Con artists find it easy to commit fraud because Medicare's system automatically pays the bulk of the bills it received if the claim has a supplier number issued by the federal government. The situation is compounded by the focus of software and audit systems on overbilling and unusual medical procedures instead of fraudulent claims.
A proof of the system's vulnerability to fraudsters was high school dropout Rita Campos Ramirez who electronically submitted over a four-year period more than 140,000 fake Medicare claims for useless equipment and services using only a laptop. With her loot, Ramirez bought two condo units and a Mercedes Benz.
Ramirez was subsequently caught and helped the FBI apprehend several doctors and patients who claimed to have received expensive HIV drug therapy. Aside from medical treatments, other items often cited in fake Medicare claims in South Florida were wheelchairs, walkers, canes and hospital beds.
Meanwhile, a report by Families USA said many states, including Florida, lacked basic protection for buyers of health insurance policies. Most of their cover were patchwork that gave insufficient protection to policy holders.
One glaring example is the refusal of health maintenance organizations to include preexisting conditions and the failure to define a timetable until when would it not be covered even if the resident had a policy for years.
Another is the absence of a mandatory minimum cap that 75 percent of the premiums collected must be spent on the provision of health care.
