William Charles Tinker wtinker@metrocast.net
Thu, 30 Jun 2005 12:56:05 -0400

HIV care scam uses homeless

Posted on Thu, Jun. 30, 2005


Activists: HIV care scam uses homeless

Homeless people with HIV/AIDS are being used by storefront clinics to make
millions off Medicare, activists and healthcare experts said.



Some storefront clinics are paying Broward homeless people with HIV/AIDS
$100 to $300 a pop to get expensive, probably useless treatments that are
costing Medicare huge sums of money.
''Since we became aware of this problem, back in 2003, we and our
contractors . . . began taking steps to try to stop the scammers,'' Medicare
spokesman Peter Ashkenaz said.

Broward AIDS activists say clinic recruiters go to Fort Lauderdale homeless
shelters and drug treatment programs to find poor people with the virus.
Many of these are officially disabled, qualifying them for Medicare. The
recruiters offer these patients cash to get in vans to travel to clinics for
injections costing up to $6,000 a session.
A widespread investigation by the FBI, Florida Department of Health and
local police has led to three arrests at a Little Havana clinic in
Miami-Dade County.

Medicare says it has blocked $214.5 million in claims in these South Florida
AIDS scams and suspended more than two dozen providers.

But Broward AIDS activists are alarmed that many clinics are still
''They don't care for the patients,'' Pat Callahan Taylor, a healthcare
worker, told the South Florida AIDS Network at a May meeting in Fort
Lauderdale. ``They just care about the money.''
''I don't see why this isn't being yelled from the rooftops,'' said Ken
Fountaine, a staff member at Shadowood II, a Fort Lauderdale shelter for the
homeless with HIV/AIDS. ``They're taking advantage of the lowest of the low.
. . . I don't understand why they can't go there and shut them down right
FBI spokeswoman Judy Orihuela said she could not confirm whether her agency
was investigating, ``but very generally, healthcare investigations are
document-intensive. They can involve hundreds of interviews, multiple
agencies and generally take a lot of time to investigate.''

Ashkenaz of Medicare said the agency's computers have set up the equivalent
of ''red flags'' to block certain providers and patients connected with the
AIDS investigation, and in the past five months, as these programming edits
have kicked in, Medicare has stopped $144.5 million in payments to suspect
The three arrests in the investigation concerned people working at the R.A.
Medical Center in Little Havana.
One patient at the AIDS Network meeting who asked not to be identified
showed The Herald a bill with a long list of charges from the Little Havana

The bills show she was given injections of immune globulin at $6,000 each.
Medicare paid for at least two at $4,092.96 each. The patient said she and
others were paid $100 each time they visited the clinic.
Margaret Fischl, a physician who is an AIDS specialist at the University of
Miami, said such expensive injections are sometimes useful for patients with
low platelet counts, but very rarely. ''I can't remember the last time I
used that,'' she said. ''Perhaps a couple years.'' She treats hundreds of
patients a year.

Fischl said any clinic that paid people to become patients should be
immediately suspect. ``It's just not done that way.''
Ana Puga, a Broward physician who works with AIDS patients, said one of her
patients told her she was paid $300 a visit for one to three trips a week to
clinics. ``They're making them come into the clinic when it's not
Fountaine said he has banned recruiters from the clinics from coming on the
property at the Shadowood shelter and he has brought in a Department of
Health speaker to warn residents that treatment at these clinics might not
be safe.
Still, Fountaine said he understands why homeless people would be enticed.
``When you have nothing, the cash is way too tempting.''

Fountaine said that he didn't know of anyone in the shelter who wanted to
talk about taking the money, because most of those with AIDS want privacy
and those who are taking the cash wouldn't want to jeopardize their income.
At the AIDS Network meeting, a woman who asked that she be identified only
as a ''PWA'' -- person with AIDS -- said she was offered money to take a van
to a clinic last year, but ``I asked questions and didn't go.''
The PWA said she had heard that the clinics were billing $5,500 a visit for
some alleged treatments, ``but they don't tell you what they're putting in
your body. . . . We need to send a message that it's not OK to prey on the
most vulnerable.''

The probe of R.A. Medical Center came after a patient talked to
In March, Raul Ramirez, 50, identified by patients as administering the
treatments, was charged with the unlicensed practice of medicine. Ramirez
has a string of drug charges dating to the 1980s.
Later, another employee of the Little Havana clinic, Beatriz B. Hernandez,
40, also was charged with the unlicensed practice of medicine. Both
Hernandez and Ramirez have pleaded not guilty. Their attorney did not return
a call seeking comment.
Last week, Miami-Dade police arrested Joseph Barata, 74, a physician at R.A.
Medical Center, and charged him with aiding and abetting the unlicensed
practice of medicine for allowing Hernandez and Ramirez to treat patients at
his clinic.
None of the three have been charged with Medicare fraud connected with the
treatment of HIV/AIDS patients. The clinic no longer operates.