Operation Healthcare: Fraud Squad

By Ashli Sims, The News On 6

TULSA, OK -- Before we spend billions more on healthcare, many in Congress want to see us reclaim the billions lost every year.

They're talking about criminals raiding government coffers through fraud. Oklahoma has its own fraud squad and they say the problem is bigger than you'd ever imagine.

Some say there's a healthcare emergency that needs a cure stat. A stealth disease, slipping by our defenses, replicating exponentially and eating away tens of billions of dollars.

"Big, very big and getting bigger," said Don Brown, Medicaid Fraud & Control Unit. 

Don Brown's job is to ferret out fraud in the state's Medicaid program.

"The amount of bills and billing that run through the system on a daily basis is almost insurmountable to keep track of," said Brown.

That's what the criminals are counting on.

Like Emmanuel Akande, who ran Oklahoma City's Peace of Mind Counseling Center. From January 2004 to May of 2005, Peace of Mind billed Medicaid for more than $130,000. 

To receive Medicaid money, medical professionals have to have documentation. Fraud investigators found "there was no documentation for any alleged services" at Peace of Mind.

Medicaid also requires a licensed doctor to sign off on every treatment. Police say Akande used photocopies of a doctor's signature, without his permission, for almost $280,000 worth of services.

Oklahoma's fraud squad found out and Akande was ordered to pay back more than $400,000 and he got a five year deferred prison term.

Sandra Taylor was working as a registered nurse for a counseling center in Wynnewood. Investigators say she provided behavioral health services to 25 Medicaid recipients.

"Well as it turns out, she had never received the degree she said," Brown said. "In fact, had been denied a license in Idaho based on a former felony conviction, which she lied about on her application here in Oklahoma."

She filed almost 1,500 Medicaid claims to the tune of $78,000. She was forced to pay it all back and got a three-year suspended sentence.

"It's getting to the point where the healthcare system is where they're keeping the money. And it's going to attract more crooks. It’s that simple," said Brown.

Don Brown's team opened an average of 47 new fraud cases a year. It may not sound like much, but those are just the ones who got caught.

"I would imagine that we're getting somewhere in the neighborhood of half of the fraud that's actually being committed," said Brown.

Oklahoma Senator Dr. Tom Coburn wants to see states use the same technology as banks to catch more crooks in the act, but Brown says that's only part of the solution.

"We need more people on the ground to investigate because some of it, regardless of the technology, requires shoe leather and someone looking at the documents," said Brown.

Don Brown says he wants to see his department's budget and staff tripled. And he says the agency more than pays for itself, bringing in more than $40 million in the last fifteen years.

Thursday on The News On 6 at 6:00 p.m., the Operation Healthcare series continues. The News On 6 talks with some doctors who say they've found where the money for healthcare reform is hiding, but could patients pay the price?

11/17/2009  Related Story: Operation Healthcare: The High Cost Of Care