NCPA - National Center for Policy Analysis

FRAUD SUSPECTED IN MIAMI-DADE DIABETES CARE

December 11, 2009

Medicare paid $520 million to Miami-Dade Co. home health care agencies for treating diabetic patients, more than what the agency spent in the rest of the country combined, according to federal investigators.

The investigators suspect the disproportionate amount of Medicare dollars spent in Miami-Dade in 2008 is fraudulent because the county is home to just 2 percent of the nation's diabetic patients eligible for the federal program.  The money may have been misspent in two areas: Questionable claims for patients who either didn't need twice-daily nursing services to inject their insulin or who didn't actually have diabetes.

No other part of the country -- including other trouble spots in California, Texas and New York -- comes close to Miami-Dade, which is dubbed the nation's health care fraud capital, says the Herald:

  • Medicare loses an estimated $60 billion annually to fraud.
  • The situation in Miami-Dade has spun so out of control that Medicare's average cost for each home health care patient with diabetes runs $11,928 every two months; that's 32 times the national average cost of $378.
  • Medicare officials, along with FBI agents and federal prosecutors, say some home health care agencies pay $100 bribes to doctors for each referral, and between $700 and $1,500 in monthly kickbacks to patients to use their Medicare numbers.
  • Home-care operators also bribe patients with groceries, housekeeping, even flat-screen TVs.

The government health care program for the elderly and disabled is extremely vulnerable to fraud because of its policy of paying claims fast without verifying them, says the Herald:

  • A year ago, Medicare began suspending payments to Miami-Dade home-care agencies suspected of overbilling for diabetic services and other chronic illnesses.
  • So far, Medicare has effectively shut down 33 agencies in the county.

Source: Jay Weaver, "Fraud suspected in Miami-Dade Diabetes Care," Miami Herald, December 10, 2009.

 

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