AP News Wire / South Florida called Medicare Fraud "Ground Zero'
Tony Barr
Description
Collection
Title:
AP News Wire / South Florida called Medicare Fraud "Ground Zero'
Creator:
Tony Barr
Date:
12/2/2005
Text:
Authorities vow crackdown on Medicare, Medicaid fraud By CURT ANDERSON
December 2, 2006
AP Legal Affairs Writer
MIAMI - South Florida was labeled ground zero Thursday for Medicare and
Medicaid fraud as state and federal authorities vowed to crack down on an
increasing number of crimes that cost taxpayers billions of dollars every
year.
Florida Attorney General Charlie Crist and U.S. Attorney R. Alexander Acosta
of Miami said their cooperative investigations so far this year have
produced charges in 28 cases totaling $20 million in Medicare or Medicaid
losses. Another $14 million in assets have been frozen in those cases.
But that's only the tip of the iceberg, said Michael Clemens, FBI special
agent in charge of the Miami field office. He estimated health care fraud
losses in southeastern Florida at $1 billion in 2004, one of the highest
amounts of any region of the country.
South Florida is ground zero for health care fraud, Clemens said at a news
conference.
Clemens said the FBI office in Miami has 30 agents devoted solely to health
care fraud cases, with 100 active investigations involving $3 billion in
losses. Crist said the state Legislature recently voted to add 50 new state
investigators to his office to work health fraud cases.
We're really ramping up to address this problem, Crist said.
Acosta also said that a quick-hit team of prosecutors and investigators
has been formed to focus on smaller fraud cases. If you engage in
small-time fraud, you're not going to fly below the radar screen, he said.
Medicare is the federal health program for the elderly, while Medicaid is a
federal-state program to provide care for the poor. Florida spends about $16
billion on Medicaid alone each year, Crist said.
The fraud cases take many forms. In one recent Miami case, patients were
recruited and then paid kickbacks to visit certain clinics where two doctors
allegedly would write unnecessary prescriptions for drugs that fight AIDS.
The prescriptions were filled under the Medicaid program, but the drugs were
then delivered to another pharmacy and resold at a profit.
Other South Florida cases involve false submissions for medical equipment,
stolen medical devices, claims for patients fitted with special orthotics
like custom shoe inserts and prosthetics that were false and illegal
distribution of prescription drugs.
Acosta said 17 percent of Florida's population is enrolled in Medicare or
Medicaid, one of the highest concentrations in the country. Crist said that
has drawn an increasing number of criminals.
They have taken the opportunity to go where there are massive dollars, he
said. That draw is there.
Miami U.S. attorney: < <URL Redacted>>
<URL Redacted>
Florida attorney general: <URL Redacted>
Sadly, neither the Florida O&P Licensure Board nor any of the national
professional, credentialing or industry trade associations , have been
effective in reducing the escalating fraud occuring in O&P in South Florida
or for that matter in the nation.
In particular recently targeted as fraud was the Palmetto GMS case that
rocked South Florida last May .
On May 10, 2005, the Miami Herald, Anatomy Of A Scandal (attached)
reported that federal prosecutors in Miami filed a civil suit against 48
small durable medical equipment businesses and the billing agency All-Med
Billing, a Miami Lakes firm operated by Abner and Mabel Diaz. The
prosecutors alleged that in 2004, the companies fraudulently billed the
Medicare program for $122 million for 21,000 amputees in Miami-Dade.
In her ruling, U.S. District Judge Cecilia M. Altonaga questioned why the
federal government had not also named Palmetto GBA (for Government Benefits
Administrator) for its failure to adequately monitor and analyze claims for
durable medical equipment. The article noted that Palmetto GBA was
identified in an April 2004 Government Accountability Office (GAO) report as
responsible for hundreds of millions of dollars of questionable expenditures
for expensive power wheelchairs. When the attorney for All-Med Billing
attempted to have Palmetto GBA added to the lawsuit, Palmetto attorneys
responded that the firm was statutorily and officially immune from
liability, and the judge agreed.
