Published: 2009-11-01 22:46:37
Author: Greg Burns | Chicago Tribune | October 19, 2009
If Varnador Sutton can do it, you can too.
Or
at least you get that impression from the case of the Indiana man who
out of nowhere started billing the Medicaid program for "counseling
sessions" that prosecutors said no one ever provided.
In less
than two years, he collected $3.3 million, buying seven real estate
parcels, two Jaguars, a Volkswagen Phaeton, a Lincoln MKX, tickets to
the Indiana Pacers basketball team and $33,172 in goods from Vincent's
Furs and Leathers. Testifying in his own defense, before he was
convicted and sent to prison last year, he pointed out that the tickets
were a gift for his nephew.
Now, as the fight over health reform
enters its terminal phase on Capitol Hill, Democrats and Republicans at
least agree on this: Fraud is bad.
Only last month, the president vowed to go after the "hundreds of billions of dollars in waste and fraud." Who could disagree?
Yet
in a troubled economy, cheating Medicare and Medicaid just might be the
easiest money anywhere. Recent reports about violent criminals and
organized-crime figures putting aside their drug-running enterprises to
pose as health care providers only scratch the surface.
Although Barack Obama might be shooting high with his estimate, even conservative estimates peg Medicare and Medicaid fraud at $60 billion a year.
"I'm not sure you can really say it's up. It's consistent," said John Blum, a law professor at Loyola University Chicago who specializes in health matters. "The big problem is that Medicare and Medicaid are so dense, and they lack such transparency, it's easy to commit fraud."
Some health care fraud is sophisticated and subtle. Some results in bloody crime scenes as hardened criminals enter the racket. But many schemes such as Sutton's require no "gigantic intellectual leap," in the words of Timothy Morrison, U.S. attorney for the Southern District of Indiana, which prosecuted the case.
"If you're going to defraud somebody, the government is a reliable payer," he said. "Eventually, people like me catch up to you."
In fact, these cases are tough to unravel. Prosecuting Sutton involved "investigators, lawyers, an auditor," Morrison said. "It was a major undertaking."
Armed with a business degree from Indiana State University but no relevant medical experience, Sutton enrolled as a provider of mental health services in May 2005 and started billing. By the following January, he billed Medicaid for 4,769 psychotherapy sessions in a single month. That would have required 29 therapists working overtime, prosecutors said.
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