Miami Herald: South Florida is scam capital

Dec 11, 2009

The Miami Herald published this article on December 11, 2009.

OUR OPINION: Home-health charges for diabetics on Medicare add up to fraud in South Florida

A half billion dollars to help homebound diabetics get insulin injections?

That’s how much Medicare handed out in so-called outlier payments to Miami-Dade home-healthcare agencies treating diabetic patients in 2008. The $520 million in payments make up over half the $1 billion spent by Medicare for home care for diabetics in the 50 states last year.

In a county that houses only 2 percent of elderly diabetics on Medicare, the payment numbers don’t add up to anything but fraud.

Even though Hispanics and African Americans — the two top population groups in Miami-Dade — are more likely to suffer from diabetes than non-Hispanic whites, there are many other Florida counties with higher diabetes rates and far lower treatment costs.

Thanks to an aggressive federal push to catch the fraud in medical equipment sales, HIV infusion therapy and fake diabetes treatments, dozens of scammers have been prosecuted the past two years in South Florida. But more can be done, starting with a new Medicare policy in January that will cap payments to home-health agencies treating diabetics to 10 percent of the bill for such services.

The cap is long overdue. It’s similar to one used by the Centers for Medicare & Medicaid Services to limit payments to hospice agencies, based on the number of Medicare patients an agency serves.

As Medicare rules have allowed more home-health services, the costs have soared. Last year, Medicare paid about $15 billion for home-health services, covering all types of afflictions, according to a Health and Human Services Office of Inspector General study released this week. “However, the recent growth in home health care services relative to the number of eligible beneficiaries indicates that it may be subject to fraud,” the I.G. report states.

It surely is in South Florida, and fake diabetes treatments and billings seem to lead the pack.

Truth is, there aren’t that many diabetics needing home care in South Florida. But there’s plenty of fraud: kickbacks by crooked providers to doctors for referrals; bogus bills; a little spending money, even flat-screen televisions, to some “patients” who give home care agencies their Medicare number to sock it to the taxpayer with fraudulent bills.

Those elderly diabetics who need home care can still get the service if warranted — but the cap will ensure that the fraudulent agencies will have to close down.

As the I.G. report spells out, outlier payments for Miami-Dade’s home health diabetic care are a staggering eight times the national average.

The average cost per patient in Miami-Dade, $11,928 every two months, is 32 times the national average of $378. In Broward, the average $1,379 cost per diabetic patient is four times the average.

This is unsustainable, particularly as Congress looks to expand healthcare insurance coverage to millions of uninsured people.