Kenneth Rijock

Kenneth Rijock

Wednesday, February 5, 2014

WATCH CAREFULLY FOR MEDICARE "COMMUTER" FRAUDSTERS FROM CUBA


The arrest this week, of a fugitive, wanted since 2009, on a smuggler's boat, coming into the US from Cuba, reminds us of the dangers posed by the new breed of Medicare fraudster, who commits his crimes, and then returns to the safety of Cuba. Hector Hernandez, wanted in connection with a million dollar fraud, and for money laundering, is typical of the transient Cuban Medicare fraudster, who relocates back to Cuba, after serving as the titular head of a medical services or supply business.  His big mistake was coming back. These individuals are specifically brought to the US, to act as front men, and are thereafter sent back to Cuba, where they will not be extradited.

Given that Florida is the epicenter of the billion dollar a year Medicare fraud industry, let me give you a few red flags that may indicate that your medical services company client is a "temporary" front man:

(1) is he or she a recent arrival from Cuba ? If so, how did they get the funds to open a business ? Cubans arrive in the US with nothing of value.

(2) If he or she is a manager of a medical business, what is their experience for that position ?

(3) Where are their clients coming from, if this is a new venture in an extremely competitive business ?

(4) Do they run their business out of a small storefront, which simply could accommodate the volume of business that their Medicare payments require ?

Cuban-Ameicans at your bank should easily be able to determine whether your new client is a newly-arrived immigrant, through their slang, employment and residence history, educational background, and any number of characteristics that identify them as new arrivals.

While I always frown on profiling in the AML field, in this case, where the fraudsters skip out, in the middle of their criminal operation, and law enforcement rarely catches them in the act. Insure that you are not banking Medicare fraudsters, by checking out all your clients now.


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