You call the U.S. Department of Health and Human Services Regional Office to report waste, abuse and fraud and you get a really nasty upper echelon diva telling you to put it in writing, to which you never, ever get a response.
Or, you could simply keep sending stuff to your State Medicaid Fraud Control Unit in the Attorney General Office where the Attorney General has Assistances who can fashion up a really snazzy letter of dismissal.
Perhaps, you push the correct sequence of legalese and find yourself hauling boxes of actual documents to show the Inspector General and U.S. Attorney General only to be later told that you cannot do it yourself.
All I can say is Carmel Wilson should be honored for who she truly is, and that is a whistleblower.
| Carmel Wilson |
Sharp Hinchey aide foils Medicare scam
Carmel Wilson, who works as an aide to Rep. Maurice Hinchey in his Middletwon office, was one of the first people to notice the proliferation of Medicare recipients complaining of procedures they said they never received, in places they had never been.
MIDDLETOWN — Right made might in the three-year hunt to get to the bottom of who was responsible for absurdly suspicious Medicare charges that began to appear on medical statements of people in the Hudson Valley in 2007.
A modest public servant and Orange County mother of two played a huge role in bringing down what the FBI says is an international crime organization that bilked Medicare out of millions with bogus claims.
Carmel Wilson, a longtime aide to Rep. Maurice Hinchey who works in his Middletwon office, was one of the first people to notice the proliferation of Medicare recipients coming into her office with charges for procedures they said they never received in places they had never been – like California or Arizona.
118 sham clinics
On Wednesday, the U.S. Attorney General unsealed two indictments, charging 44 alleged members and associates of an Armenian-American crime organization with Medicare fraud.
Wilson provided information used against 40 of the defendants, according to officials in Hinchey's office. The mobsters worked out of New York City and Los Angeles, but many of the identities used for the claims likely were obtained from a 2005 data breach at Orange Regional Medical Center, authorities said. Hospital spokesman Rob Lee said the hospital has reached out to law enforcement officials to help them determine if the breach occurred within the hospital or at another site.
The FBI said Armenian mobsters billed more than $163 million in false claims to Medicare, making this the largest, single Medicare fraud case in history. Medicare paid out over $35 million in U.S. taxpayer money to at least 118 sham clinics in 25 states, according to the indictment.
Wilson is a shy, sweet woman with short red hair who roots for the Mets. She says she loves her job as a liaison between ordinary folks and the federal government because she can help so many people. Before working for Hinchey she worked for former Rep. Ben Gilman.
She's an unlikely candidate for striking a blow against what the FBI says is a Mafia-like organization complete with a Tony Soprano-like boss, called a vor, which is roughly the equivalent of a Mafia godfather, who once threatened to “disembowel” a man who owed him money and to kill an associate who failed to show him proper respect.
Wilson goes to FBI
Wilson, nevertheless, relentlessly documented each suspicious billing incident. Then she would send out letters with the support of her boss to both the Medicaid fraud division and the Medicare billing contractor.
Since states usually contract their Medicare billing out to other states — New York's billing is done in Minnesota, for instance — there was a fair amount of red tape involved.
When Wilson didn't see enough movement to resolve the issue, she contacted the FBI.
Warren Smith of Middletown says he estimates about $50,000 was billed under his name in fraudulent claims. At first, he tried to report the fraud to Medicare himself. “Have you ever called Medicare?” Smith asked. “You wait forever.”
Medicare asked Smith to contact the provider to see if it was a clerical error. It was pretty hard to contact nonexistent clinics, he said.
Frustrated he turned to Wilson. Subsequently, he was involved in the FBI investigation. “I was glad to learn about the indictments,” Smith, 76, said. “(Wilson) is awesome.”
A modest public servant and Orange County mother of two played a huge role in bringing down what the FBI says is an international crime organization that bilked Medicare out of millions with bogus claims.
Carmel Wilson, a longtime aide to Rep. Maurice Hinchey who works in his Middletwon office, was one of the first people to notice the proliferation of Medicare recipients coming into her office with charges for procedures they said they never received in places they had never been – like California or Arizona.
118 sham clinics
On Wednesday, the U.S. Attorney General unsealed two indictments, charging 44 alleged members and associates of an Armenian-American crime organization with Medicare fraud.
Wilson provided information used against 40 of the defendants, according to officials in Hinchey's office. The mobsters worked out of New York City and Los Angeles, but many of the identities used for the claims likely were obtained from a 2005 data breach at Orange Regional Medical Center, authorities said. Hospital spokesman Rob Lee said the hospital has reached out to law enforcement officials to help them determine if the breach occurred within the hospital or at another site.
The FBI said Armenian mobsters billed more than $163 million in false claims to Medicare, making this the largest, single Medicare fraud case in history. Medicare paid out over $35 million in U.S. taxpayer money to at least 118 sham clinics in 25 states, according to the indictment.
Wilson is a shy, sweet woman with short red hair who roots for the Mets. She says she loves her job as a liaison between ordinary folks and the federal government because she can help so many people. Before working for Hinchey she worked for former Rep. Ben Gilman.
She's an unlikely candidate for striking a blow against what the FBI says is a Mafia-like organization complete with a Tony Soprano-like boss, called a vor, which is roughly the equivalent of a Mafia godfather, who once threatened to “disembowel” a man who owed him money and to kill an associate who failed to show him proper respect.
Wilson goes to FBI
Wilson, nevertheless, relentlessly documented each suspicious billing incident. Then she would send out letters with the support of her boss to both the Medicaid fraud division and the Medicare billing contractor.
Since states usually contract their Medicare billing out to other states — New York's billing is done in Minnesota, for instance — there was a fair amount of red tape involved.
When Wilson didn't see enough movement to resolve the issue, she contacted the FBI.
Warren Smith of Middletown says he estimates about $50,000 was billed under his name in fraudulent claims. At first, he tried to report the fraud to Medicare himself. “Have you ever called Medicare?” Smith asked. “You wait forever.”
Medicare asked Smith to contact the provider to see if it was a clerical error. It was pretty hard to contact nonexistent clinics, he said.
Frustrated he turned to Wilson. Subsequently, he was involved in the FBI investigation. “I was glad to learn about the indictments,” Smith, 76, said. “(Wilson) is awesome.”
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