A subsidiary of
<blocked:: http://www.hoovers.com/blue-cross-&-blue-shield-of-south-carolina/
--ID__109455--/free-co-factsheet.xhtml> Blue Cross & Blue Shield of South
Carolina, Palmetto GBA oversees Medicare benefits for people in 16 states in
USA , most of which are in the Southeast and Midwest, as well as in Puerto
Rico and the US Virgin Islands. Palmetto GBA's services include the
processing and payment of health insurance claims, customer service support,
and payment safeguarding services that seek to eliminate Medicare abuse,
fraud, and waste. Palmetto GBA is one of the largest Medicare contractors in
the United States -- processing more than 125 million Medicare recipient
claims annually.
Palmetto GBA is going to argue that they are immune because they were acting
as agents of Medicare. My point is that they were not fulfilling their
legal obligation to detect fraud and Palmetto paid unregulated providers in
a regulated state for O&P services.
As prior appointee of the CMS Medicaid/Medicare Negotiated Rules Committee,
a amputee and full-time advocate for amputees and as a prosthesis wearer
myself, I am outraged that Palmetto GBA suffers no adverse consequences from
its failure to provide adequate monitoring services and oversight for the
payment of Medicare claims in the area of durable medical equipment. On its
website, Palmetto GBA says that it is responsible for preventing,
detecting, and deterring Medicare fraud and abuse. It states that Palmetto
GBA initiates appropriate administrative actions to deny claims, suspend
payments....
It is clear to me that Palmetto GBA does not fulfill this obligation. As a
result, fewer dollars are available to meet the needs of our state's
amputees. Fraudulent DME dealers are allowed to continue to steal
healthcare dollars from amputees and other Medicare patients. A noble,
however feeble attempt of determining recourse and resolution by
professional and industry leaders, via teleconference call last June, which
I participate in, was none effective. Leaders of the above organizations
concluded not to rock the boat by making formal complaints to CMS of
their a major Medicare contractor
<blocked:: http://www.hoovers.com/blue-cross-&-blue-shield-of-south-carolina/
--ID__109455--/free-co-factsheet.xhtml> Blue Cross & Blue Shield of South
Carolina, and its subsidiary Palmetto GBA, who oversees Medicare benefits
for people in in Florida and 15 other states in USA , regarding violations
in Florida's state licensure law and the subsequent fraud that evolved
This is not only about an investigation of a company, it's a investigation
of your credibility and professional ethics.
This is not the first investigation of this industry.
Last June , 2004 News Channel 4 Investigation reported Prescription For
Fraud.
The country's largest supplier of prosthetic limbs is facing investigation
for allegedly stealing from Medicare, Medicaid and insurance companies.
Multiple national class action lawsuits resulted yet no complaints nor
investigations by the industry or profession have been conducted.
Not one practitioner nor professional association filed a formal complaint
with the state attorney's office or the credentialing association whom
accredited the facility or the practitioner accused of forging thousands of
patient files or providing O&P services to beneficiaries that were
nonexistent.
Cross Credentialing was also evident in the case since the accredited
provider was not certified to provide prosthetic services.
Upon yours truly filing the only formal complaint, I was informed by the
credentialing association that their position is that they can not
restrict the free trade of a certified practitioner. If a person can legally
practice orthotics and or prosthetics without any qualifications in their
jurisdiction, we will not interfere with the right of a certified
prosthetist to perform orthotic work, so long as that person does not imply
that he/she is certified as an orthotist. The reverse holds true as well.
Both facility and practitioner continue to provide O&P services for Medicare
with restrictions.
There is an expression often used to identify some things, use it or lose
it . For this industry, to be even have a remote opportunity of ever
becoming recognized as a legitimate health care profession, each one of you
going to have to develop it, support it or you'll lose it.
To do anything less will not only take you down but the millions of
handicapped people that require and deserve competent O&P services as well.
It's the apathy by the leadership, members and the individual certifees of
these organizations that is most disturbing.
No formal complaints, discussion nor outrage on behalf of this group of 3500
plus certified professionals? has taken place of the recent case of a
major contractor and subcontractor to CMS nor a major supplier and provider
of O&P services presently under federal investigation. The blinders wont
work any longer!
I am interested in interviewing legal firms and bringing a lawsuit outside
the box to further expose this injustice and force CMS, Palmetto GBA (and
<blocked:: http://www.hoovers.com/blue-cross-&-blue-shield-of-south-carolina/
--ID__109455--/free-co-factsheet.xhtml> Blue Cross & Blue Shield of South
Carolina), and the OIG to better safeguard Medicare resources against fraud.
