TALLAHASSEE — As Florida hemorrhages as much as $3.2 billion in Medicaid fraud a year, Chief Financial Officer Alex Sink proposed reforms Thursday and pinned much of the blame for the problem on her political opponent, Attorney General Bill McCollum.
Sink, a Democrat running for governor, said that since McCollum took office, the number of cases opened for Medicaid fraud has dropped from 727 in 2004-05 to 372 in 2008-09.
Florida has the second-highest number of Medicaid recipients in the nation, but ranks 39th in convictions per person in its fraud unit.
"This is not a new problem but nobody is focused on it or paying attention to it," Sink said. "Every time I go to South Florida, I hear about some fly-by-night company who's billing the state for a Cadillac wheelchair, and they're providing the Ford version and pocketing the difference."
McCollum, a Republican seeking his party's nomination for governor, agrees there is room for improvement — but he places the blame on the federal government. In two letters to U.S. Health and Human Services Secretary Kathleen Sebelius in the past year, he noted that a 1992 federal rule prohibits the state from screening Medicaid claims to look for a pattern of fraud. He asked Sebelius to waive the rule so his department could work with the agency that administers Medicaid, the Agency for Health Care Administration, to ferret out corruption.
"We investigate the leads that are given to us as opposed to being the kind of proactive office that I would like for us to be," McCollum said. "Just throwing more money is not the answer, even though we always welcome more money."
In a May 2009 letter, McCollum said that Florida estimates "that fraud, waste, and abuse in Florida's Medicaid program may account for as much as 20 percent, or potentially $3.2 billion, of Florida's $16 billion Medicaid budget."
In a December 2009 letter, he said he was grateful the federal government would lift the prohibition, but voiced frustration that it would take another year. "Waiting another year makes no sense for a state believed to have so much fraud as Florida," he wrote.
Sink counters that other states have overcome the obstacles of the federal rule and, as governor, she would propose:
• Creating a Medicaid fraud inspector general to coordinate fraud fighting activities in different departments.
• Instituting visual checks to verify the address and inventory of Medicaid suppliers.
• Eliminating exemptions to Florida's background checks on Medicaid providers.
• Adopting a Florida grand jury recommendation to ban prescription payments to doctors who have been barred from Medicaid for fraud.
• Sending bills to Medicaid recipients so that they can report overbilling.
But Tom Arnold, head of AHCA, said Medicaid fraud is not just a law enforcement problem, it's bureaucratic hurdles.
He said the agency already performs many of the functions Sink is proposing. For example, the agency already does visual checks on fraud-prone suppliers, does background checks on Medicaid providers and bans most prescription payments from banned doctors.
There are no clear numbers that show how much Medicaid fraud actually costs taxpayers.
A 2008 report from the Legislature's policy research office estimated that fraud could account for 5 to 20 percent of the Medicaid program, or $940 million to $3.7 billion.
Medicaid costs will hit about $19 billion in 2010 and provides health services to about 2.8 million poor children, frail elders and severely disabled Floridians — about 14 percent of the population.
Sen. Durell Peaden, a Crestview Republican who chairs the Senate health budget committee, said there's only so much that can be done to stop the rip-off artists. But he also faulted the U.S. Attorney's Office and McCollum's Medicaid Fraud Control Unit for not focusing enough on Medicaid fraud.
"He needs to get his butt in gear," Peaden said. "All he's doing is chasing pedophiles around. If he'd spend half the time on Medicaid fraud, we'd be in better shape."
Sen. Don Gaetz, R-Fort Walton Beach, sponsored legislation last year that gave fraud investigators more tools, designated Miami-Dade County as a health care fraud crisis area, and provided financial incentives for people who report Medicaid fraud.
Gaetz said some of Sink's ideas about cracking down on fraud are noncontroversial, but didn't think they would do much to stop the swindlers. Still, he agreed more enforcement could help. "It's time we send in the sheriff," he said.
Times/Herald staff writer Steve Bousquet contributed to this report. Mary Ellen Klas can be reached at meklas@MiamiHerald.com.
Correction: The number of cases opened for Medicaid fraud has dropped since Bill McCollum took office. An earlier version of this story was incorrect.