Investigators have described it as a multibillion-dollar fraud scheme targeting people who rely on Medicare services.
Call recordings provided to NBC6 by federal agents show how criminals are targeting seniors from their own backyards.
In the recording, used as evidence in a criminal case, an 84-year-old man receives a phone call from someone claiming to work for a “testing service.” She asked if she had received her FedEx package that was sent to him earlier.
“I didn’t order it, but I received it,” the man answered.
Investigators from the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) say the call was actually a telemarketer trying to persuade the man to undergo genetic testing for heart disease. .
“I’m a champion of genetics here,” she continues. “My job is just to help you take the test.”
The man replied, “No, this is another CMS scam so they can make money.” And that’s why Medicare is in such bad shape! ”
As the man suspects, the call has nothing to do with the Centers for Medicare and Medicaid Services (CMS, as he calls it).
Investigators say the calls originated from a call center located in an office building in Boca Raton.
“So the way this center worked was to contact beneficiaries and Medicare enrollees and convince them to undergo heart genetic testing and cancer genetic testing through our call center here,” said Assistant Special Agent in Charge Stephen. Mahmoud explained. U.S. Department of Health and Human Services, Miami Office, Office of the Inspector General.
On the phone, a Medicare recipient could be heard arguing against having a genetic test, but a man who identified himself as his boss answered the phone and tried to convince him why genetic testing was needed.
“This is to see if you are in a high-risk category for certain diseases such as heart attack, stroke or coronary artery disease,” a caller can be heard saying.
The man replies: “At 84 years old, don’t you think I could probably be a candidate for all of these?”
Mr. Mahmoud drove us along US 1 in Boca Raton and told us that most of the call centers involved in this type of telemarketing scam are located here in South Florida.
“They’re all over the place,” he said.
He said the scheme begins with telemarketers using illegally obtained personal data to contact Medicare beneficiaries.
“They might say, ‘I’m on Medicare.’ You have this benefit, otherwise you should take advantage of this benefit,” he added.
Your doctor or other health care provider will then approve unnecessary genetic tests, usually for cancer or heart disease. Shell Labs would then bill Medicare for the worthless tests, and everyone involved would get a cut.
“The money is flowing and the lab owners are profiting from it,” Mahmoud said. “So the lab owner filed a claim with Medicare. Genetic testing bills could be as high as $24,000 for him each.
He explains that South Florida is a hub for this type of health care fraud, and people across the country are targeted. The Office of Inspector General works with state and federal partners, including the FBI, Department of Justice, U.S. Attorney’s Office, and Centers for Medicare and Medicaid Services, to crack down on these crimes.
“We have a health care fraud task force…Miami is the largest in the country,” he said.
The costs of genetic testing fraud are staggering.
“Data shows that from 2018 to date, genetic testing fraud has contributed to approximately $7 billion in fraud,” Mahmoud said.
Nevertheless, In 2022, just about 2 cents of every $100 spent by Health and Human Services went to oversight and enforcement. –This prompted the agency to request additional funding this year.
“We have arrested people. But, as you know, the fraud does not stop. Our resources are limited. We will do the best we can,” Mahmoud said.
Several people, including a brother, were charged in connection with the Boca Raton call center. Daniel Carver and Louis “Gino” Carver He pleaded guilty last year to submitting more than $67 million in false claims for genetic tests and durable medical equipment that patients did not need. third man, Jose Goyos He was found guilty of deceiving a doctor into agreeing to a fraudulent order.
“It took up a large portion of one floor of this large building,” Mahmoud said of the call center. I can only hear the phone. And they’re constantly calling people on Medicare and trying to convince them to get tested. ”
They were so persuasive that even a skeptical 84-year-old man, who struggled with the telemarketer throughout the phone call, eventually agreed to the test.
The caller insisted, “This is really a win-win. There’s no reason to be afraid of or against a doctor-approved test.”
“Yes, that’s right. I understand,” the man answered. “If I find it, I’ll try it.”
“CMS is committed to preventing fraud and ensuring that Medicare enrollees do not become victims of fraud. If we suspect fraud, we take swift action to prevent fraudulent payments from going to the wrong parties. ,” a CMS spokesperson said. “CMS does not confirm or discuss the existence of ongoing investigations to avoid compromising the integrity of the investigation process. However, that does not mean that action is not being taken behind the scenes. Not.”