Please let confirm receipt of this e-mail and if you may have an interest in
pursing and protecting the integrity of your profession call or e-mail.
Anthony T. Barr
561-394-6514
December 2, 2006
AP Legal Affairs Writer
MIAMI - South Florida was labeled ground zero Thursday for Medicare and
Medicaid fraud as state and federal authorities vowed to crack down on an
increasing number of crimes that cost taxpayers billions of dollars every
year.
Florida Attorney General Charlie Crist and U.S. Attorney R. Alexander Acosta
of Miami said their cooperative investigations so far this year have
produced charges in 28 cases totaling $20 million in Medicare or Medicaid
losses. Another $14 million in assets have been frozen in those cases.
But that's only the tip of the iceberg, said Michael Clemens, FBI special
agent in charge of the Miami field office. He estimated health care fraud
losses in southeastern Florida at $1 billion in 2004, one of the highest
amounts of any region of the country.
South Florida is ground zero for health care fraud, Clemens said at a news
conference.
Clemens said the FBI office in Miami has 30 agents devoted solely to health
care fraud cases, with 100 active investigations involving $3 billion in
losses. Crist said the state Legislature recently voted to add 50 new state
investigators to his office to work health fraud cases.
We're really ramping up to address this problem, Crist said.
Acosta also said that a quick-hit team of prosecutors and investigators
has been formed to focus on smaller fraud cases. If you engage in
small-time fraud, you're not going to fly below the radar screen, he said.
Medicare is the federal health program for the elderly, while Medicaid is a
federal-state program to provide care for the poor. Florida spends about $16
billion on Medicaid alone each year, Crist said.
The fraud cases take many forms. In one recent Miami case, patients were
recruited and then paid kickbacks to visit certain clinics where two doctors
allegedly would write unnecessary prescriptions for drugs that fight AIDS.
The prescriptions were filled under the Medicaid program, but the drugs were
then delivered to another pharmacy and resold at a profit.
Other South Florida cases involve false submissions for medical equipment,
stolen medical devices, claims for patients fitted with special orthotics
like custom shoe inserts and prosthetics that were false and illegal
distribution of prescription drugs.
Acosta said 17 percent of Florida's population is enrolled in Medicare or
Medicaid, one of the highest concentrations in the country. Crist said that
has drawn an increasing number of criminals.
They have taken the opportunity to go where there are massive dollars, he
said. That draw is there.
Miami U.S. attorney: < <URL Redacted>>
<URL Redacted>
Florida attorney general: <URL Redacted>
Sadly, neither the Florida O&P Licensure Board nor any of the national
professional, credentialing or industry trade associations , have been
effective in reducing the escalating fraud occuring in O&P in South Florida
or for that matter in the nation.
In particular recently targeted as fraud was the Palmetto GMS case that
rocked South Florida last May .
On May 10, 2005, the Miami Herald, Anatomy Of A Scandal (attached)
reported that federal prosecutors in Miami filed a civil suit against 48
small durable medical equipment businesses and the billing agency All-Med
Billing, a Miami Lakes firm operated by Abner and Mabel Diaz. The
prosecutors alleged that in 2004, the companies fraudulently billed the
Medicare program for $122 million for 21,000 amputees in Miami-Dade.
In her ruling, U.S. District Judge Cecilia M. Altonaga questioned why the
federal government had not also named Palmetto GBA (for Government Benefits
Administrator) for its failure to adequately monitor and analyze claims for
durable medical equipment. The article noted that Palmetto GBA was
identified in an April 2004 Government Accountability Office (GAO) report as
responsible for hundreds of millions of dollars of questionable expenditures
for expensive power wheelchairs. When the attorney for All-Med Billing
attempted to have Palmetto GBA added to the lawsuit, Palmetto attorneys
responded that the firm was statutorily and officially immune from
liability, and the judge agreed.
A subsidiary of
<blocked:: http://www.hoovers.com/blue-cross-&-blue-shield-of-south-carolina/
--ID__109455--/free-co-factsheet.xhtml> Blue Cross & Blue Shield of South
Carolina, Palmetto GBA oversees Medicare benefits for people in 16 states in
USA , most of which are in the Southeast and Midwest, as well as in Puerto
Rico and the US Virgin Islands. Palmetto GBA's services include the
processing and payment of health insurance claims, customer service support,
and payment safeguarding services that seek to eliminate Medicare abuse,
fraud, and waste. Palmetto GBA is one of the largest Medicare contractors in
the United States -- processing more than 125 million Medicare recipient
claims annually.
