Wednesday, Nov. 10, 2004 | 9:11 a.m.
A Las Vegas podiatrist allegedly seeking reimbursements for ingrown toenails that were never clipped is one of the growing number of cases across the nation involving health care fraud, authorities noted at a national conference Tuesday.
Dr. Nick T. Nguyen was indicted on 86 counts of health care fraud in Las Vegas in May after he allegedly billed Medicare for ingrown toenail surgeries that he never conducted, said Timothy Delaney, supervisory special agent and chief of the FBI's health care fraud unit.
There is also a Las Vegas tie to an FBI case in Los Angeles that is still taking shape. Two weeks ago indictments were released in Los Angeles in connection with an investigation into more than 5,000 reports of patients getting cosmetic surgery and billing it as a needed surgical procedure, Delaney said.
"Some of those people were brought in from Las Vegas," Delaney said. "Casino workers usually have good health care and that's what is looked for in recruits."
But the Las Vegas cases are just part of a nationwide trend, Delaney said.
"It's happening everywhere," Delaney said. "We've had cases in smaller towns like Redding, Calif., and large cities such as Chicago."
Delaney is in Las Vegas this week, along with about 1,100 other investigators with various law enforcement and health care providers for the National Health Care Anti-Fraud Association's annual training meetings.
Dave Hennings, chairman of the association, estimates that at least $48 billion is lost each year through various health fraud schemes in the United States.
Among the schemes commonly used are doctors charging insurers for procedures that were never conducted or conducting unnecessary procedures on a patient in order to file a claim.
In addition there are those who obtain patients insurance or Medicare numbers and use those accounts to make purchases without the knowledge of the patient. An example of that type of case occurred in Nevada, Utah and Arizona in the late 1990s when Richard and Deborah Ridgeley used the Medicare numbers of nursing home residents to purchase medical equipment.
The Ridgeleys then sold that equipment to other seniors through their Las Vegas company, Prescriptives Medical Services.
The couple pleaded guilty to health care fraud in the case. Richard Ridgeley was sentenced to 21 months in prison, while his wife was ordered to serve 46 months in prison. Both were ordered to pay more than $1.4 million in restitution.
The purpose of the association's meetings in Las Vegas this week is to give insurance investigators and law enforcement agents a chance to meet and learn from each other, Hennings said.
The industry is concentrating on new technologies and software that can quickly and efficiently search through insurance claims and help to illuminate patterns and trends for investigators to follow. Health care fraud ranks second to only corporate fraud in terms of priorities for the FBI's white collar crime agents around the country.
One of the most insidious types of health care fraud that agents are seeing more and more of is doctors preforming unneeded operations on patients in order to file a claim, Delaney said.
"The willingness of providers to put patients at risk is something we didn't used to see," Delaney said. "Now we have cases where there is open heart surgery with rib cracking, and they put the organs on a table. The patient doesn't need the surgery and is completely unaware that they don't need it."
Delaney said the best defense against the unscrupulous practices comes from the patients themselves.
"You have to use sound common sense and manage your health care," Delaney said. "You can't always rely on the doctor. The patient needs to become more involved."
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