US Military Retirees in the Philippines Victims of Healthcare Fraud

Tricare/CHAMPUS Fraud Update 07:

The U.S. military's health insurance program has been swindled out of more than $100 million over the past decade in the Philippines, where doctors, hospitals and clinics have conspired with American veterans to submit bogus claims, according to prosecutors and court records. Seventeen people have been convicted so far — including at least a dozen U.S. military retirees — in a little-noticed investigation that has been handled by federal prosecutors out of Wisconsin because Madison-based WPS Health Insurance holds the contract to process many of the claims. It has not been accused of any wrongdoing. At the center of the case is Tricare, a Pentagon-run program that insures 9.2 million current and former service members and dependents worldwide. The United States closed its military bases in the Philippines in 1992 and withdrew its active-duty forces, but thousands of retirees remained. Some saw an opportunity to pry easy cash from Tricare. Health care providers in the Philippines filed claims for medical services never delivered, inflated claims by as much as 2,000% and shared kickbacks with retirees who played along, court records reviewed by The Associated Press show. "There just seemed to be so many possibilities for abuse of the system, and there were so few controls in terms of monitoring," said former U.S. Attorney Peg Lautenschlager, who oversaw prosecutions in the late 1990s.

Pentagon auditors say Tricare moved slowly to uncover and stop the fraud. And a FEB 08 audit warned that the program is still vulnerable to rip-offs because of lax controls and that similar fraud schemes are starting to emerge in Latin America. News of the scope of the fraud comes as the Pentagon seeks to raise fees for Tricare's beneficiaries — fourfold, in some cases. The proposed increases have outraged groups representing servicemen and have been blocked by Congress. Tricare paid $210.9 million in overseas claims in 2006, the latest year for which figures were available. At the height of the fraud in 2003, Pentagon officials say, two-thirds of the $61.8 million paid to Philippine providers — about $40 million — was fraudulent. The fraud in the Philippines was so extensive that the number of claims filed there skyrocketed nearly 2,000% between 1998 and 2003 even as beneficiaries there — about 9,000 mostly retired military members and dependents — remained constant. "I know this is illegal and wrong to submit fraudulent claims to get money, but I did it for fun," U.S. Navy retiree Romulo Estoesta told investigators. He died in 2002.

Austin Camacho, a spokesman for the Pentagon's Tricare Management Activity, which runs the program, said the fraud has been hard to prove because of language barriers, a lack of cooperation from providers and limited law enforcement resources. But he said the agency added numerous controls and is making every effort to stop fraud. In one big case, prosecutors say Health Visions Corp. — which owns hospitals and clinics in the Philippines — bilked the program out of nearly $100 million from 1998 to 2004. Its former president, Thomas Lutz, has pleaded guilty to his role in a kickback scheme and could get five years in prison. He could be sentenced in Madison as early as 2 4APR. The company has also reached a plea agreement, but it is sealed. Prosecutors say Health Visions executives instructed billers to inflate every claim by at least 233% and falsify diagnoses. Lutz refused to comment when reached by telephone in Columbia, Mo., where he is living with relatives. The company's lawyer had no comment. Pentagon officials received fraud allegations against the company in 2000 but waited until late 2005 to move to cut off payments, according to an internal audit report. The company reaped tens of millions of dollars in payments in the meantime. In a 2005 memo, William Winkenwerder, then assistant secretary of defense for health affairs, complained that his requests to send additional investigators to the Philippines were ignored.

The fraud went well beyond Health Visions. A Pentagon official warned in 2004 that the Philippine schemes were costing U.S. taxpayers $40 million a year. In all, those convicted have been ordered to pay back only about $1.8 million. Assistant U.S. Attorney Peter Jarosz said of the 37 people indicted, about 20 remain free, in part because requests to extradite suspects from the Philippines have rarely succeeded. Claro de Castro, chief of the Philippine National Bureau of Investigation's Interpol division, insisted Philippine authorities have cooperated with the U.S. Nevertheless, federal agents have resorted to trying to capture defendants when they step on U.S. soil. Dr. Diogenes Dionisio, who ran a clinic near Manila, was arrested earlier this year after he arrived in Guam for a vacation. He has pleaded not guilty to submitting $2 million in fraudulent claims. His lawyer, Charles Giesen, said his client was never notified he was facing indictment. "He was getting off the plane with his golf clubs and they put him in handcuffs," Giesen said. "It was a complete surprise and somewhat baffling."