Palmetto GBA is going to argue that they are immune because they were acting
as agents of Medicare. My point is that they were not fulfilling their
legal obligation to detect fraud and Palmetto paid unregulated providers in
a regulated state for O&P services.
As prior appointee of the CMS Medicaid/Medicare Negotiated Rules Committee,
a amputee and full-time advocate for amputees and as a prosthesis wearer
myself, I am outraged that Palmetto GBA suffers no adverse consequences from
its failure to provide adequate monitoring services and oversight for the
payment of Medicare claims in the area of durable medical equipment. On its
website, Palmetto GBA says that it is responsible for preventing,
detecting, and deterring Medicare fraud and abuse. It states that Palmetto
GBA initiates appropriate administrative actions to deny claims, suspend
payments....
It is clear to me that Palmetto GBA does not fulfill this obligation. As a
result, fewer dollars are available to meet the needs of our state's
amputees. Fraudulent DME dealers are allowed to continue to steal
healthcare dollars from amputees and other Medicare patients. A noble,
however feeble attempt of determining recourse and resolution by
professional and industry leaders, via teleconference call last June, which
I participate in, was none effective. Leaders of the above organizations
concluded not to rock the boat by making formal complaints to CMS of
their a major Medicare contractor
<blocked:: http://www.hoovers.com/blue-cross-&-blue-shield-of-south-carolina/
--ID__109455--/free-co-factsheet.xhtml> Blue Cross & Blue Shield of South
Carolina, and its subsidiary Palmetto GBA, who oversees Medicare benefits
for people in in Florida and 15 other states in USA , regarding violations
in Florida's state licensure law and the subsequent fraud that evolved
This is not only about an investigation of a company, it's a investigation
of your credibility and professional ethics.
This is not the first investigation of this industry.
Last June , 2004 News Channel 4 Investigation reported Prescription For
Fraud.
The country's largest supplier of prosthetic limbs is facing investigation
for allegedly stealing from Medicare, Medicaid and insurance companies.
Multiple national class action lawsuits resulted yet no complaints nor
investigations by the industry or profession have been conducted.
Not one practitioner nor professional association filed a formal complaint
with the state attorney's office or the credentialing association whom
accredited the facility or the practitioner accused of forging thousands of
patient files or providing O&P services to beneficiaries that were
nonexistent.
Cross Credentialing was also evident in the case since the accredited
provider was not certified to provide prosthetic services.
Upon yours truly filing the only formal complaint, I was informed by the
credentialing association that their position is that they can not
restrict the free trade of a certified practitioner. If a person can legally
practice orthotics and or prosthetics without any qualifications in their
jurisdiction, we will not interfere with the right of a certified
prosthetist to perform orthotic work, so long as that person does not imply
that he/she is certified as an orthotist. The reverse holds true as well.
Both facility and practitioner continue to provide O&P services for Medicare
with restrictions.
There is an expression often used to identify some things, use it or lose
it . For this industry, to be even have a remote opportunity of ever
becoming recognized as a legitimate health care profession, each one of you
going to have to develop it, support it or you'll lose it.
To do anything less will not only take you down but the millions of
handicapped people that require and deserve competent O&P services as well.
It's the apathy by the leadership, members and the individual certifees of
these organizations that is most disturbing.
No formal complaints, discussion nor outrage on behalf of this group of 3500
plus certified professionals? has taken place of the recent case of a
major contractor and subcontractor to CMS nor a major supplier and provider
of O&P services presently under federal investigation. The blinders wont
work any longer!
I am interested in interviewing legal firms and bringing a lawsuit outside
the box to further expose this injustice and force CMS, Palmetto GBA (and
<blocked:: http://www.hoovers.com/blue-cross-&-blue-shield-of-south-carolina/
--ID__109455--/free-co-factsheet.xhtml> Blue Cross & Blue Shield of South
Carolina), and the OIG to better safeguard Medicare resources against fraud.
Please let confirm receipt of this e-mail and if you may have an interest in
pursing and protecting the integrity of your profession call or e-mail.
Anthony T. Barr
561-394-6514
Citation
Tony Barr, “AP News Wire / South Florida called Medicare Fraud "Ground Zero',” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/225786.
