Medicaid zeroes in on South Florida

Wednesday, September 2, 2009

TALLAHASSEE, Fla. - Florida in July cast a wide net over Medicaid fraud when it designated Miami-Dade County as a health care fraud crisis area.

But for legitimate providers, that designation could be a double-edged sword, said Sean Schwinghammer, executive director of the Florida Alliance of Home Care Services.

"We are very pleased that unethical providers are being shut down," he said. "But we've been in touch with the fraud and abuse liaison for Medicaid to see what we can do to make sure legitimate business aren't being harmed."

South Florida has a reputation for being a hotbed of fraud and abuse.

In June, the Agency for Health Care Administration (AHCA), which oversees Florida Medicaid, investigated 12 companies suspected of fraud connected to oxygen concentrators. Last year, Medicaid reimbursements for oxygen concentrators exceeded $1.4 million in Miami-Dade county--17% of the statewide total, said the agency in a press release.

The designation is part of a new law that went into effect July 1. The law also increases licensure requirements for HME providers and home health agencies, including additional financial documentation and a $500,000 surety bond for non-immigrant aliens. The law also creates new third-degree felony offenses for violations relating to providers.

"Medicaid has always been far more proactive with fraud than Medicare," said provider Raul Lopez, director of operations for Miami Lakes-based Bayshore Dura Medical. "The minute a provider spikes their billing number, (Medicaid's) got inspectors in their office the next week."