By JACK ANDERSON and
MICHAEL BINSTEIN

It's unlikely that Hollywood will ever make a movie romanticizing the exploits of health care fraud artists, yet there is growing evidence that a "medical mafia" of sorts has sprung up across the country, engaging the FBI in one of its most urgent law enforcement challenges.

No one "family" or "godfather" directs the medical mafia. Yet it is adding millions of dollars to the health care burden already breaking the backs of American families. One government estimate shows that fraud and abuse add some 10 percent to U.S. health care costs, which approach $1 trillion a year.

If accurate, that number suggests health care fraud is shaping up as the savings and loan scandal of the 1990s.

FBI officials say such abuses include fraudulent billing schemes by medical equipment suppliers; nursing home scams; hospital billing frauds; psychiatric hospital and diet-clinic rip-offs; and "rolling lab" swindles that prey on the elderly and loot Medicare as well as private insurance.

The FBI has redeployed 150 agents nationwide on health care cases, while the Justice Department has assigned 10 new positions to the job and formed a health care unit within its criminal division. But despite evidence of widespread white-collar looting, prosecutors have not gone after cases they regard as promising mere pocket change. Many prosecutors apparently only accept criminal health care cases that involve $100,000 or more, because the workload from the savings and loan scandal and drug cases has so taxed resources.

Here are some of the scams contributing to the $80 billion-a-year health care crime wave:

Rolling Labs. According to the FBI, the vulnerability of the health care system to fraud is most vividly illustrated by California schemes that have involved more than $1 billion in fraudulent billing from as many as 200 physicians and other providers. The schemes revolved around getting people with health insurance to visit mobile labs, called "rolling labs," where non-invasive tests -- such as health and blood pressure movements -- were conducted. The labs and doctors use phony diagnoses when submitting the insurance claims. Although some of the owners of these labs have been successfully prosecuted, no money has yet been recovered. Some six similar schemes are still known to be operating in Southern California.

Durable Medical Equipment (DME) fraud and kickbacks. DME firms pay kickbacks to health care providers, including doctors, nursing homes and hospitals in return for obtaining supply contracts. Medicare and private insurance firms are easy prey. These unscrupulous businessmen also employ telemarketing scams, and fraudulently bill unnecessary DME supplies and services.

Diet Clinics. Patients are solicited through promises of weight loss at normal expense. Sometimes patients are even provided free airfare to country club facilities, which can include chauffeured limousine service to the hospital. (Investigators commonly discover taxi and shuttle-bus services billed as ambulance services to insurance companies.) Patients are required, however, to submit to psychological exams, a series of blood tests, and X-rays, which are billed to insurers under the false pretense of a fabricated psychological malady. Under the guise of "group therapy," trips are taken to shopping malls and amusement parks and then billed as treatment for mental illness to private insurance carriers.

Psychiatric Hospitals. With a rising tide of insurance claims and government benefits involving substance abuse, alcoholism and depression, this has become a gold mine for fraud. Patients who would be better served by out-patient treatment are steered into in-patient hospitalization. Other patients have been forcibly admitted into psychiatric treatment programs even though they pose no threat to the community or themselves. They are subjected to a battery of blood tests, X-rays, shock treatment, and something called "wave therapy." Though relatively painless, it is very expensive. The doctor, with a single wave of his or her hand during a routine exam, submits bills to government programs and insurance companies for $125 in individual therapy. (By 2022 dollars given the cost of living and medical inflation, that would be over $1000)