HHS OIG Report Finds “High Risk” of Medicare Fraud in South Florida

April 24, 2009 by Conrad Dillon · 3 Comments
Filed under: Fraud & Abuse, Medicare 

Photo by BenSpark via Flickr

Photo by BenSpark via Flickr

A report released Tuesday by the HHS Office of Inspector General identifies South Florida as “a high risk area for fraudulent billings to Medicare” by suppliers of durable medical equipment. According to the report, South Florida accounts for 17% of Medicare’s total spending on inhalation drugs, but is home to only 2% of the nation’s Medicare beneficiaries.

While warmer climates are known to cause a variety of respiratory problems, that alone does not explain the “aberrant claim patterns” identified in the report.

In 2007, Medicare spent $143 million on claims for costly drugs to treat respiratory ailments in Miami-Dade County.

That’s 20 times more than the amount Medicare spent in the Chicago area, which has twice as many beneficiaries,

reports the Miami Herald.

The Herald explains the root of the alleged abuse is that two-thirds of the patients in South Florida listed on Medicare claims for expensive inhalation drugs did not have office visits with the physician who prescribed the treatment in the previous three years.

Additionally, medical equipment suppliers and pharmacies are alleged to have recycled the offending doctors’ names for ongoing patient billing, and billed far beyond the Medicare guidelines for inhalation drug therapy. As a result, the Herald says,

Medicare has spent five times more per patient on inhalation drugs in South Florida than the rest of the country — $4,400 versus $815 per beneficiary[.]

Read the HHS Office of Inspector General’s full report here (PDF).

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Comments

3 Responses to “HHS OIG Report Finds “High Risk” of Medicare Fraud in South Florida”
  1. Arthur Marshall, MD says:
    07/03/2009 at 1:10 pm

    Is there someplace to which I can go in the public record to find lists of names or individual/companies who have been accused of/convisted of Medicare fraud in the South Florida area in the last ten years?

    Thanks

  2. Arthur Marshall, MD says:
    07/13/2009 at 2:04 pm

    Conrad,

    I am a medical doctor and live in Miami which is a virtual swarm of corruption. If possible, please provide me with a list of or direct me to info on those in Miami who have been accused/convicted of Medicare fraud in the Miami area in the last 15 years.

    Thank you

    305 387 6780

  3. Conrad Dillon says:
    07/14/2009 at 9:04 am

    Hello Dr. Marshall:

    Thank you for contacting me. There are a couple of options that you may pursue.

    1) The Office of the Inspector General for the Department of Health and Human Services maintains a list of health care providers who have entered into Corporate Integrity Agreements. You can find the list here: http://oig.hhs.gov/fraud/cia/cia_list.asp.

    2) If you are interested in a state prosecution, you can go to the web page of the Court of Common Pleas in most counties. For Miami-Dade, you can go here: http://www2.miami-dadeclerk.com/cjis/CaseSearch.aspx. You can search by case number or the defendant’s name.

    3) I was unable to find any kind of searchable database on the U.S. District Court for the Southern District of Florida, but the web site can be found here: http://www.flsd.uscourts.gov/

    4) Of course, your other option is to do some Google investigating and see what comes up.

    Warm Regards,

    Conrad Dillon

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