[Source: Associated Press Ryan J. Foley article 23 Apr 08 +]

Preparing for Battle

Spiritual Warfare and You
by David Jeremiah

Arizona police officers were dismayed to discover that their bulletproof vests were defective. Now it's a full-blown scandal.

Christians are engaged in spiritual warfare against a powerful enemy. "You're going to face a powerful, invisible enemy every day-the Devil. …Put on your body armor and be prepared to fight him and his demonic hosts. Put on every piece of your battle dress" (Ephesians 6:10-20).

Paul lists seven pieces of equipment every Christian should wear to win this spiritual battle:

"Stand…having girded your waist with truth, having put on the breastplate of righteousness, and having shod your feet with the preparation of the gospel of peace; above all, taking the shield of faith with which you will be able to quench all the fiery darts of the wicked one. And take the helmet of salvation, and the sword of the Spirit, which is the Word of God; praying always. . . ." (verses 14-18)

The Combat Harness
The Christian's combat harness is truth. Paul said, Stand therefore, having girded your waist with truth.... Jesus said, "I am the...truth"(John 14:6). Satan is like a roaring lion seeking someone to destroy. He's a liar, deceiver, serpent, the accuser of the brethren. Whatever he says to us is a distortion.

The Bulletproof Vest
Our "shield of righteousness" is the Christian's bulletproof vest. Be honest, upright, authentic, and full of integrity. The little sins we tolerate represent dangerous "holes" in our bulletproof vests. You can be sure that sooner or later, Satan will aim right at that spot.

The Tactical Duty Boots
Wear the shoes of the Gospel of Peace. As the right boots protect our soles, the peace of the Gospel protects our souls. The Good News of Christ brings composure to our lives, putting hard leather between us and the jagged stones of fear and doubt.

That's why the Bible constantly tells us, "Do not fret… do not fear… do not let your hearts be troubled… do not be anxious… don't be discouraged."

The Riot Shield
Trust God and keep going when everything falls apart: ". . . above all, taking the shield of faith with which you will be able to quench all the fiery darts of the wicked one."

The Helmet
Wear the "helmet of salvation. Possess the mind of Christ. Think as Jesus thinks, equipping yourself with the wisdom of God.

Our battle will be won or lost in the realm of ideas. We read in 2 Corinthians 10:4-5:"the weapons of our warfare are not carnal but mighty in God for pulling down strongholds, casting down arguments and every high thing that exalts itself against the knowledge of God, bringing every thought into captivity to the obedience of Christ."

Are you increasingly letting the Holy Spirit give you His wisdom as you read the Word of God and pray?

The Assault Rifle
The "sword of the Spirit" is our assault rifle. Until now, all the armor has been defensive. Now we come to our offensive weapon-the Word of God.

In Matthew 4, Jesus confronted Satan with three simple words: "It is written. . . ." And then He quoted passages from Deuteronomy to defeat Satan.

Think of areas in which you know Satan will tempt you, find some Bible verses relating to those areas, write them out on little cards, and put them where you see them often. Memorize them. Learn them by heart, and be ready to use them when the Enemy confronts you.

The Radio--Prayer
Paul says, "praying always with all prayer and supplication in the Spirit, being watchful to this end with all perseverance and supplication for all the saints."

Praying always… all prayer… all perseverance… for all the saints. Our prayer lives should be strong, consistent, and sincere. The prayers of a righteous person are powerful and effective (James 5:16 NIV).

God intends us to be "more than conquerors," but we have to be strong in the Lord and in the power of His might. Be dressed for battle, keep your armor on, and when it's all over but the shouting, you'll still be on your feet.

This article was excerpted from Turning Points, Dr. David Jeremiah's devotional magazine. Call Turning Point at 1-800-947-1993 for your complimentary copy of Turning Points.

Tuesday, August 23, 2005