Health care fraud schemes increasing

Howard Co. couple convicted for posing as physical therapists

March 15, 2000|By Del Quentin Wilber | Del Quentin Wilber,SUN STAFF

Anthony Cannon was a smooth talker but not a very good physical therapist.

He forced one of his patients, suffering from spinal problems, to lift 60-pound weights. During one "therapy session" with a 66-year-old woman recovering from cancer surgery, Cannon only sat on the couch and listened to music. Both patients later told authorities that they were suspicious of Cannon's methods.

That's not surprising. Cannon, 39, wasn't a licensed physical therapist and was helping to orchestrate a fraud scheme with his wife, Diane, out of Howard County that earned them more than $400,000.

The Cannons, recently sentenced to federal prison terms, represent a growing trend: organized groups of criminals making easy and quick profits in health care fraud schemes.

"This is not mom-and-pop health care fraud," said Lynne A. Battaglia, the U.S. attorney for Maryland. "It's groups of people involved in defrauding the government. The schemes we're seeing are very sophisticated."

Health care fraud was once the province of large health organizations, private insurers, doctors and hospitals that bill the federal government for services that never happened or for patients that never existed.

But in growing numbers across the country, thieves such as the Cannons, who have no medical background, are finding ways to siphon off part of the $60 billion lost every year to health care fraud.

Last month, Florida authorities arrested two dentists and three others involved in two separate schemes involving the recruitment of children for dental work -- by unlicensed practitioners, the state's attorney general said.

The defendants paid people to entice children with food or gifts to a dental office, where a man pretending to be a dentist cleaned their teeth and submitted fake bills for other procedures to Medicaid, a federal and state health insurance program for the poor, authorities said.

Florida has seen an explosion in health care fraud by organized criminals, because the money is easy and the work is less dangerous than other illegal activities, says Mark Schlein, who heads the Florida Attorney General's Medicaid fraud unit. "Folks who smuggled dope in the past are finding out how lucrative and easy health care fraud can be," he said.

California authorities uncovered a scheme in which thieves stole confidential patient and physician billing information from hospitals and doctors' offices so they could submit phony claims.

Late last year, the U.S. General Accounting Office issued a report that showed organized groups of criminals were increasingly targeting health insurance companies and Medicare, a federal insurance program for senior citizens. The criminals set up medical clinics, physician groups and diagnostic labs to submit false claims, the report says.

In Maryland, authorities say they have noticed several bizarre Medicaid and Medicare fraud cases, including one in which a social worker visited elderly patients, combed their hair, cleaned their apartments and then charged Medicaid for "therapy" visits, says J. Joseph Curran Jr., Maryland's attorney general.

But Curran and federal authorities say they couldn't recall a scheme similar to the one operated by the Cannons out of their North Laurel home.

Four years ago, after working for various home health care agencies under assumed names as a physical therapist, Diane Cannon (who was not licensed) founded a company, which acted as a subcontractor to other agencies offering physical therapy to homebound patients.

Working on an hourly rate and using other therapists' names and licenses to submit claims, Diane and Anthony Cannon went into people's homes and administered therapy. Not only was neither licensed, but Anthony Cannon also had a criminal record: a conviction in Howard County Circuit Court for depositing stolen checks at several banks. Anthony Cannon's patients discovered his fraud when FBI agents called to question them. Nevertheless, the patients describe Cannon as a "charming," "happy" and "nice fellow."

Charles Bolcik was recovering from knee surgery in late 1996, when Anthony Cannon came to his door -- and told him he needed to build upper body strength.

"I told him I thought he had the wrong guy," said Bolcik of Gaithersburg. "I had knee surgery. I could already stand up by myself. But he told me that this was the correct treatment."

Cannon never returned after that initial visit.

"I'm dumbfounded," Bolcik said. "I thought he worked for a firm. I didn't ask for ID."

`Insurance reasons'

Glenwood Brown of Montgomery County told authorities how Cannon arrived at his home starting in September 1996. Cannon told Brown, who was suffering from a spinal cord disease, that he couldn't help him get out of chairs for "insurance reasons," according to an FBI report.

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