60 Minutes The Cost of Dying (Video and Transcript)

"Families cannot imagine there could be anything worse than their loved one dying. But in fact, there are things worse....Most generally, it's having someone you love die badly, suffering, dying connected to machines." -- Dr. Ira Byock, Dartmouth-Hitchcock Medical Center....

Last year, Medicare paid $50 billion just for doctor and hospital bills during the last two months of patients' lives. That's more than the budget of the Department of Homeland Security or the Department of Education. And it has been estimated that 20 to 30 percent of these medical expenditures may have had no meaningful impact.

The vast majority of people say they want to die at home, but 75 percent die in a hospital or nursing home. Many Americans spend their last days in an ICU, subjected to uncomfortable machines or surgeries to prolong their lives.

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60 Minutes Medicare Fraud A $60 Billion Crime (Video, Text Transcript)

Scammer Explains How Easy It Is To Steal Millions

60 Minutes Medicare Fraud A $60 Billion Crime is sure to make taxpayers irate.

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Medicare Fraud: A $60 Billion Crime
A.G. Holder Tells 60 Minutes More Oversight Is Needed; Scammer Explains How Easy It Is To Steal Millions

Of all the problems facing the United States right now, none are more important than health care.

President Obama says rising costs are driving huge federal budget deficits that imperil our future, and that there is enough waste and fraud in the system to pay for health care reform if it was eliminated.

At the center of both issues is Medicare, the government insurance program that provides health care to 46 million elderly and disabled Americans. But it also provides a rich and steady income stream for criminals who are constantly finding new ways to steal a sizable chunk of the half trillion dollars that are paid out each year in Medicare benefits.

In fact, Medicare fraud - estimated now to total about $60 billion a year - has become one of, if not the most profitable, crimes in America.

This story may raise your blood pressure, along with some troubling questions about our government's ability to manage a medical bureaucracy.

If you want to find Medicare fraud, the first place you should look is South Florida, where 60 Minutes and correspondent Steve Kroft were told it has pushed aside cocaine as the major criminal enterprise.

It's a quiet crime - there are no sirens or gunfire. The only victims are the American taxpayers, and they don't even know they are being ripped off.

FBI Special Agent Brian Waterman, who 60 Minutes rode with for several days, told us the only visible evidence of the crimes are the thousands of tiny clinics and pharmacies that dot the low-rent strip malls.

You don't even know they're there because there's never anyone inside. No doctors, no nurses and no patients.

"This office number should be manned and answered 24 hours a day," Waterman explained, standing outside one of those small, unstaffed businesses.

The tiny medical supply company billed Medicare almost $2 million in July and a half million dollars while 60 Minutes was there in August, but we never found anybody inside, and our phone calls were never returned.

Sometimes, they don't even have offices: we went looking for a pharmacy at 7511 NW. 73rd Street that billed Medicare $300,000 in charges. It turned out to be in the middle of a public warehouse storage area.

"They've already told us that there's no offices here," Waterman told Kroft. "There are no businesses here. In fact they are not even allowed to have a business here."

Waterman is the senior agent in the Miami office in charge of Medicare fraud. And Kirk Ogrosky, a top Justice Department prosecutor, oversees half a dozen Medicare fraud strike forces that have been set up across the country.

The office Kroft visited operates out of a warehouse at a secret location in South Florida and includes investigators from the FBI, Health and Human Services, and the IRS.

"There's a healthcare fraud industry where people do nothing but recruit patients, get patient lists, find doctors, look on the Internet, find different scams. There are entire groups and entire organizations of people that are dedicated to nothing but committing fraud, finding a better way to steal from Medicare," Waterman explained.

"Is the Medicare fraud business bigger than the drug business in Miami now?" Kroft asked.

"I think it's way bigger," Ogrosky said.

Asked what changed, Ogrosky told Kroft, "The criminals changed."

"Sophistication," Waterman added.

"They've figured out that rather than stealing $100,000 or $200,000, they can steal $100 million. We have seen cases in the last six, eight months that involve a couple of guys that if they weren't stealing from Medicare might be stealing your car," Ogrosky explained.

"You know, we were the king of the drugs in the '80s. We're king of healthcare fraud in the '90s and the 2000's," Waterman added, speaking about South Florida.

