CMS To Announce New Medicare Anti-Fraud Efforts, Including Some That Target Miami-Dade County

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Litigation / Medical Malpractice
Article Date: 07 Oct 2008 - 7:00 PDT

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Acting CMS Administrator Kerry Weems on Monday plans to announce new anti-fraud measures aimed at curbing the number of inappropriate Medicare payments, with some measures specifically targeting Miami-area home health care agencies, USA Today reports. Medicare spending on home health care in Miami-Dade County this fiscal year is on track to cost an estimated $1.3 billion, a 1,300% increase over five years, government data show. Medicare home health care costs in the Miami area have increased by 20 times the national average in the past five years.

Federal investigators say agencies that are billing Medicare for millions of dollars in services that are unnecessary, overused or not provided at all are driving the spending increase because the Medicare beneficiary population has grown by 10.2% between 2004 and 2007. Medicare spending on home health care services was six times larger in Miami-Dade County during the first five months of 2008 than in Los Angeles County, where the Medicare beneficiary population is three times the size, CMS data show.

According to USA Today, South Florida is a "bellwether" for Medicare scams that eventually surface in other large cities and investigators from around the country are paying attention to any crackdown efforts in Miami (Appleby [1], USA Today, 10/6). USA Today on Monday also examined efforts by the CMS field office in Miami-Dade County to expose Medicare fraud by going door-to-door and investigating claims by beneficiaries who allegedly are homebound diabetics in need of nurses to administer insulin.

According to USA Today, the "[s]oaring" home health care spending in Miami-Dade is largely due to the amount of outlier Medicare payments that are for treating sicker-than-average patients. Such payments account for 60% of all home health care reimbursements in Miami -- compared with 6% nationwide -- and are rising in Miami-Dade faster than anywhere else in the U.S. (Appleby [2], USA Today, 10/6).

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