Elderly Immigrants Used in Medicare Scam

Erin McCormick, San Francisco Chronicle, Apr. 17

Brigido and Quintina Pullan, both 81, have no use for the pair of power wheelchairs and the two semielectric hospital beds sitting in unopened boxes at their tiny South of Market rental unit. Yet the federal government’s Medicare program was billed more than $15,000 for them.

Bagtolome Gorero, 80, and his wife Estelita, 79, each received a crisp $100 bill for taking a van ride to a sleep clinic in San Jose, where they were asked to lie on beds for four hours with wires attached to their bodies and watch movies. In turn, the clinic operators billed Medicare $7,950 for sleep studies on the two, who say they have no sleep problems whatsoever.

These and two dozen other San Francisco seniors interviewed by The Chronicle say their Medicare accounts were purloined by medical con artists, who induced them—and perhaps hundreds of others—to give their Medicare numbers for health services and equipment they didn’t need.

Their stories are evidence of a series of scams that may have cost the government health plan millions of dollars in the Bay Area.

The schemes—which have resulted in FBI raids that shut down two clinics—shed light on how fraud, abuse and error cost Medicare tens of billions of dollars a year.

The Chronicle’s investigation shows how senior citizens and immigrants are used to defraud the giant health care system for the elderly. In San Francisco, the Medicare scammers targeted Filipino seniors—many of them veterans who served with U.S. forces in World War II. Hundreds of people have reportedly received investigative letters from the FBI, questioning their Medicare usage.

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Apolonio Ladia, 81, is physically fit and has no major medical complaints. Yet recruiters paid him to go to three Bay Area clinics where he underwent 46 medical and laboratory tests—for which clinic operators billed Medicare more than $8,500.

Gonzalo Esnero, 80, is not diabetic nor does he require tube feeding. Yet his Medicare records show the insurance program for the elderly was billed $4, 806 for diabetes and tube feeding supplies that he says he never ordered.

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The network of scams targeting Bay Area seniors appears to mirror medical fraud rings that have been investigated and prosecuted in Los Angeles and dozens of other cities. Many of the schemes have involved organized crime.

“In the past six years, we’ve seen increasing amounts of criminal activity from several well-established organized crime groups, including the Russian mafia and Southeast Asian gangs,” said Collin Wong, who heads California’s Medi-Cal fraud unit.

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The sleep clinic at 2342 Harris Way in San Jose is closed now. John Jarrett, landlord of the office park where the clinic operated, said its staff vanished shortly before FBI agents arrived with search warrants in late 2004.

“They just disappeared,” said Jarrett.

Through the blinds one can still see the clinic’s tiny patient rooms. Each room has a single bed, a faux wood nightstand and a television. In one, there are still thin, white, wire electrodes, which people described as having had attached to their bodies, now lying in a loose bundle on the bed.

Seniors who visited the clinic told of being urged to go there by recruiters in the West Bay clinic.

Reputation in community

Apolonio Ladia said the sleep clinic soon had a wide reputation in the Filipino senior community, where many of the retired veterans live in substandard housing and depend on food bank programs to supplement Social Security checks totaling less than $1,000 a month.

“Everyone was saying, ‘You sleepy-sleep, you get $100,’ “ he said.

A West Bay worker who asked not to be named for fear of retaliation said 20 seniors a day rode vans from there to San Jose six days a week for almost a year.

When they arrived at the clinic, the seniors said, office workers took photocopies of their Medicare cards and directed each of them to one of many tiny rooms, where technicians attached wires to their bodies. “They placed wires on all parts of my body. I was like a robot,” said Pablito Nidua, who said he visited the clinic in the fall of 2004.

Some said there was no sign of any medical machinery attached to the wires. Several said the wires attached to their bodies seemed to end in tangled balls on the floor.

“We had all these gadgets attached to us with no connections,” said Purita Ladia, 80, who went to the clinic with her husband, Apolonio, in March 2004.

None of the seniors reported being urged to sleep. Most said they never saw a doctor.

Then the seniors said they were driven back to the West Bay Multi-Service Center in San Francisco, where they lined up to receive $100 bills from a clinic employee.

Doctors’ bills

Not all patients interviewed by The Chronicle saved the monthly summaries that show how much Medicare was billed for their clinic visits. But the five of those who visited the sleep clinic and were able to share their statements with The Chronicle had billings similar to what Bagtolome and Estelita Gorero found on theirs after visiting the clinic in March 2004:

Dr. Mohammad Jahangiri had billed $1,500 for an electroencephalograph (EEG) and a “polysomnography,” defined in Medicare documents as the “continuous measurement and recording of physiological activities during sleep . . . to establish a diagnosis or rule out sleep apnea, narcolepsy and other sleep disorders.”

Jahangiri also billed $800 for breathing tests. He is listed as the referring doctor for another $1,600 panel of tests of the inner ear (often used to diagnose dizziness) billed by a Dr. Narindar Nat the same day.

Jahangiri—through his attorney Mark Hardiman—declined to comment for this story.

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