Medicare Fraud in the News Again

"In 2008, Medicare paid $520 million to Miami-Dade home healthcare agencies for treating diabetic patients
more than what the agency spent in the rest of the country combined, according to federal authorities."

Attached an article from today's Miami Herald highlighting the growing problem of Medicare fraud in South Florida and the efforts to contain its metastatic growth.
I still am puzzled WHY CMS cannot hold the contracted Medicare administrators in Florida accountable for their mistakes amounting to billions of dollars each and every year.
Its either a problem of political unwillingness to tighten the screws, or professional incompetency and absence of any oversight and control mechanisms.
Meanwhile, fraudsters getting away with hundreds of millions per incident and good physicians who are trying to serve Medicare patients are being nickled and dimed by CMS.
But our politicians do not have to worry to find a doctor who still takes new Medicare patients. They go to Walter Reed Medical Center to enjoy the benefits of a government controlled healthcare system. Go figure!!
Yours
Bernd





Posted on Wed, Jul. 14, 2010
Magnitude of Medicare fraud in South Florida grows

BY JAY WEAVER
jweaver@MiamiHerald.com

As the feds squeeze tighter, South Florida's Medicare schemers have scurried into new territory to loot hundreds of millions of dollars from taxpayers, now billing the system for bogus mental health, physical therapy and other rehabilitation services.
The magnitude of the region's fraud is astonishing: Florida mental health clinics submitted $421 million in bills to Medicare last year -- about four times more than Texas and a whopping 635 times higher than Michigan, both also hotbeds of healthcare rackets, according to government records.

Florida rehabilitation facilities billed $310 million for physical and speech therapy -- 140 times more than New York and 10 times higher than California, records show.

Not all of that activity is criminal. But Florida's numbers are so much higher than other major states' that officials say the only logical explanation is fraud -- the bulk of it in Miami-Dade, Broward and Palm Beach counties.

Law enforcement and healthcare officials say that mental health and rehabilitation providers are the latest agents of pervasive theft in South Florida, long considered the nation's epicenter of Medicare corruption. The services are not needed or provided, yet the federal program for the elderly and disabled still foots the bill.

``This is like a game of whack a mole,'' U.S. Attorney Wifredo Ferrer told The Miami Herald. ``The numbers are off the charts.''

The vexing problem of Medicare corruption will take center stage on Friday, when Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius hold the nation's first healthcare fraud summit in Miami. The issue has gained a higher profile as the Obama administration pushes ahead with the expansion of government-subsidized healthcare for more than 30 million uninsured Americans.

FBI supervisory special agent Randy Culp, who joined the nation's first Medicare strike force in South Florida in March 2007, said the majority of fraud prosecutions still involve medical equipment such as powered wheelchairs, HIV medical services and home healthcare for diabetics.

But federal agents now are investigating more physical and occupational therapy schemes and looking at potential criminal cases against mental health centers, he said.

``We're seeing a shift of people moving into these areas,'' Culp said.

He and other experts said the transition occurred over the past year when Medicare imposed unprecedented caps on claims submitted by healthcare agencies for homebound patients seeking up to four daily nursing visits for insulin injections.

In 2008, Medicare paid $520 million to Miami-Dade home healthcare agencies for treating diabetic patients -- more than what the agency spent in the rest of the country combined, according to federal authorities.

``After we put pressure on them, they started moving their activities into other areas such as mental health and rehabilitation facilities,'' said Cecilia Franco, director of Medicare in South Florida. ``We see them move year after year from one business to another. Their patients' Medicare numbers carry great value, and they're always coming up with new ways to bill for them.''

Last year, for example, Florida's comprehensive rehabilitation facilities billed $171 million for physical, occupational and related services -- about 23 times higher than California and 26 times more than New York, records show.

Overall, Medicare fraud in South Florida costs taxpayers between $3 billion and $4 billion annually, according to experts. Nationwide, Medicare and other healthcare fraud is estimated to cost $68 billion annually -- about $18 billion more than the Obama administration plans to spend on education in the next fiscal year.

``The government has to stop pretending these are legitimate businesses and cut them off,'' said Washington attorney Kirk Ogrosky, former head of the Justice Department's healthcare fraud section, who oversaw hundreds of criminal prosecutions.

Last year, the Justice and Health and Human Services departments expanded criminal ``strike forces'' from Miami, Los Angeles and Houston to Detroit, Brooklyn, Baton Rouge and Tampa. They also committed about half a billion dollars to fraud-prevention efforts, and began working on sharing suspicious billing information with Medicare -- an agency that pays claims fast without verifying them -- to help stop fraud.

The fight to stamp it out is a constant struggle, despite convictions of about 1,000 defendants in South Florida alone who submitted roughly $3 billion in false Medicare claims since 2005. The region accounts for one-third of all healthcare fraud prosecutions in the nation.

During the past five years, thousands of Medicare fraud offenders have shown that they can outsmart the system. Their weapons: cash kickbacks to Medicare patients, repeated use of their ID numbers for unnecessary costly services, manipulation of medical records to justify phony charges, and submitting different billing codes to get around Medicare's technology to block false claims.

Authorities say the rising wave of Medicare fraud over the past decade is the result of more immigrants from Cuba and elsewhere switching from violent to white-collar crime, partly because the risks of getting caught and concurrent penalties are relatively low.

In South Florida, authorities have made a handful of major criminal cases against rehabilitation clinics.

In December, Dr. Fred E. Dweck of Hollywood, director of a Miami healthcare clinic, Courtesy Medical Group, was arrested along with 14 others, including nurses, operators and a patient.

Dweck, 74, was charged with accepting bribes to write prescriptions at $100 a pop for about 1,300 homebound patients at Courtesy and other local clinics. But the patients didn't need the prescribed diabetic, physical therapy and other costly services billed to Medicare,according to a federal indictment.

The Medicare bill from Courtesy and the other clinics: almost $41 million between 2006 and 2009. The government paid out nearly $24 million.

In April, a longtime Miami-Dade healthcare operator and his son, along with a business partner, were charged with bilking more than $2.8 million from Medicare in an undercover FBI case. Ernesto Angel Montaner, 69, and his son, Ernesto Montaner, 44, were accused of operating a chain of physical rehabilitation clinics in Miami-Dade that submitted millions of dollars in phony Medicare bills between 2003 and 2008.

Kickbacks were paid to assisted living facilities and others for Medicare referrals,prosecutor Ryan Stumphauzer said.

Ernesto Angel Montaner fled to Costa Rica in February 2009, five months after the FBI executed a search warrant at his four medical clinics, prosecutors said. He was arrested last week.

The son, Ernesto Montaner, and business partner Jose Antonio Varona, have pleaded guilty to one count of conspiring to commit healthcare fraud.