Brace Yourself for This Stunning $109-Million-Dollar Moment in Corruption

Tuesday, July 28, 2020

I have to thank a good, solid Trump appointee, Andrew Lelling, the U.S. Attorney for the District of Massachusetts, and Lelling's colleagues in the federal government, for getting to the bottom of a mystery that had long gnawed on my mind.

For me, the story began when I, like most Americans passing the 65th anniversary of their births, signed up for Medicare.  This was, alas, a while back in time.

Even if you still have private health coverage at 65, as I did, and even if you intend to keep private coverage, as I did, you have to enroll in Medicare at 65 to retain the privilege of partaking later in the program.

Soon after entering Medicare's ranks, I started getting calls at home from an entity that did not identify itself and offered to assist me in obtaining orthopedic braces at no cost through Medicare.

The first time, I made the mistake of responding to a pre-recorded voice instructing me to, "Press 1 for important information on your Medicare coverage."  A live person, a woman who sounded as if she was in her twenties, immediately came on the line, rushed through a confusing introduction, and asked for the name of my physician.  I had recently seen my doctor.

My first reaction was, This person might be calling from my doctor's office, where several medicos were employed.  I asked her if she worked for my doctor but did not mention his name.  She said, "No, but we have your records and want to confirm a few things to get you on your way to obtaining braces that will help you in your everyday activities."

This sounded funny, not least because I did not have (then or subsequently) any muscular or skeletal problems that could be ameliorated by braces.  I said, "I would like to talk with my doctor first. Perhaps we could talk later?"  Before she could get out a response, I said good-bye and hung up.

I said it was a mistake to "Press 1" because I did not realize at that time that there are innumerable scam artists who prey upon older Americans through robocalls.  If you engage in this process simply by answering the phone, even for a moment or two, you will automatically be identified as a possible mark, a "live one," and that one call will trigger an endless number of follow-ups.

For at least a year after that first call about braces, calls would come in from the same outfit at least twice a week.   Our home phone announces the caller or the number of the party calling. Since the brace people didn't use personal phones or give their names, they would be announced by the number.  Not recognizing the number, we'd let the call go to voicemail, where a pre-recorded voice would say something like: "We're calling about your braces and the limited time you now have to take advantage of this incredible offer."

After several months, the pre-recorded message switched to something like:  "This is your last call for free braces.  Please call immediately."

We got those calls repeatedly.  For months.  I could not possibly count those final offers. They became such a regular feature of our lives that I expected them to persist until the day I actually needed braces to get around the house.  Eventually, however, the calls for braces stopped.

Yesterday, Lelling's office issued a press release announcing that "A Columbian national  residing in Lighthouse Beach, Fla., has agreed to plead guilty in connection with submitting more than $109 million in false and fraudulent claims for durable medical equipment (DME) such as arm, back, knee and shoulder braces."

The guilty party was identified in the release as Juan Camilo Perez Buitrago, age 31, who was referred to as Perez subsequently in the release.  It said that he had been charged with one count of health care fraud and one count of payment of kickbacks in connection with a federal health care program, and that a plea hearing for him would be scheduled at a later date.

According to the charging documents cited by Lelling, Perez "manufactured and submitted false and fraudulent Medicare claims by instructing his employees to establish shell companies in more than a dozen different states, including Massachusetts."

Further, the documents say that "Perez directed employees to list his mother, wife and yacht captain as corporate directors and to use fictitious names when registering the shell companies as DME providers."  Also:

"Perez allegedly purchased Medicare patient data from foreign and domestic call centers that targeted elderly patients, and instructed call centers to contact the Medicare beneficiaries with an offer of ankle, arm, back, knee, and/or shoulder braces 'at little to no cost.'  He then submitted Medicare claims for those patients without obtaining a prescriber's order to ensure that the braces were medically necessary.  It is further alleged that he submitted blatantly fraudulent claims, including claims for deceased patients and repeat claims for the same patient and the same DME."

In total, the charging documents allege that Perez submitted $109 million in Medicare claims and pocketed more than $12 million.

"When Perez did provide DME to patients," the release from Lelling states, "he typically billed insurance policies more than 12 times the average price of the DME that he provided to the patient."

And for the majority of the money allegedly collected through the scam -- $7.5 million in claims -- Perez failed to provide any equipment to his victims, according to the release.

No wonder they refer to Florida as "a sunny place for shady people."

I'm thinking the least the feds could do now is offer the Sunshine State targets of this scheme a ride on Perez's yacht.

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