South Florida Home to 20% of Nation’s Medicare Fraud

Twenty percent of the Medicare fraud nationwide that results in criminal cases is originating in South Florida, according to a report by the Florida Times-Union.

U.S. Attorney General Michael Mukasey gave kudos last week to a federal strike force responsible for uncovering the abuse. The Medicare Fraud Strike Force, a multi-agency group started in March 2007 in Miami has brought 120 criminal cases against 200 defendants. The South Florida fraud cases involve more than $638 million, the newspaper reported.

“Your work brings these criminals to justice, and protects our health care system from those to whom stealing dollars is more important than saving lives," the Times-Union reported Mukasey told prosecutors with the Medicare Fraud Strike Force, investigators and other officials in a brief speech at the U.S. attorney's office.

Industry experts say Medicare fraud raises the cost of health care and may increase patient medical debt. Medicare fraud cases range from prescriptions to durable equipment and other items beneficiaries don’t need. The products or services are billed to Medicare but never delivered.

Some cases involve the theft of patient information, which may result in fraud victims being billed deductibles and co-pays for services they never receive. The patient uses the victim’s identity to avoid paying these costs, said Marilyn Koczan, vice president of patient financial services for Meridian Health, an operator of several New Jersey medical centers.  The health care provider is typically paid a discounted rate, and the taxpayer foots the bill for the ineligible recipient.

The amount of Medicaid fraud is difficult to determine because many states don’t require Medicaid patients to pay deductibles or co-pays for care, Koczan said. “But ultimately, it’s running up services and raising the cost of health care,” she said.

Florida ranks third in the nation in the number of uninsured people under 65 years old behind California and Texas. The amount of unpaid medical bills Florida hospitals wrote off in 2006 was 73 percent higher than that of 2000 (“Florida Hospitals Uncompensated Care Cost Skyrocket,” May 6).