But it's not just Miami: in March, the FBI arrested 53 people in Detroit, including a number of doctors, and charged them with billing Medicare more than $50 million for unnecessary medical procedures.

And in Los Angeles, the City of Angels Medical Center recruited homeless people off the street to fill their empty beds, offering them cash and drugs plus clean sheets and three square meals a day, while billing Medicare tens of millions of dollars for their stay.

"We have to understand this is a major fraud area," United States Attorney General Eric Holder told Kroft.

Holder is taking a crime that has been in the backwaters of law enforcement and made it a top priority at the Justice Department.

"Why do you think it's been so attractive for the criminals?" Kroft asked.

"Because I think it's been pretty easy. I think that they have found a way in which they have been able to get pretty substantial amounts of money with not a huge amount of effort and at least until now, without the possibility of great detection," Holder explained.

The attorney general agreed that the risks are much lower. "You'll see some of these people and they'll say 'You know there is not a chance that you are going to have some other drug dealer shooting at you.' The chances of being incarcerated were lower, the amount of time you would spend in jail was smaller. All of which is different now."

"You're wakin' up every day makin' $20,000, $30,000, $40,000. Every day, almost literally. And you're like 'Wow I just won the lottery,'" a man we'll call "Tony" told Kroft.

Tony is not his real name. Before he was ratted out by a friend and brought down by the FBI, he was making Wall Street money running a string of phony medical supply companies out of a building that were theoretically providing wheel chairs and other expensive equipment to Medicare patients.

He told Kroft he stole about $20 million from Medicare. He told Kroft it was "real easy."

"And you're not exactly a criminal mastermind?" Kroft asked.

"No. No," Tony said. "No, not really. It's more like common sense."

Asked if he actually ever sold any medical equipment, Tony said, "No. Just have somebody in an office answering the phone, like we're open for business. And wake up in the morning, see how much, check your bank account and see how much money you made today."

He told Kroft he didn't have any medical equipment or real clients - all of it was fake.

"And you would just fill out some invoices and some forms and send 'em to Medicare?" Kroft asked.

"That's it. In 15 to 30 days you'll have a direct deposit in your bank account. I mean it was ridiculous. It's more like taking candy from a baby," Tony said.

According to the FBI, all you have to do to get into this business is rent a cheap storefront office, find or create a front man to get an occupational license, bribe a doctor or forge a prescription pad, and obtain the names and ID numbers of legitimate Medicare patients you can bill the phony charges to.

"There's a whole industry of people out there that do nothing but provide patients," Waterman told Kroft.

Asked what he means by "provide patients," Waterman said, "I'm just talking about lists of patients, people's names, Social Security numbers, addresses, and date of birth. With those four things, you can bill for a patient."

Asked where Tony got his fictitious customers, he told Kroft, "They'll be people that would sell you a list of maybe $10 per patient. And I'll buy 1,000, 10,000 maybe at a time. And then you just fill in the patient's name and you send it. And then I used the same patients with the same company and then the next company I used the same patients and I kept using them, and they'll pay for the same patient every time."

Once the crooked companies get hold of the patient lists, usually stolen from doctors' offices or hospitals, they begin running up all sorts of outlandish charges and submit them to Medicare for payment, knowing full well that the agency is required by law to pay the claims within 15 to 30 days, and that it has only enough auditors to check a tiny fraction of the charges to see if they are legitimate.

If they're not, it's usually people like 76-year-old Clara Mahoney who catch them.

She began to notice all sorts of crazy things turning up on her quarterly Medicare statements back in 2003 - things that Medicare paid for on her behalf that she had never ordered, never wanted and never received.

"Air mattresses, a wheel chair, urine bag for my leg," Mahoney said, listing some of the unwanted items Medicare was charged for on her behalf. "It was getting so I didn't wanna open up the explanation of benefits because you know, it's like, 'Oh, no. Not again.'"

Mahoney, who says she hasn't been sick in 30 years, began calling Medicare to tell them that someone was ripping them off. But the only responses she received were letters saying that someone was looking into it. The bogus charges are still turning up on her statements.

"And I continued to report and I kept saying, 'Can't you flag my account? You know, I'm not getting any equipment or supplies. Nothing,'" she told Kroft.

They have been "looking" into Mahoney's issue for six years.

Once criminals like Tony get their hands on usable patient numbers, they try and charge Medicare for the most expensive equipment possible, which requires having access to a list of Medicare codes.

