Medicare Fraud in Florida

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As we worry about the rising costs of healthcare, we also must worry about whether the money spent is going to the right people and for the right reasons.

An article in today’s Washington Post examining fraud in South Florida makes it clear that even as we worry about the rising costs of healthcare, we also must worry about whether the money spent is going to the right people and for the right reasons.

By the end of 2006, national health expenditures totaled $2.1 trillion, accounting for 16% of the Gross Domestic Product. About 19% of all health expenditures, or $401 billion, went toward Medicare spending. As is becoming increasingly apparent, much of this money is not reaching the intended recipients.

High-school dropout Rita Campos Ramirez was able to single-handedly scam $105 million out of the Medicare system by creating R and I Medical Billing, through which she showed clinic owners how to rationalize various expensive HIV treatments and make faulty Medicare claims, and in doing so making fake clinics seem like real healthcare facilities. From 2002 — 2006 Ramirez submitted more than 140,000 false Medicare claims for unnecessary equipment and services. Since being caught she has reduced her prison sentence by helping prosecutors find others conducting similar scams.

Law enforcement authorities estimate that healthcare fraud could be as high as $60 billion each year. While focus is consistently placed on over-billing and billing for unusual medical treatments, fraud usually slips through the cracks due to lack of federal attention. Medicare is particularly vulnerable in South Florida, where schemes tend to target expensive HIV medications, and basic equipment such as wheelchairs, canes, and walkers. Justice Department officials were surprised to find that the region had bills of more than $2 billion every year related to HIV medications, particularly because this is 22 times the average rate in other parts of the country. The Justice Department began taking action by freezing money for suspicious bank accounts and opening almost 900 criminal investigations. As a result, there was a $1.75 billion decrease in Medicare claims in the Miami area last year. However, this does not appear to be a permanent solution, as there is very little preventing offenders from ceasing to file claims in one area just to move to another, less heavily scrutinized area and resume their scheme.

Further Sources of Information:

National Health Expenditures

Kaiser Family Foundation: US Health Care Costs

Health Fraud resources at MedlinePlus

HealthFraud.org

Florida Health Fraud Task Force

US Government Accountability Office

Centers for Medicare

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