Since 2007, the U.S. Department of Health and Human Services “HEAT” Task Force has indicted over 1000 people for Medicare fraud. The heroes in these cases are whistleblowers; concerned physicians, billing clerks and other insiders who are sick and tired of watching others rip off taxpayers and the government. Corrupt hospital administrators doctors and clinic owners are the “sinners” who profit from these illegal schemes. Often caught in the middle of the controversy are patient recruiters.
Look at many of the healthcare fraud press releases coming from the FBI, HEAT or the Justice Department and there is mention of “patient recruiters.” Who are these people?
Patient recruiters, sometimes called “cappers”, are people who are paid to sign up new patients for some type of medical service.
Patient recruiters are frequently paid a fee to sign up new patients, often as high as $100 although the fees can be much higher for specialized (expensive) medical services. Typically the recruiter shares a portion of the fee with the patient.
The patient goes to the clinic or provider and receives some type of medically unnecessary service or procedure. The patient gets to pocket a couple bucks, the recruiter pockets their portion of the fee and the unscrupulous provider bills Medicare for millions of dollars.
Many times the services are not even provided.
Worse, sometimes the services are dangerous exposing the patient to unnecessary surgery, radiation or medications.
Exposing these schemes is often very difficult. Many of these operations occur in inner city neighborhoods or involve homeless people. Tracking down the homeless or getting inner city residents to cooperate with regulators is challenging. Especially when everyone is making money.
Everyone except taxpayers, that is. Medicare and Medicaid are taxpayer funded programs. We pay the bills.
Patient recruiting scams are especially prevalent in certain cities. The worst offenders? Detroit, Miami, Ft. Lauderdale, Chicago, Dallas and Houston. So many residents have left Flint, Michigan and Camden, NJ that they missed being counted on the list of places with the highest Medicare fraud.
Two weeks ago a patient recruiter was sentenced to 60 months in a federal prison. Jurors found that James Hunter recruited Medicare recipients from Houston, Texas group homes to attend a psychiatric health program. Hunter was reportedly paid $1500 for each week a patient attended. He in turn gave the patients $75 per week and told them what to say to doctors about their supposed psychiatric symptoms.
The cost to Medicare? $16.5 million.
Patient recruiters who directly participate in a Medicare fraud scheme are barred from receiving a whistleblower award under the federal False Claims Act. They are also barred under many state Medicaid fraud whistleblower laws. Billing clerks who are not getting paid kickbacks probably are eligible for awards, however.
Whistleblowers are eligible to receive up to 30% of whatever the government recovers from wrongdoers. Because the government can obtain triple damages, the awards can be huge. In the case of the Houston mental health clinic, that could be as much as $15 million, although the average award is usually between 15 and 20%.
To qualify, you must have original source information about a fraud involving a government funded program. Because they are funded with tax dollars, Medicare and Medicaid qualify.
Chances are if a patient recruiter is involved, healthcare fraud is also involved. Have direct knowledge about healthcare fraud or a clinic employing patient recruiters? We want to speak with you. Our whistleblower lawyers have brought several successful billion whistleblower cases. For more information, contact attorney Brian Mahany at or by telephone at (414) 704-6731 (direct). All inquiries are kept in strict confidence.