This is how the fraud works: (1) clinic owner pays “patient-recruiter” $100 per patient that comes to the clinic for testing; (2) patient recruiter goes downtown and pays $50 to anyone willing to give up their Medicare number and submit their bodies to bogus testing; (3) clinic bills millions to Medicare; (4) Medicare pays millions; (5) taxpayers lose. DoJ reports that it just caught another one; yesterday “patient recruiter” Emma King pleaded guilty to one count of conspiracy to commit healthcare fraud. King’s plea documents divulged the following scam:
“[B]eginning in approximately September 2007, King began recruiting and transporting patients to a clinic called Ritecare LLC. Ritecare, was owned and operated by co-conspirators and had locations in Detroit and Livonia, Mich. King admitted that she and a co-conspirator paid kickbacks to Medicare beneficiaries that she recruited and transported to Ritecare…. King admitted that she would keep part of the funds she received from the owners and operators of Ritecare to secure patients as a kickback for referring the Medicare beneficiaries she recruited. Typically, the owners of Ritecare would provide $100-$150 per patient King recruited, with King retaining $50-$75 of that amount for the referral.”
The “patients” lied about their symptoms so that medical charts would look as if the tests were necessary. All told, King and her co-conspirators billed Medicare for nearly $1,000,000 in false claims of which Medicare promptly paid $533,643. King faces 10 years in prison and a $250,00 fine. But ultimately taxpayers and the American healthcare system pay the largest price — over half a million dollars that will likely never be recovered.