Shoring Up Medicare's Weak Spot

By CARRIE JOHNSON

MIAMI — - All it took to bilk the federal government out of $105 million was a laptop computer.

From her townhouse, a high school dropout named Rita Campos Ramirez orchestrated what prosecutors call the largest health care fraud by one person. Over nearly four years, she electronically submitted more than 140,000 Medicare claims for unnecessary equipment and services. The proceeds financed two condominiums and a Mercedes-Benz.

Health care experts say the simplicity of Campos Ramirez's scheme underscores the scope of the growing fraud problem and the need to devote more resources to combat it. Law enforcement authorities estimate that health care fraud costs taxpayers more than $60 billion each year.

Medicare, the health program for the elderly and the disabled, is vulnerable because it automatically pays the vast majority of the bills it receives from companies with federally issued supplier numbers. Computer and audit systems now in place to detect problems generally focus on overbilling and unorthodox medical treatment rather than fraud, scholars say.

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