Joyce Heap, lived in a home operated by Armenians in North Hollywood
Not only was this poor woman overmedicated but they were charging her Medicare account with drugs
that were not even used by Mrs. Heap. This is a good reminder to read the statement of benefits from Medicare
you may think it doesn't matter, after all it is the government paying for it. But Medicare fraud harms everyone, in October 2010 the largest Russian and Armenian ring of Medicare fraud $60 million was gathered up by the FBI. There is such little oversight on the people in these homes that administer the drugs to the patient via unit dose dispenseries that are never on site. They usually deliver the drug and it's up to the honesty of the staff to see that the people actually get their proper medication. California Armenian Home has many people that are over medicated on anti-psychotic medication, their care in the skilled nursing section is not "skilled" but operated by too many low wage, low educated LVNs with barely 12 month certification licenses. They need to put cam recorders on them when they are dispensing the drugs. This poor woman.
At another time in her life,
Denise Heap might have tossed aside the insurance forms listing the drugs
prescribed to her mother.
The“explanation of benefits”
forms came like clockwork and didn’t require any action on her part.
But Heap was worried about her
mother, Joyce, who was in the end stages of Alzheimer’s disease. Her health had
inexplicably declined in the Los Angeles-area nursing home where she’d been
living. So in April, when a thick envelope arrived from her mother’s Medicare
drug plan, Heap scrutinized it.
As Heap began Googling the
drugs, she realized something was drastically wrong. Either her mother was
being given expensive medications for conditions she didn't have — such as
breast cancer, asthma, emphysema and high cholesterol — or something sinister
was going on: Someone was using her mother to steal drugs.
“I flipped,” Heap said.
Medicare's prescription program, known as Part D, paid for more than “$10,000
worth of meds” in just three months, she said.
She first called Medicare to
report her suspicions, she said, then the insurance company that managed her
mother’s Medicare drug plan. Neither, she said, seemed very concerned.
“I was like, ‘No. No. No. You
have to understand. I am trying to help you guys,’”she said.
Soon, Heap became convinced
someone had stolen her mother's identity while she was living at a nursing home
run by an Armenian couple. The
couple kept moving the location of the nursing home. And Heap believed they had
been over-sedating her mother with high doses of antipsychotics, inappropriately treating her blood pressure
and allowing bed bugs to feast on her.
“I knew something crooked was
going on,” said Heap, 59, who, with her mother, had co-founded a Holocaust
education nonprofit in the 1990s to document stories of German resistance to
Hitler.
Frustrated, Heap called Los
Angeles County sheriff's Sgt. Steve Opferman, head of a task force specializing
in prescription drug fraud. As soon
as Heap began describing what had happened, Opferman said he knew her mother
had been caught up in a fraud scheme involving Armenian organized crime.
Opferman and other
investigators say criminals wager that patients and their families will not be
like Heap. They bank on the fact that their victims—Medicare beneficiaries —
will be too old or too sick to review insurance forms summarizing the
medications and services billed in their names. And they count on the tendency
of busy family members to give such forms a cursory glance, if that.
“Suffice it to say most people
don't pay attention, let alone know what they're looking at,” Opferman said.
But Heap's case, and others
like it, shows the important role patients and their families can play in
uncovering fraud within Part D. The program now covers 36 million seniors and
disabled people and fills 1 in 4 prescriptions nationwide. Last year, it cost
taxpayers $62 billion.
In an earlier
report [2], ProPublica found that Medicare’s
system for pursuing such fraud is so cumbersome and poorly run that schemes can
quickly siphon away millions. Tips such as Heap's can come into private
insurers, which run Part D for Medicare, to contractors hired by Medicare to
spot fraud, or to the U.S. Department of Health Human Services inspector
general, which investigates health care fraud. But only a small percentage of
cases funneled through this chain are prosecuted.
Reporters, using Medicare’s
own data, were able to identify scores of doctors whose prescribing within the
program followed known patterns of fraud: the cost of doctors’prescribing
jumped dramatically — in some cases by millions of dollars— from one year to
the next and they chose brand-name drugs that scammers can easily resell.
Some doctors claimed that they
— like some of the patients involved — were unwitting victims of identity
theft. In other cases, federal investigators found, the doctors were paid for
writing bogus or inappropriate prescriptions.
In a response to these
findings, a Medicare official said more focus has been placed on fraud
detection within Part D.
The drugs listed on Joyce
Heap's explanation of benefits forms are those most-desired in such fraud
schemes. They included the asthma drugs Spiriva and Advair Diskus, for which
her insurance plan paid nearly $270 a month each, the cholesterol drug Crestor,
which cost nearly $170, and the antipsychotic Abilify, for which the plan paid
about $920 for a 30-day supply.
Opferman said Heap's call
launched an investigation that uncovered a large Part D scheme allegedly
connecting the owners of the nursing home to a North Hollywood pharmacy
operation, including evidence that other residents' identities were used. A
September search of the pharmacy where Heap's mother's prescriptions were
filled found evidence that drugs were being relabeled or repackaged for resale,
he said.
The doctor who prescribed the
drugs has denied prescribing the vast majority of them, Opferman said. The case
is now part of an ongoing investigation by California’s Department of Justice
and his group, he said.
Opferman said investigators
might never have known of the scheme without Heap's tip.
Joyce Heap didn't live long
after her daughter unearthed the problems.
She improved briefly after
moving to a new nursing home, where a doctor reduced her psychiatric
medications, Denise Heap said. But she died of a heart attack on April 21.
In the months following her
mother’s death, Heap said, she sent letters alerting Medicare and her mother's
insurer to the possible fraud. In July she wrote,“Please note that 100% of the
prescriptions charged in April 2013 … are FRAUDULENT.”
Heap said she is “outraged”
Medicare didn't follow up and ask detailed questions about her allegations. In
fact, it was either her insurer or Medicare— she can't recall which — that
recommended she call the local sheriff if she was worried.
“I would have thought
immediately they would have gotten on it,” she said.
But Heap said she is mostly
tormented that she didn’t know such fraud schemes existed — and that elderly
people like her mother could become prey.
“It’s a hard thing to live
with,” she said, tearfully. “I feel like I failed.”
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