Health-care fraud: Little guys get jail; big guys get deals

http://www.orlandosentinel.com/opinion/os-hospital-medicaid-fraud-scott-maxwell-20150523-column.html

In March, Attorney General Pam Bondi announced she had nailed someone for Medicaid fraud.

The culprit was a 49-year-old home-health worker from dirt-poor Gadsden County, accused of bilking the state out of $13,000.

For her crime, Melissa Letica Simmons was ordered to spend six months behind bars — and repay all the money she stole from taxpayers.

Six months. For $13,000.

A few years earlier, the state accused three hospitals of bilking the Medicaid system as well … only this time, it involved millions.

Yet no one was criminally prosecuted. Or even ordered to repay all the money. Instead the hospitals settled — without admitting wrongdoing — and repay taxpayers pennies on the dollars.

All Children’s Hospital of St. Petersburg, accused of improperly taking $2 million, repaid $100,000, according to Florida Today.

Lakeland Regional Memorial, accused of taking $1.7 million, paid $108,000.

We saw something similar locally in 2013 when Hospice of the Comforter was accused of $10 million worth of fraud — in part for billing taxpayers for patients who weren’t actually dying, which helped the CEO earn $200,000 worth of bonuses.

The U.S. Justice Department used harsh words, accusing the Altamonte Springs nonprofit of misusing the taxpayer program for its “own enrichment.”

Yet no one went to jail. And Hospice was asked to pay back only $3 million.

This, my friends, is the Tale of Two Justices.

The small-time thieves get prison sentences.

The big-time thieves get deals.

Yes, theft. So says Bondi herself on her website: “Medicaid fraud essentially steals from Florida’s taxpayers.”

But perpetrators of that fraud get treated very differently.

I can show you case after case where individuals — home-health providers, private nurses and small nursing-home operators — get prosecuted with zeal.

(A Tampa woman recently got 18 months in prison and ordered to repay all of the $70,000 she improperly billed taxpayers for services to a developmentally disabled relative.)

However, when big companies — including hospitals and big nonprofits — get accused of doing something similar, they are offered breaks.

In one fraud case involving many hospitals, the state issued a statement saying it wanted “to resolve this matter amicably with our industry partners.”

Think about that. These companies were accused of stealing from taxpayers … and the state hoped to resolve things “amicably.”

How often do you hear prosecutors call for amicable resolutions to other thefts?

The message seems to be that fraud committed by lone grifters is evil, intentional and criminal.

Corporate fraud, however, is the result of clerical errors and misunderstandings — cases where we should seek solutions that make everyone happy.

No wonder it keeps happening. Companies might as well keep breaking the rules. If they get caught, no one personally pays with jail time. And the fines are often less than what was stolen.

Those who can afford the best attorneys often make out the best.

This is why health-care fraud costs American taxpayers billions.

Aesop, the ancient Greek fableist, once said: “We hang the petty thieves and appoint the great ones to public office.” Today, Florida is governed by a man at the center of one of the largest Medicare fraud cases in U.S. history.

Meanwhile, the home-health aide from Gadsden County is behind bars.

This inequality isn’t limited to Florida. The feds prosecute just as unequally.

Authorities occasionally spear the big fish — such as last year in Tampa when the feds secured prison sentences of one to three years for three WellCare execs convicted of defrauding taxpayers out of $30 million.

This was the one case of convictions for a big, established corporation cited by the Attorney General’s Office when I asked about the apparent discrepancy in the way fraud cases are handled.

Interestingly, though, in this case of convicted execs, the judge decided to impose some of the lightest sentences possible, saying the poor men’s reputations had already been damaged so badly that “they’ve already been punished.”

Filed under: General Problems