Asked what some of the best codes were, Tony told Kroft, "Artificial limbs, electric arms, electric wheelchairs. I mean, a regular patient, you can put them on two artificial legs and an artificial arm and they'll pay for it."

And that's what happened to former Federal Judge Ed Davis. He was one of those patients who started getting charges on his Medicare statement for artificial limbs.

"And I looked at it and it had charges for prosthesis. And I knew I had my arms," Judge Davis explained.

Though he has two healthy arms, his statement showed Medicare had been billed for a left and a right arm.

"Didn't anybody in Medicare check to see if any of these charges were valid?" Kroft asked Tony.

"Sometimes they'll do it. But by the time they did it, it was too late," Tony said. "We've already made $300,000, $400,000, $500,000 on it. And then we will never send 'em nothing back. And then at 30 days they'll send an inspector to your office. And by that time…it's all closed down."

They would pay first and send an auditor later.

"There's somethin' I don't understand. I mean, you're saying essentially people just fill out the phony paperwork, they send a bill to Medicare and they pay it," Kroft remarked to Brian Waterman.

"That's why you have companies that can run for 60, 90 days, and bill for ridiculous things. Because there are very few checks and balances to even determine whether these things a, were medically necessary, b, were ever given, or c, even physically possible for a patient with the kind of conditions they have," Waterman explained.

The FBI calls it "pay and chase." And riding around with them we saw plenty of examples. One tiny pharmacy in a Hialeah strip mall went from billing Medicare $13,000 in May to billing nearly a million dollars a month later.

The small, now shut-down office billed $800,000 in the month if June.

By the time we were there in August, the FBI says the owners had already burned the company, shut it down and moved on to another operation.

"We were here last week. There was stuff on the shelves. The business still had a name on it. You can still see from where the tape is that someone just took this off," Waterman told Kroft, standing outside the empty storefront.

To understand just how preposterous all of this is, the FBI says the tiny little store collected six times more money from Medicare in June than the largest Walgreen Pharmacy in the state of Florida.

It's quite an achievement, since neither the FBI nor the proprietor of the bingo parlor next door ever saw a customer coming or going.

"I've never seen people, only twice," the Bingo hall proprietor told Kroft. "No customers. It's always been locked."

We obviously had a few questions to ask the people at Medicare and requested an interview with the person in charge of preventing fraud. That turned out to be Kim Brandt, Medicare's director of program integrity.

"We went around with an FBI agent and a woman from Health and Human Services. They took us to storefront, billing three or four hundred thousand dollars a month. And they were completely empty. Nobody there. I mean, how do they get away with that?" Kroft asked.

"We're as frustrated by that as the law enforcement officials that you went out with. And in fact, our primary focus over the past years has been to tighten our enrollment standards to make it so it's much harder for people like that to be able to get in the program, and to be able to commit that kind of fraud," Brandt said.

"Look, I'm sure that you're aware of these problems. But it doesn't seem like you're doing a very good job. I don't mean you personally, but I mean, the government. This is still like a huge problem, and getting worse, right?" Kroft asked.

"Well, it really does come down to the size and scope of the Medicare program, and the resources that are dedicated to oversight and anti fraud work. One of our biggest challenges has been that we have a program that pays out over a billion claims a year, over $430 billion, and our oversight budget has been extremely limited," Brandt said.

About that there is little dispute: Medicare has just three field inspectors in all of South Florida to check up on thousands of questionable medical equipment companies.

"Clearly more auditing needs to be done and it needs to be done in real time," Attorney General Eric Holder said.

Asked why it has taken Medicare so long to figure out they were being scammed, Holder told Kroft, "I think lack of resources probably. And then I think people I don't think necessarily thought that something as well intentioned as Medicare and Medicaid would necessarily attract fraudsters. But I think we have to understand that it certainly has."

The Obama administration is providing Medicare with an additional $200 million to fight fraud as part of its stimulus package, and billions of dollars to computerize medical records and upgrade networks, which should help Medicare catch more phony charges.

But Tony, who has just begun serving his 12 year prison sentence, says there's no shortage of people in Miami waiting to take his place.

Asked how many people in Miami were doing this, Tony said, "I'd say at least 2,000 people. At least 2,000, 3,000 companies."

He estimated that less than five percent of these companies were legitimate.

