Medicare payments stop during fraud investigation

02/26/09 Seán Kinane
WMNF Drive-Time News Thursday | Listen to this entire show:


This afternoon in St. Petersburg, about 50 patients came together at the medical clinic where they had been receiving help to demand that Medicare resume paying for their medical treatments. Because of an investigation into alleged fraud, Medicare has stopped all payments to the Advanced Medical Therapy Institute.

A dozen of the patients spoke about how the non-traditional treatment they’ve received at Advanced Medical has helped them fight their cancers and other afflictions.

Mary Burton Roberge is one of the patients who is organizing others to fight for their rights. She has had bad experiences with traditional doctors who wanted to treat her cataracts by injecting cortisone into her eyeballs. She credits the clinic run by Joe Distefano with saving her sight.

Distefano, Advanced Medical’s administrative director, says Medicare stopped reimbursing the clinic for treatment because of an investigation triggered by an allegation of Medicare fraud.

“Therefore, we haven’t been paid for any of the treatments for our Medicare patients in four months.”

Distefano says that for seven years before the allegation, Medicare reimbursed the clinic for the non-traditional medical practices, such as intravenous treatment of antibiotics, vitamins or minerals. But since the investigation, the employees of the clinic and many of its patients have been harassed by what they say are aggressive investigators.

Donald White is a spokesperson for the U.S. Department of Health and Human Services Office of Inspector General (OIG). “OIG can neither confirm nor deny the existence of any pending open investigation.”

An audit is being conducted by SafeGuard Services LLC, who referred all inquiries to their parent company, Electronic Data Systems. EDS said it could not comment on any ongoing investigation.

Lisa Vriezen, deputy director of program integrity with Centers for Medicare and Medicaid Services (CMS) says Medicare reimbursements to doctors are not automatically stopped whenever there’s an investigation.

“The decision to stop payment would largely come from CMS determining whether there’s a significant threat to the trust fund or a request from law enforcement.”

Natalia Rakowski, an immigrant from Ukraine, has been coming to the clinic for 10 years to treat complications she attributes to the 1986 nuclear meltdown at Chernobyl.

Gertrude Foster has been receiving treatments at Advanced Medical for 20 years. “If I didn’t have these treatments my symptoms would be worse.”

The Florida state chapter of the Southern Christian Leadership Conference (SCLC) helped organize a press conference following the patients’ meeting. The SCLC has written letters to members of Congress on behalf of the clinic and their patients. Sevell Brown is their president and criticizes the policy of the investigating agency collecting up to 12.4 percent on alleged fraud claims.

Rinky Parwani is the attorney representing Advanced Medical Therapy Institute.

“[Obama’s idea of cutting Medicare payments is] the last thing these patients need”

Reducing frivolous and excessive investigations is one way to save money, Parwani suggests, especially getting rid of the percentage fee paid to the company if they find alleged fraud.

comments powered by Disqus