An 82-year-old has caught alleged health care fraud in McAllen, Texas on tape.
In the investigative segment, ABC producer Megan Chuchmach has her healthy grandmother, Doris Ace, go undercover and meet with medicare recruiters who refer her to a local clinic doctor.
After a routine visit in which Ace tells Dr. Padmini Bhadrijaju she’s the picture of health, Ace receives around $1,800 worth of Medicare billings for home nurse visits and other treatments filed on her behalf. For nearly a month, Ace is also shown on camera being treated for diabetes (which she doesn’t have) and described in her paperwork as being homebound and “needing assistance for all activities.” (ABC stopped the investigation once the bills rolled in, and said the network plans to reimburse the government for any costs incurred.)
Tim Menke, senior adviser for investigations in the Inspector General’s office at the Dept. of Health and Human Services told ABC reporter Brian Ross this is outright “fraud.”
Dr. Bhadrijajau’s lawyer, John Rivas, felt differently, and in a letter the network wrote “it would be irresponsible journalism to air a story on Medicare/Medicaid fraud using this referral as an example when there is clearly no evidence of fraud.”
Texas is no stranger to Medicare fraud. In one of the year’s biggest headlines to date, Dallas-based doctor Jacques Roy and five other home health workers were arrested for their alleged involvement in a $375 million fraud scheme that had been going unnoticed for years.
Watch ABC’s investigation: