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Florida House passes bill 114-0 to crack down on medical fraud

TALLAHASSEE — In an effort to crack down on health care fraud, the Florida House on Monday unanimously passed tighter licensing rules for certain health service providers to reduce the number who fleece Medicare and Medicaid, then flee the United States.

The proposal by Rep. David Rivera, R-Miami, designates Miami-Dade as a "health care fraud area of special concern'' and would require an applicant to be a resident of the United States for at least five years to be licensed to operate a home health agency, medical equipment provider or a health clinic, unless the applicant files a bond of at least $500,000.

A similar bill by Sen. Carey Baker, R-Eustis, is ready for debate in the Senate.

Rivera's legislation comes in response to a Miami Herald series detailing billions of dollars in Medicare fraud in South Florida.

Federal prosecutors have targeted upward of 800 Medicare fraud offenders in the past five years — including about 60 who have fled to Cuba and other countries to evade prosecution after billing the U.S. health insurance program for hundreds of millions of dollars in false claims.

Many of the fugitives are Cuban immigrants who arrived in South Florida during the past decade and migrated to health care rackets — only to return to their native island after discovering they were under investigation or facing prosecution, the Herald series found.

Cuban immigrants who reach U.S. shores automatically become lawful residents after one year.

"Everyone should be concerned about Medicare and Medicaid fraud because every taxpayer in this state pays for this fraud," Rivera said. "But we should be particularly concerned when the fraud benefits a criminal government like Cuba."

The state last year passed stiffer licensing rules for home health agencies that included criminal history checks. Similar background screenings are done for applicants who want to run health care clinics and become medical equipment providers.

Supporters of this year's bill say that for those who have arrived in the United States recently, criminal history information is limited, making a background check difficult.

Under the bill, applicants also must submit proof that they have the financial ability to operate or provide proof that they can cover startup costs.

The bill, which cleared the House 114-0, imposes a one-year ban on new licenses in counties that already have a high number of home health agencies — a provision that would affect Miami-Dade and Broward.

Both state regulators and trade association representatives said the tighter restrictions should help fight the rampant health care scams in Miami-Dade and prevent them from spreading.

"Additional scrutiny is always a good thing," said Jim K. Hampton, a fraud and abuse administrator for Florida Medicaid.

In March, state investigators began sweeps targeting fraud and abuse in the home health care industry in Miami-Dade, aiming to save millions of dollars in questionable payments by Medicaid.

Medicaid, a program for the indigent and low-income financed by state and federal tax dollars, is zeroing in on Miami-Dade because "something is wrong'' with the county's disproportionately large billing records, Florida officials have said.

Miami-Dade has 20 percent of the Medicaid population in Florida, yet the state program spent more than $55 million on home health care in the county, according to the Florida Agency for Health Care Administration. That's 90 percent of all home health care covered by Medicaid statewide.

The agency's inspector general, Pete Williams, said the "whole system is in jeopardy'' if an increasing number of home health care operators in Miami-Dade are submitting bills for services that aren't necessary or provided. He said patients are receiving kickbacks, including household chores, from agencies that use their Medicaid numbers to bilk the program.

Medicaid's federal partner, Medicare, also has serious problems with overbilling by Miami-Dade home health care providers. Last fall, Medicare began suspending millions of dollars in payments to dozens of home health care providers in Miami-Dade suspected of overcharging for diabetic services.

Florida House passes bill 114-0 to crack down on medical fraud 04/27/09 [Last modified: Monday, April 27, 2009 7:20pm]

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