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Report: Medicare fraud runs rampant in Miami-Dade

MIAMI — Miami-Dade County received about half a billion dollars from Medicare in home health care payments intended for the sickest patients in 2008, which is more than the rest of the country combined, according to a report released Monday.

The county accounted for a little more than half the country's claims even though only 2 percent of those patients receiving home health care live here, according to a report by the Department of Health and Human Services Office of Inspector General.

Authorities say it's just another example of Medicare fraud from the county that accounts for more than $3 billion a year in false claims. In some cases, agencies have billed Medicare for home health services for homeless people. In other cases, home health aides visited patients multiple times a day and did little more than house cleaning.

Unlike nurses, critics say the training for aides is minimal in many cases.

"The aide becomes a maid," said Cecilia Franco, the Miami field director for the Centers for Medicare and Medicaid Services. "Instead of helping patients take a bath, they go to the supermarket for them, they clean the clothes."

A large percentage of the patients are diabetics who claim they are blind and bill Medicare for a day and night nurse to give insulin shots.

"What we're finding in a lot of the cases is the patients don't even have diabetes and certainly aren't blind," said Kirk Ogrosky, who heads the Medicare Fraud Strike Force across the United States for the Department of Justice.

Medicare outlier payments for home health care related to diabetes in Miami was eight times the national average, according to the report.

In many cases, authorities say Medicare is billed for services that are never provided. Patients are paid between $700 and $1,400 a month in cash as part of the scam. In one government-subsidized apartment building in Miami, many people billing for home health care services had large plasma-screen TVs — believed to be payment for their participation.

In one Medicare scam, prosecutors charged eight Miami suspects with bilking $22 million from the system. They were accused of recruiting patients for services that were unnecessary, and even faking medical tests to prove they were entitled to the payments.

Authorities say Miami scammers have tapped into "outlier payments" reserved for extremely sick patients. When a health care provider bills for more services like occupational therapy and mental health services, it is granted outlier status and can almost double the amount of Medicare reimbursements it receives

The Centers for Medicare and Medicaid Services doesn't limit how much the agencies can be paid for those extra services, make it an easy target for fraud. It will start capping those payments in 2010 in an effort to curb phony payments.

Report: Medicare fraud runs rampant in Miami-Dade 12/07/09 [Last modified: Monday, December 7, 2009 10:55pm]
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