“I was told that I could make a quick 200 bucks. And basically I went up there and I made like $800” on the first day, said Lorine Hawthorne, of Houston. She had been recruited as a marketer for a Houston scam in those go-go days, finding elderly people and delivering them to a handpicked clinic.
“The most I ever made in one day, probably, was like $20,000,” she said. “That’s a lot of money for one day.” Hawthorne pleaded guilty to one count of fraud in 2005.
But first let’s take a look at the big picture in this Washington Post story.
Since 1999, Medicare has spent $8.2 billion to procure power wheelchairs and “scooters” for 2.7 million people. Today, the government cannot even guess at how much of that money was paid out to scammers.
One study estimated that in 1994, only 1 in 9,000 beneficiaries got a new wheelchair.
By 2000, it was 1 in 479.
By 2001, it was 1 in 362.
By 2002, it was 1 in 242.
And beyond the simple increase in wheelchair claims, there were other signs that these claims might be bogus. Before the scam took off, for example, power-wheelchair prescriptions were usually written for patients with serious and advanced illnesses such as multiple sclerosis or Parkinson’s disease.
But as the scam grew, that changed.
“Many more of the diagnoses were things where you sort of go, ‘What?’ ” said James Goodwin, a University of Texas medical school professor. Looking in Medicare’s own data, he saw a rise in power wheelchairs prescribed for more common conditions such as arthritis and back pain. “It becomes a very, very strong picture, strongly suggesting there’s a lot of abuse going on there.”
When officials review old wheelchair bills, they discover that at least 80 percent of them were “improper”: They contain major errors and shouldn’t have been paid as is. Perhaps the patient’s diagnosis didn’t actually qualify for a power wheelchair. Perhaps the paperwork was incomplete.
How many of those bills were sent in by fraudsters, trying to squeeze through the system’s blind spots?
Medicare can’t say.
And now let’s look at the picture on the ground.
In the courtroom in Los Angeles, 42-year-old Olufunke Fadojutimi was on trial. Prosecutors alleged she’d run a wheelchair-scam operation out of an office-park suite in suburban Carson, Calif.
As these scams go, this one was medium-sized. It billed Medicare for about 1,000 power wheelchairs.
“I said I didn’t need it,” witness Heriberto Cortez, 73, testified on the stand. Cortez was recalling the day when a stranger — allegedly one of Fadojutimi’s patient recruiters — came to his house and offered him a wheelchair. He said no. She didn’t listen.
“She insisted,” Cortez said. “She said that they were giving the chairs away.”
Later in the trial, 71-year-old Rodolfo Fernandez testified that a woman showed up at his house in Los Angeles. The woman asked if he was on Medicare. He was.
The next day, she came back with a van. Other seniors were already inside.
“They took us to a clinic. They did an exam on us,” Fernandez recalled, translated speaking through a Spanish interpreter.
After seeing the doctor, prosecutors said, both Cortez and Fernandez got power wheelchairs from Fadojutimi’s company. The company then sent Medicare the bills. Medicare paid.
This scam was a Nigerian operation. Except that it was happening in the US. Nigerian medical personnel were recruiting Latino immigrants.
Charged with health care fraud were Olufunke Fadojutimi, 41, of Carson, a registered nurse; Ayodeji Temitayo Fatunmbi, 41, formerly of Carson, believed to be in Nigeria; and Maritza Velazquez, 40, of Las Vegas. Their charges involve Lutemi Medical Supplies, a durable medical equipment company Fadojutimi owned and where Fatunmbi and Velazquez worked.
Also arrested and charged were owner-operators of three other medical equipment companies: Akinola Afolabi, 53, of Long Beach, owner of Emmanuel Medical Supply, for $2.6 million in Medicare billings; Queen Anieze-Smith, 52, of Encino, and Abdul King-Garba, 47, of Westwood, owner- operators of ITC Medical Supply, for more than $1.8 million in Medicare billing.
Clement Etim Aghedo, 53, of Fontana, owner of Ace Medical Supply, is accused of submitting more than $1.8 million in fraudulent claims to Medicare.
Ayodele admitted that he defrauded Medicare by participating in a power wheelchair fraud scheme with the operators of fraudulent durable medical equipment (DME) supply companies.
As a result of their conduct, Ayodele and Maciel admitted that they and the owners and operators of Bonfee, Lutemi Medical Supplies, and other fraudulent DME companies submitted and caused to be submitted over $10,132,178 in false and fraudulent claims to Medicare. Ayodele and Maciel admitted that Medicare paid Bonfee and the other DME supply companies over $5,388,754 on these false and fraudulent claims.
Fadojutimi’s chunk of this comes to around $4.3 million. While this sounds like a lot of money, it’s only one of many similar scams being run on a centralized system that is too slow, unwieldy and bureaucratic to adapt quickly enough so that it isn’t a target.
In Puerto Rico, the next big thing seems to be arms and legs.
In one case there, two dozen companies billed Medicare for $5.3 million in prosthetic legs inside of a year. In many cases, their “patients” had no record of amputations in their medical history. Many of them didn’t even live in Puerto Rico. But Medicare paid for the legs.