HHS Report Finds Medicare Fraud Prevalent In South Florida

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Litigation / Medical Malpractice
Article Date: 24 Apr 2009 - 7:00 PDT

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Just 2% of Medicare beneficiaries in the U.S. live in South Florida, but the area accounted for 17% of Medicare's total spending on inhalation drugs in 2007 because of potential fraud, according to a fraud report released Tuesday by the HHS Office of Inspector General, the Miami Herald reports. The report found that Medicare in 2007 spent $143 million on drug claims to treat respiratory ailments in Miami-Dade County, which is 20 times more than the amount Medicare spent in the Chicago area, which has twice as many beneficiaries. The report also found that Medicare spent $4,400 per beneficiary on inhalation drugs in South Florida compared with $815 per beneficiary in the rest of the country.

According to the report, two-thirds of all Medicare beneficiaries in South Florida who have submitted claims for inhalation drugs did not have an office visit with the prescribing physicians in the previous three years. As a result, beneficiaries' conditions are not being re-evaluated but the providers are continuing to submit claims in their name. According to the Herald, such a practice could lead to unnecessary Medicare payments for inhalation drugs that are not needed. Providers also billed above Medicare guidelines for the inhalation drugs for thousands of patients, the report showed. In addition, the report found that medical equipment suppliers and pharmacies have re-used physicians' names for ongoing patient billing.

In March, CMS acting Administrator Charlene Frizzera in a letter to Inspector General Daniel Levinson wrote, "In Florida alone, approximately 60% of the top 100 ordering physicians are the subject of administrative actions by (Medicare) or its contractors or are the subject of law enforcement investigations." According to the Herald, federal prosecutors have cited "dozens" of physicians, pharmacies and medical device suppliers for submitting fraudulent drug inhalation claims. The Herald reports that many of the patients do not require inhalation drugs but are paid kickbacks by the provider in exchange for the use of their Medicare numbers. Some providers have been cited for misappropriating Medicare beneficiary lists to fraudulently bill the agency.

Medicare officials acknowledged oversight problems but said the program last year adopted a more advanced computer program to stop "medically unlikely" claims, which they said decreased improper payments in the region by half (Weaver, Miami Herald, 4/22).

The report is available online.

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