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Magnitude of Medicare fraud in South Florida Grows

July 16, 2010

Medicare fraud has spread to mental health and rehabilitation services in South Florida. The costly problem will take center stage this week, when top federal officials hold the nation’s first healthcare fraud summit in Miami.

BY JAY WEAVER
jweaver@MiamiHerald.com
As the feds squeeze tighter, South Florida’s Medicare schemers have scurried into new territory to loot hundreds of millions of dollars from taxpayers, now billing the system for bogus mental health, physical therapy and other rehabilitation services.

The magnitude of the region’s fraud is astonishing: Florida mental health clinics submitted $421 million in bills to Medicare last year — about four times more than Texas and a whopping 635 times higher than Michigan, both also hotbeds of healthcare rackets, according to government records.

Florida rehabilitation facilities billed $310 million for physical and speech therapy — 140 times more than New York and 10 times higher than California, records show.

Not all of that activity is criminal. But Florida’s numbers are so much higher than other major states’ that officials say the only logical explanation is fraud — the bulk of it in Miami-Dade, Broward and Palm Beach counties.

Law enforcement and healthcare officials say that mental health and rehabilitation providers are the latest agents of pervasive theft in South Florida, long considered the nation’s epicenter of Medicare corruption. The services are not needed or provided, yet the federal program for the elderly and disabled still foots the bill.

“This is like a game of whack a mole,” U.S. Attorney Wifredo Ferrer told The Miami Herald. “The numbers are off the charts.”

The vexing problem of Medicare corruption will take center stage on Friday, when Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius hold the nation’s first healthcare fraud summit in Miami. The issue has gained a higher profile as the Obama administration pushes ahead with the expansion of government-subsidized healthcare for more than 30 million uninsured Americans.

FBI supervisory special agent Randy Culp, who joined the nation’s first Medicare strike force in South Florida in March 2007, said the majority of fraud prosecutions still involve medical equipment such as powered wheelchairs, HIV medical services and home healthcare for diabetics.

But federal agents now are investigating more physical and occupational therapy schemes and looking at potential criminal cases against mental health centers, he said.

“We’re seeing a shift of people moving into these areas,” Culp said.

He and other experts said the transition occurred over the past year when Medicare imposed unprecedented caps on claims submitted by healthcare agencies for homebound patients seeking up to four daily nursing visits for insulin injections.

In 2008, Medicare paid $520 million to Miami-Dade home healthcare agencies for treating diabetic patients — more than what the agency spent in the rest of the country combined, according to federal authorities.

“After we put pressure on them, they started moving their activities into other areas such as mental health and rehabilitation facilities,” said Cecilia Franco, director of Medicare in South Florida. “We see them move year after year from one business to another. Their patients’ Medicare numbers carry great value, and they’re always coming up with new ways to bill for them.”

Last year, for example, Florida’s comprehensive rehabilitation facilities billed $171 million for physical, occupational and related services — about 23 times higher than California and 26 times more than New York, records show.

Overall, Medicare fraud in South Florida costs taxpayers between $3 billion and $4 billion annually, according to experts. Nationwide, Medicare and other healthcare fraud is estimated to cost $68 billion annually — about $18 billion more than the Obama administration plans to spend on education in the next fiscal year.
“The government has to stop pretending these are legitimate businesses and cut them off,” said Washington attorney Kirk Ogrosky, former head of the Justice Department’s healthcare fraud section, who oversaw hundreds of criminal prosecutions.
Last year, the Justice and Health and Human Services departments expanded criminal “strike forces” from Miami, Los Angeles and Houston to Detroit, Brooklyn, Baton Rouge and Tampa. They also committed about half a billion dollars to fraud-prevention efforts, and began working on sharing suspicious billing information with Medicare — an agency that pays claims fast without verifying them — to help stop fraud.
The fight to stamp it out is a constant struggle, despite convictions of about 1,000 defendants in South Florida alone who submitted roughly $3 billion in false Medicare claims since 2005. The region accounts for one-third of all healthcare fraud prosecutions in the nation.
During the past five years, thousands of Medicare fraud offenders have shown that they can outsmart the system. Their weapons: cash kickbacks to Medicare patients, repeated use of their ID numbers for unnecessary costly services, manipulation of medical records to justify phony charges, and submitting different billing codes to get around Medicare’s technology to block false claims.
Authorities say the rising wave of Medicare fraud over the past decade is the result of more immigrants from Cuba and elsewhere switching from violent to white-collar crime, partly because the risks of getting caught and concurrent penalties are relatively low.

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2 Comments
  1. My name is Aleiaue Ramirez I am acting on behalf of my mother Ms. Lillie B. Sims My mother and lawyers have been trying to get doctors to release medical records with her consent they refuse to release them I spoke to Michele in Ocala Florida also faxed a consent letter to release medical files from the Ocala archives My mother waited two weeks to hear from Michle at the Ocala Florida medical archive, talked to Michele she stated my mother records are no longer in the archive they have been trans ferred back to Dr. Antonio Bunker office and referred back to Dr. Bunker office. between Michele at Ocala medical archive division all are giving the lawyers and my mother the run around all doctors as follow are of supicion and fraud with medicare/medicaid my mother went over some of her medical papers found that appointments doesn’t coincide with her time frame Gainesville, Florida, DR.Linda Glover last appointment with her was October 27 2008 on her medical papers it shows my mother is aware of nine appointments at shands hospital which is not true I am hoping someone can help us because we think medicare/medicaid has been frauded other Dr. that are involved Dr.Bernard Ballou,Dr. Linda Grover,&Dr.Bernard Ballou.my moyher phone no. 352-224-5726 Ms. Lillie B. Sims
    Thank You,

  2. Contac Ms. Lillie B.Sims for futher information
    address:3501 NE 15th Street R135
    Gainesville, Florida 32609
    phone no.352-224-5726

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