Copyright held by The John Cooke Fraud Report. Reprint rights are granted with attribution to The John Cooke Fraud Report with a link to this website.
There are two little words that strike terror into the collective hearts of less than ethical New Mexico health care providers.
T A S K F O R C E
On April 27, 1993, a federal jury found an Albuquerque psychiatrist, Dr. James D. C. Jaramillo, guilty of 228 felony counts.
In the original indictment of June 1994, Jaramillo was alleged to have billed Medicare, Medicaid and CHAMPUS (covering military dependents) for services performed when he was not even in town. In fact, in some instances the good doctor was not even in the country.
Jurors were shown a paper trail that left little room for doubt about the alleged crime. While federal health finance officials had over 7,000 suspects billing copies, lacking proper documentation, they presented only 228 of them to the grand jury. Exhibiting the remaining 6,800 would have placed them in the courtroom until the 21st century.
The government alleged that Wayne Meyerwitz, a codefendant who testified for the prosecution after being granted a separate trial by the judge performed many of the services that Jaramillo billed for at an MD rate. Among other things, Meyerwitz was said to have filled out blank, pre-signed (by Jaramillo) prescription forms at times when Jaramillo was out of the country.
Blue Cross Blue Shield New Mexico assisted in the lengthy investigation by issuing subscriber cards and an employer group for use in an undercover operation. Then they threw in senior investigator Bob Casey as well.
Casey assisted the FBI and other involved federal agencies by posing as a patient from the fabricated employer group. Casey’s therapy sessions proved very useful for the FBI as they attempted to analyze how a single doctor could bill insurance companies for up to 24 hours of service in a single eight-hour day.
Kurk Klissner, a 25year FBI employee and computer wizard, was able to download billing information obtained from a large number of insurers who were being besieged with Jaramillo’s bills. Using a common software package, he looked at daily billing patterns. In one particular case, Klissner was able to show that the doctor was billing for over 20 hours a day but working less than ten hours.
The proof was in the pudding, so to speak, after Jaramillo’s billing records, computer discs and appointment records were seized. It was clearly demonstrated that even when the doctor was out of the country, billing forms continued to pour in to insurers.
The trial lasted two and a half weeks and included expert testimony geared at showing that the questionable billings were not simply clerical or billing errors.
Government task force participants also included Barbara Harriman, a criminal investigator with the Office of Inspector General, Health and Human Services; John Lake, a criminal investigator with Defense Contractor Investigative Service; and members of the New Mexico Attorney General’s Medicaid Fraud Unit. The taskforce enjoys a close working relationship with two-experienced health care fraud Assistant United States Attorneys, Paula Burnett and Mary Higgins.
Working closely with prosecutors, Burnett and Higgins spent over two years developing the case to bring it to trial. The agents and prosecutors met each evening during trial to prepare for the next day’s testimony.
Jaramillo could face revocation of his medical license based on the convictions. That decision will be at the ultimate discretion of the New Mexico Board of Medical Examiners.
© Copyright 1995 Alikim Media