money that someone is making off the system.

Thank you for giving me the opportunity to vent about this because it has really bothered me for a long time.”

Reply

Diane Dimond March 20, 2012 at 4:59 pm

Dear Patricia:
I sure hope you use the 1800-HHS-Tips line to report this to the Inspector General’s office. Why in the world couldn’t the supplier simply call or write you and ask – what sized nose piece do you need? – thereby saving the other sizes for people with corresponding noses!?!
You are exactly right that it “adds up.” Multiply your case by multiple thousands (tens or hundreds of thousands?) of others who are now stuck with extra briefcase and zipper bags and nose pieces they’ll never use. SOMEBODY is making money off oversupplying you with these items.
Thank you for writing – I’m so glad my column touched something in you – and, again, I hope you’ll make that call! ~DD

Reply

C F X July 26, 2012 at 9:21 pm

As a former claims fraud investigator of a large, monopolized health insurance company (I would mine claims data for patterns indicating fraud), its safe to say that 99.999% of the population has no idea how vast & pervasive healthcare fraud is in America.

We were extremely understaffed and even then I was fired for creating too much of a ruckus (some of the doctors on our company’s medical board were implicated in other ongoing investigations). I would say at least 20% of all physicians in our network regularly overbill their clients – up to 50% have done it at one time or another.

Doctors regularly perform unnecessary surgeries, prescribe dangerous levels of addictive medications or recommend useless treatments all for the sake of making a few extra bucks. Its absolutely disgusting, and it is one of the major reasons why medicare costs such an astonishing amount of money.

Other doctors have become so accustomed to overbilling their patients, they don’t even realize that what they are doing is against the law, but they’ll be damned if they have to go back and live like a “normal.”

There’s no hope for correcting the system, however. Like with the financial industry, there’s too much money and government influence put in the hands of too few people, and they will make sure the balance continues to tilt in their favor. Until the whole system collapses, that is.

Reply

Leave a Comment

Previous post:

Next post: