Finally Medicare fraud is investigated!

This has been one of our legislative priorities. We're delighted to see action being taken. A couple of years ago, a County Commissioner, speaking at one of our meetings, challenged our opinion and stated that there was no major fraud. Better late than never!

Posted on Tue, Jul. 03, 2007 Miami Herald online

Medicare goes after S. Florida bill cheats
BY JOHN DORSCHNER

In their boldest move yet to stamp out healthcare fraud in South Florida, Medicare officials said Monday they will require every provider of medical equipment -- about 2,700 local firms -- to re-apply for a license. Acting Medicare Administrator Leslie V. Norwalk said the goal is ``to keep out the fraudulent providers of the program before they rip us off.''

Each new applicant will have 30 days to reapply for a license. If they don't, their ability to bill Medicare will be revoked. If they do, the next step will be unscheduled site visits to make sure they adhere to 21 requirements, including regular hours and substantial inventories.

Healthcare fraud by South Florida equipment companies -- which provide everything from power wheelchairs and inflatable air mattresses to artificial limbs and oxygen tanks -- is estimated to run to hundreds of millions of dollars a year and has been going on for decades, according to law enforcement officials.

Only two regions of the country -- South Florida and Southern California -- have been chosen for special scrutiny during the two-year pilot project because they are considered the areas most responsible for Medicare fraud in durable medical equipment, prosthetics, orthotics and supplies.

One reason for the feds' heightened interest in medical equipment is that costs are rising at a stunning rate. In 2002, Miami-Dade equipment companies billed Medicare $470 million. By 2006, their charges had increased fourfold to $1.68 billion -- almost as much in billings as the entire state of California, which has about 10 times the population of Miami-Dade.

Esta Ress, an Aventura Medicare recipient who has seen her identity used for almost $100,000 in fraudulent payments, was not impressed with news of the pilot program: ''They should have done this a long time ago.'' She said although she repeatedly complained to federal officials, fraudulent claims kept getting paid. ''They've been very lax,'' she said.

ENOUGH IS ENOUGH

Asked on Monday why the government was clamping down on fraud now, Medicare's Norwalk said, ''I've had enough!'' She paused, then added: ``Actually, I've had enough for a while.''

The news was applauded by R. Alexander Acosta, the U.S. attorney for South Florida. ''The steps . . . will go a long way toward reducing healthcare fraud in South Florida,'' Acosta said. ``Prevention will undoubtedly have much greater impact than after-the-fact prosecution.''

Norwalk said she hopes the measures will lead to quicker exposure of places such as Faster Medical Equipment, a Kendall company that received more than $1 million from Medicare. When investigators checked out the place, they found ''a small closet with buckets of tar and a broken oxygen machine,'' Norwalk said. That closet produced enough money in claims for its co-owner, Eduardo Moreno, to buy a Rolls Royce. Moreno is now under indictment for healthcare fraud.

Medicare officials hope the reapplication process will scare away at least some of those commiting fraud, but there are no specific requirements for operating a durable medical equipment company, and those who apply are not likely to be turned down unless they have been convicted of felonies.

In fact, federal regulations are such that Medicare cannot reject the application of a person who had a $10 million civil penalty for healthcare fraud, Norwalk said, although such a person would be watched closely by officials.

She said a primary purpose of the new push is to ''put some feet on the street,'' with investigators visiting the equipment companies to make sure that they're functioning businesses.

South Florida durable medical equipment businesses will also have to go through a second step to keep Medicare business -- getting accreditation for quality of service by an approved healthcare group, according to Medicare's Director of Program Integrity, Kimberly Brandt.

INSTANT RESULTS

The agency boasts that its investigations have already helped to reduce the number of durable medical equipment providers, which run up to 147 in some zip codes in Hialeah and Little Havana.

In 2006, 1,554 such providers were licensed in Miami-Dade. As of April 2007, that number had been cut to 1,245. In Broward, the number shrank from 830 to 761. In Palm Beach County, there were 666 providers in April.

Harold Schainberg, 75, of Pembroke Pines, said he thinks the government's promise of improvement is hollow. For a year, companies used his name to get money for ''urinary things and bags and catheters and a $7,000 mattress,'' when he used none of those things. When he complained vehemently, Medicare's contractors stopped paying the legitimate claims from his doctors and others, but still kept paying the fraudulent claims.