Stop Medicare Fraud

I applaud the efforts of the Miami Herald Editorial Board to refocus our collective attention on the out-of-control Medicare fraud in South Florida. Several former and current leaders of organized medicine in Florida have attempted to address and resolve this problem only to find themselves rebuffed by a wall of silence, feigned commitment to seek solutions, or refusal to accept responsibility. During my tenure as President of the Dade County Medical Association I traveled to Jacksonville to meet with the leadership of First Coast Service Option, advertised as " one of the nation’s largest Medicare administrators for more than 45 years, and is the current Medicare Administrative Contractor (MAC) for Jurisdiction 9 (J9), which includes Puerto Rico, the U.S. Virgin Islands and Florida." Once I "dared" to raise the issue of accountability and transparency for the (in)action in regards to Medicare fraud and contacted Senator Nelson, I was reminded that my public position could be interpreted as defaming their business and might trigger legal action. Needless to say that I had to back off. Why does nobody hold Medicare contractors such as FCSO accountable for their inability to stop blatant Medicare fraud? Why do honest providers toil under intense scrutiny, whereas others gain outsize profit with brazen abuse? Until we are addressing those issues nothing will change. Yours Bernd

Hospital Hiring on Hold

Attached an article titled " Rare drop in healthcare hiring brings Miami-Dade its slowest job growth in three years" which highlights the dependence of the healthcare industry on (ir)rational political decisions made in Tallahassee and Washington. Small business owners like me and hospital executives have to pay attention to the grinding stalemate resulting from the ideological rigidity of our Florida legislature. The refusal to reach ANY decision regarding the Medicaid expansion and acceptance of federal money borders not only on legislative malpractice but essentially forces healthcare business leaders to put hiring decisions on hold. Hospitals, which are the largest employers in South Florida, expected that with the Medicaid expansion the numbers of uninsured would drop, thereby decreasing the costly treatment of uninsured in emergency room. But by providing health insurance for more people through Medicaid and other programs, including the requirement that everyone obtain health insurance, there should be less need for federal government payments under the “Disproportionate Share Hospital” (DSH) program. DSH payments are made to hospitals that serve a high number of patients without health insurance as well as a high number of Medicaid patients. Starting in 2014, the government will reduce total DSH allotments by $0.5 billion, and that reduction will increase to $4 billion per year by 2020. But without Medicaid expansion and facing diminishing DHS payments hospitals have no other choice but to defer scheduled workforce expansion. Small business owners like me also expected to see increased Medicaid payments for primary care physicians and an expansion of their insured patient base. Now, I will wait and see and I definitely won't hire new staff. Meanwhile, in Tallahassee, our legislators appear to live in splendid isolation from the real world. They seem to be more concerned about ideological correctness than solving problems that affect all of us. Yours Bernd

Medicare Fraud

Attached a link to an interesting article published in today's Miami Herald titled " Miami actor, cable station founder arrested in Medicare fraud takedown" highlighting the audacious Medicare fraud activities in South Florida. As a Medicare provider I still don't get it how Medicare works.Whereas I am being scrutinized to justify each and every meagerly claim, asked to submit medical records and evidence for care rendered, the fraudsters are getting away with millions. Why did Medicare(i.e. First Coast) pay millions of dollars without questioning the sudden spike of claims? How is that possible? Who is accountable for these transactions? Shouldn't financial institutions notify the authorities when suddenly millions of dollars appear on newly opened business accounts? How many doctors were paid to refer patients? Who credentialed those fraudulent providers? After so many years of continuous and outrageous Medicare fraud we still haven't learned how to fight these fraudsters. I witness this ongoing fraud with clenched fists in my pocket and growing anger and frustration in my belly. Yours Bernd