The high price of Medicare fraud

A Times Editorial
The high price of Medicare fraud
In Print: Sunday, December 27, 2009


--------------------------------------------------------------------------------


Some scoffed when President Barack Obama said part of the cost of health care reform could be covered by eliminating fraud in the system. But each arrest made by the federal Medicare Fraud Strike Force illuminates how extensive the bogus billing schemes can be. Rooting out that fraud is key to cutting health care costs.

Federal agents swooped into Detroit, Brooklyn and Miami recently to break up schemes the government said had defrauded Medicare of $61 million. They arrested 30 people, including doctors and nurses.

This month, the U.S. Department of Health and Human Services Office of Inspector General reported it suspected South Florida providers were fraudulently collecting Medicare reimbursement for treatment of home-bound diabetes patients that was either not delivered or was medically unnecessary. Statistics were the tip-off: In 2008, Miami-Dade accounted for more than half of the $1 billion Medicare paid nationally for home treatment of people with diabetes and related illnesses, yet the county has only 2 percent of the nation's qualifying diabetic patients. The federal government also stopped reimbursing a Miami psychiatrist who wrote nearly 97,000 prescriptions to Medicaid patients over a period of 18 months, nearly twice the number of the second-highest prescriber in Florida.

With providers under scrutiny in Miami-Dade, the Medicare Fraud Strike Force is expanding its reach to Tampa, where it has discovered similarly suspicious statistics. The strike force, created in 2007, claims to have targeted 257 people in a handful of cities who allegedly falsely billed Medicare for $600 million.

That's likely just the tip of the iceberg. Fraud at such a scale impacts the solvency of the Medicare system and enriches criminals with money that could be used to treat the sick. Stopping it is part of the solution to the country's health care crisis.



[Last modified: Dec 26, 2009 03:30 AM]

http://www.tampabay.com/opinion/editorials/the-high-price-of-medicare-fraud/1061066