Fake medical providers are costing medicare billions and putting patients at risk.

Accurate estimates of the cost of health care fraud do not exist, Sparrow said. But he told the U.S. Senate in 2009 that fraud could siphon off $100 to $500 billion a year.

Dorsey Med Group is conveniently located for Buckhead-area patients looking for a good internist. On paper, the clinic is headed by a respected physician with 39 years of experience.

Patients might be a little put off by its size, though.

The medical office could easily hold a box of sterilized latex gloves, but not much more.

It’s located at 2625 Piedmont Road Northeast, Suite 56-331 — a UPS Store mail box.

And the doctor who is the clinic’s namesake didn’t know he was the CEO, as federal records show.

He certainly never made the 192-mile drive from his Albany practice to Buckhead to see patients or review medical records.

Federal officials probably should have grown suspicious two years ago when someone using the name Olga Teplukhina incorporated the fictitious medical practice, applied for a National Provider Identification number and claimed a UPS mailbox as the practice location.

Then again, the box is the largest size UPS offers.

“So have they been billing stuff?” Dr. Harry Dorsey asked when the AJC told him the suspicious provider number was still active. “That’s identity fraud, and that really ticks me off.”

For years, officials at the agency that administers Medicare have known that fraudsters sign up as health care providers using UPS Store mailboxes and other post office box like addresses as their location. But the Centers for Medicare and Medicaid Services says it lacks the technology to identify these locations because they look like legitimate street addresses, not like the easily identified post office box addresses.

CMS doesn’t even stop providers from using post office boxes, though. They know they should and they know it’s simple, but the agency still has in its system nearly 300 providers nationwide using post office boxes as their location, according to an AJC analysis of the CMS provider registry.

So when will CMS be able to flag the providers using UPS Store addresses and boot any scammers? 

The agency says it has no timeline.

CMS officials insist they don’t need to hurry because anyone trying to rip off a federal health care program would first need to enroll in the Medicare billing system. That process should – probably, hopefully – snag anyone using a UPS Store as a practice location because it involves a more stringent review.

Don’t tell that to Ryan Stumphauzer, a former federal prosecutor in the Southern District of Florida who specialized in health care fraud.

“They’ve got a fake NPI, they’ve got a fake address, but they’re not concerned yet?” he asked.

While CMS officials say they can’t find these fake medical providers, identifying them is not hard.

The AJC used an inexpensive software program and a list of UPS Store addresses found on the Internet. That turned up 131 CMS-registered medical providers across metro Atlanta claiming a UPS Store as their practice location.

Most likely filled out their paperwork incorrectly and are not committing fraud. Some were already under investigation, while others have been identified as fronts for fraud schemes and the perpetrators prosecuted and convicted.

But several physicians said they were stunned when the AJC told them a provider number was created using their name.
http://www.ajc.com/news/news/fake-medical-providers-slip-through-medicare-looph/nTLFF/