"If went to the phone book and looked under medical equipment suppliers, 95 percent of the companies would be phony?" Kroft asked.

"Yes, sir," Tony replied.

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Original content Bob DeMarco, Alzheimer's Reading Room

'Bad Bank' Funding Plan to Rescue and Move Distressed Assets

Put me down as a fan of this plan. It could end up being a stroke of genius. This definitely trumps the Resolution Trust Corporation (RTC) plan that was used to dispose of the assets from failed Savings and Loans.

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The Obama team announced its intention to partner with the private sector to buy $500 billion to $1 trillion of distressed assets as part of its revamping of the $700 billion bank bailout last month.

...private investment managers would run the funds, deciding which assets to buy and what prices to pay. The government would contribute money from the $700 billion bailout, with additional financing likely coming from the Federal Reserve and by selling government-backed debt. Other investors, such as pension funds, could also participate. To encourage participation, the government would try to minimize risk for private investors, possibly by offering non-recourse loans.

'Bad Bank' Funding Plan Starts to Get Fleshed Out

Bob DeMarco is a citizen journalist, blogger, and Caregiver. In addition to being an experienced writer he taught at the University of Georgia , was an Asociate Director and Limited Partner at Bear Stearns, was CEO of IP Group, and is a mentor. Bob currently resides in Delray Beach, FL where he cares for his mother, Dorothy, who suffers from Alzheimer's disease. Bob has written more than 500 articles with more than 11,000 links to his work on the Internet. His content has been syndicated on Reuters, the Wall Street Journal, Fox News, Pluck, BlogCritics, and a growing list of newspaper websites (15). Bob is actively seeking syndication and writing assignments.

Bold Endeavors: How Our Government Built America, and Why It Must Rebuild Now

Whose your Daddy AIG?

It is now clear that AIG had to be bailed out. The alternative was a meltdown of the world financial system. I still remember Hank Greenberg, with hat in hand on CNBC, telling America that AIG has plenty of assets and just needed some help from the U.S. government---taxpayers (that was the first $85 Billion) . I also remember writing that there was zero chance that AIG would make it. I still believe that to be true.

The government is going to need to keep AIG going for about 20 years before they can dig themselves out of the hole they put themselves in by creating a mountain--a trillion dollars or more--of phony baloney paper. We are learning every day how toxic so called credit derivatives swaps are, and how worthless they are. Nobody can put a price on this paper. On the other hand, it did help enrich management of AIG by creating lots of fee income that turned into bonuses. The underlying assets--little did they care.

So here comes AIG hat in hand for more of the taxpayer's hard earned dollars. This is really the Donald Trump strategy--get your partners in so deep they have no choice but to give you more money. So far they are into our pockets for $150 billion.


It is time for a realistic view of this problem. We--the taxpayers--need to hire some sharp investment bankers to get in there and make the best deal possible for the American public. This plan should include a longer term plan to dismantle AIG and erase it from the face of the earth.

Throwing good money after bad is not going to work and the next thing you know we--the taxpayers--will be broke. It is time to ask--Whose your daddy?

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This is a very good explanation of the situation as it now exists. Follow the link for more.

AIG Seeks to Ease Its Bailout Terms

American International Group Inc. is seeking an overhaul of its $150 billion government bailout package that would substantially reduce the insurer's financial burden, while further exposing U.S. taxpayers to its fortunes, people familiar with the matter say.

Under the plan, the government loan of up to $60 billion at the heart of the bailout would be repaid with a combination of debt, equity, cash and operating businesses, such as stakes in AIG's lucrative Asian life-insurance arms. AIG and the government have been discussing the changes since December and plan to announce them by Monday when the insurer is expected to ...

Restoring Financial Stability: How to Repair a Failed System (Wiley Finance)

The News Hour Economists panel - Krugman, Rogoff, Marron, Rivlin Part 1

Watch Part 2

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Doctor Doom and the Black Swan Discuss the Economic Crisis

Roubini and Taleb discuss the economic crisis

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In the story, "Sarkozy, Merkel, Blair Call for New Capitalism," what group did Germany's chancellor cite as a failure?

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Question: In the story, "Sarkozy, Merkel, Blair Call for New Capitalism," what group did Germany's chancellor cite as a failure?

