PALM BEACH COUNTY, Fla. — Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz said he wants to personally investigate a Delray Beach medical supply company after learning about allegations from dozens of seniors nationwide.
More than 30 Medicare recipients across the country have contacted WPTV alleging that Sunshine Senior Solutions billed Medicare on their behalf for medical supplies they didn't need or receive. Of that group of beneficiaries, more than 20 shared their Medicare statements and explanations of benefits with WPTV Chief Investigator Jamie Ostroff. The documents accounted for nearly $400,000, billed by Sunshine Senior Solutions.
In the statements reviewed by WPTV, Medicare did not pay the full amount that was billed. The majority of the beneficiaries said their gap insurance did not pay Sunshine Senior Solutions and flagged the bills as possible fraud.
During an interview about Medicare open enrollment, Ostroff brought these concerns directly to Dr. Oz, who expressed frustration about the lengthy investigation process and offered to personally come to South Florida to address the issue.
"Jamie, I love you. I can tell you right now. God bless you for first of all, raising it to my level of intention, but also pursuing this. It frustrates me as well," Oz said. "I'd like to know, if you don't mind more details about this company, because I will personally come down there with you and address this."
After reviewing the mysterious bills from Sunshine Senior Solutions for catheters and durable medical equipment that was never requested or delivered, many of the Medicare recipients said they reported the activity to Medicare's fraud hotline.
"I was kind of shocked. I thought that they could put the clamps on this and shut these people down, but evidently it takes time to investigate," said Marty Rowe, a Medicare recipient living in suburban Cleveland, who received the unexpected statements.
Peggy Foley spoke with Ostroff with a group of her pickleball friends from suburban Chicago, who also received statements from Sunshine Senior Solution. They also said they contacted Medicare's fraud hotline.
"And they said, 'We are aware of this. We're investigating,'" Foley said.
Jim Dente, of northwest New Jersey, received similar information when he called.
"I've been told they're under investigation. But that's the extent of what I've heard," Dente said.
Dr. Oz expressed frustration with the current system that focuses on identifying and prosecuting fraudsters rather than immediately stopping fraudulent payments.
"So, what would happen is, you get a lead like the one you're giving, and the Justice Department would work very painstakingly through the legal system over several years to figure out who these guys are, and then they'd get ready to clamp down on them. They'd shut the business down," Oz said. "But in the meantime, there were several billion dollars lost. So, we don't want that anymore. I am more interested in the money than the criminal."
Oz said his priority is stopping fraudulent payments immediately rather than waiting for lengthy criminal investigations to conclude.
"I want the money stopped. Go after the criminal, if you want, but don't let the American taxpayer be taken advantage of, while the legal system works its ways," Oz said.
According to Medicare, the agency can suspend payments to a provider if there are credible allegations of fraud against that provider. Medicare won't comment on whether that's the case for Sunshine Senior Solutions, citing concerns that it could compromise an investigation.
No one at Sunshine Senior Solutions has been charged with a crime. Federal authorities including Medicare won't confirm or deny the existence of an investigation.
Medicare's medical equipment provider database no longer lists Sunshine Senior Solutions. Providers that receive reimbursement from Medicare are required to obtain an accreditation and enroll with the agency. The company was listed in the database earier this year.
When Ostroff visited the company's office suite in Delray Beach earlier this year, the person who answered the door didn't answer questions, wouldn't identify who was in charge, and said she didn't know what durable medical equipment was. The person told Ostroff to call the phone number taped to the door, which matches the number on the company's website.
Repeated calls to Sunshine Senior Solutions continue to go unanswered.
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