Question

On February 7, 2007, Betros Garabet was indicted on charges of healthcare fraud and false statements. Investigators believe that Garabet orchestrated a scheme to bill Medicare $260,842 for medically unnecessary treatments and services. According to the indictment, Garabet, who was not a licensed physician, opened several medical clinics in the Los Angeles area. Esther Foliente, a licensed physician, permitted Garabet to use her medical license to operate one of the medical clinics and bill Medicare for services rendered at that clinic. Garabet hired co-conspirators, known as "cappers" or "marketers," to recruit patients with Medicare coverage. Co-conspirators Terry Hill and Natasha Walker paid patients kickbacks in the form of cash in exchange for receiving medically unnecessary treatments and services at the clinics, which could then be billed to Medicare. Garabet posed as a physician and purportedly examined the Medicare beneficiaries. He then billed Medicare as if Foliente provided the patients with medically necessary services, when in fact the medical services were not provided by Foliente and either were not medically necessary or not provided at all. In exchange for using her information to bill Medicare, Foliente received a portion of the payments from Medicare. Foliente pleaded guilty to making false statements to FBI agents and was sentenced to 3 years home detention and ordered to pay over $146,000 in restitution. Both Walker and Hill pleaded guilty to healthcare fraud. Walker was sentenced to 2 years' probation and ordered to pay $5,571 in restitution, joint and several. Hill was sentenced to 1 year plus 1 week in prison. He was also ordered to pay $1,358,436 in restitution. Garabet is also known as Bedros Mikail Garbet and Bedros Garabed. Investigators believe that Garabet fled the United States. He remains a fugitive at-large.

• What was significant about the fraud and abuse issue(s) you learned about?
• What attempts were made, or could be made, to stop the fraud or abuse?
• What was the role of the Office of the Inspector General in addressing fraud or abuse in the case(s) you watched?

Answer 1

1) Fraud is referred to as any action or process done by an individual or a group of individual that has harmed the other part financially or emotionally. Abuse is referred to taking advantage of any person or harming them physically, emotionally, financially or by neglect. Health and social care fraud and abuse are common in today's era as the increasing opportunities have been made from government and private companies to promote insurances for the residents in United States the more prevalence of such fraud has come to light. The significance of such health and social care fraud and abuse is that these acts are done by the individual who are well oriented with the system, and have access to these services. It is also seen that there is some flaw in the system itself that such cases are increasing where the physicians go against their ethics and medical conduct and commit fraud. It is also relevant that individual undergoing such abuse are also somehow linked to the fraud made and knowingly or unknowingly they were also involved in it. Medicare is the element provided to aid the health care expenses and promote better services to the residents but some individual try and take advantage of the system and commit such fraud that indicates unethical behavior and need for better coverage.

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