Answer: International Monetary Fund

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Sarkozy, Merkel, Blair Call for New Capitalism

The head of Europe's biggest economy said Thursday that world leaders should be looking at the massive U.S. deficit and other economic imbalances, not just problems caused by financial markets, as they debate a new global order.

Speaking at a conference in Paris on the future of capitalism, German Chancellor Angela Merkel singled out the American budget deficit and China's current account surplus -- the difference between exports and imports -- as problems upsetting the global economy.

"We would be making an error if we were content to look solely at financial markets," she said. She deplored huge debts that governments are accumulating to spend their way out of the present crisis. But she said she recognized, for the moment, that "there is no other possibility."

A Congressional Budget Office report estimates that the U.S. federal budget deficit will hit an unparalleled $1.2 trillion for the 2009 budget year -- and that is before President-elect Barack Obama's sweeping stimulus package is calculated.

European governments have agreed to be flexible about budget rules that limit deficits to 3 percent of gross domestic product as recession bites.

Merkel said the International Monetary Fund has not managed to regulate global capitalism, and she called for the creation of an economy body at the United Nations, similar to the Security Council, to judge government policy.

French President Nicolas Sarkozy, leading the two-day conference with former British Prime Minister Tony Blair, blamed financial speculators for encouraging a system fueled on debt.

He called financial capitalism based on speculation "an immoral system" that has "perverted the logic of capitalism."

"It's a system where wealth goes to the wealthy, where work is devalued, where production is devalued, where entrepreneurial spirit is devalued," he said. But no more: "In capitalism of the 21st century, there is room for the state," he said.

Governments around the world have had to step in to rescue credit-starved banks and financial institutions from collapse. They are also pumping billions of euros into their economies to encourage growth.

Measures will be taken by global leaders meeting in London on April 2, Sarkozy promised, urging the U.S. to join the international consensus. Blair called for a new financial order based on "values other than the maximum short-term profit."

"The greatest entrepreneur I had the chance to meet was passionate about what he had created, not what he had accumulated," he said.

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John Harwood's article about President-elect Obama, "Leaning Left, Persuading Right" mentions which iconic president?

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Question: John Harwood's article about President-elect Obama, "Leaning Left, Persuading Right" mentions which iconic president?

Answer: Theodore Roosevelt

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Obama: Leaning Left, Persuading Right
OBAMA, POLITICS,

| 08 Dec 2008 | 03:37 PM ET
Six weeks before taking office, President-elect Barack Obama can already boast one striking accomplishment: persuading partisan, ideological adversaries to see him in a less partisan, less ideological light.

After reaching out to John McCain, George Bush’s Defense Secretary Robert Gates, and picking New York Fed president Tim Geithner as Treasury Secretary, Obama is earning praise from prominent Republican conservatives.

And he has done it without abandoning his commitment to the same policies that conservatives attacked during the campaign -- his pledge to expand health care coverage, his vow to withdraw troops from Iraq, his promise to increase government spending on infrastructure and alternative energy projects. On the contrary, Mr. Obama has indicated that his domestic goals will be even bigger in the form of a massive economic stimulus early next year.

Does this mean Obama is indeed forging the new style of politics he aspired to in the campaign? If so, will it produce a split the difference bi-partisanship between Republcans and Democrats, or a "post-partisan" Washington that renders the left and right both irrelevant?

Obama insiders see a third option: an ambitious left-leaning priority list propelled forward by the President-elect’s political skills and the public’s strong desire for change.

Last month's exit polls showed little evidence of post-partisanship. Obama winning the votes of just one in 10 Republicans and one in five conservatives. But the tone of political discussion in recent weeks suggests several reasons to expect something new.

Obama has persuaded some conservatives, at least for now, that he really is open to their ideas. He also benefits from internal dissent within the GOP — where some conservatives want to return to smaller government "first principles" and others embrace more government activism.

Obama aides say their formula for maintaining good will across the political spectrum is part Franklin Roosevelt’s New Deal, but also partly Teddy Roosevelt reform-minded Republicanism.

Bill Clinton was frustrated in trying the same thing. But some Democrats think Obama has a chance. "It is quite possible to see him as liberal and having an activist agenda, but being a type of leader who does not polarize partisans and finds ways of bringing people together" said Clinton’s one-time pollster Stan Greenberg.

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URL: http://www.cnbc.com/id/28115314/