Welcome to Hialeah, HME capital of America

Tuesday, February 28, 2006

HIALEAH, Fla. - Hialeah, Fla., is the HME capital of America. The U.S. zip code with the greatest number of DMEPOS suppliers -- 33012-- is in Hialeah: 108 suppliers are active in that zip code, according to a National Supplier Clearinghouse database.
Hialeah includes two other zip codes that are among the top 10 most active in terms of the number of DMEs doing business there. Hialeah Gardens (33016) is home to 61 suppliers. Fifty HMEs work out of Hialeah zip code 33010.
If you add up all the DMEPOS suppliers in the NSC database, which was most recently updated in September, you'll find there are 260 DMEPOS suppliers in this city of 224,522. This overwhelming density is not lost on people working in Hialeah.
"I'd say I'm no more than 30 feet from the nearest competitor," said Carlos Rebenga, of Rapid Medical Services in zip code 33012. "We are one warehouse apart."
So what the heck is going on in Hialeah? And is this concentration all that unusual when you factor in the demographics? Well, yes.
Nationally, there's about one DMEPOS supplier for every 320 seniors over the age of 65. In Hialeah, with an over-65 population of about 36,000, there's one DMEPOS supplier for every 138 seniors. That means Hialeah has more than two times as many HME suppliers servings its seniors as the country on average.
Medicare knows this. Their contractor compiled the data. Last month, Medicare surveyors were going door-to-door in Miami-Dade County, inspecting DMEPOS supplier compliance with Medicare's standards.
"They wanted the usual things. A certificate of liability insurance, and so on," said Bob Lichtenstein, president of Hollywood Medical Supply in Hollywood, who recently answered the door to a surprise visit from a surveyor.
Presumably, the same Medicare team is likely to survey Hialeah, a Miami suburb known for its warehouses and high concentration of Cuban immigrants. In fact, in addition to holding the number-one spot for the greatest concentration of HMEs, Hialeah ranks first on America's list of cities where Spanish is spoken. About 89% of the Hialeah's population speaks Spanish as a first language.
More than 90% of the population is Hispanic, and 72% is foreign born.
The high percentage of Cubans helps explain why there are so many HME suppliers in Hialeah, according to Javier Talamo, a one-time HME owner, now a healthcare attorney, and a lifelong Hialeah resident.
"Cuban immigrants always try to get their own business," he said. "They'll have a little warehouse and they'll make enough just to live on. You could have a HME with a relationship with two or three doctors, and that's it.
The nationals aren't making many inroads in Hialeah, according to Talamo, because they don't speak the same language. The small, locally owned HME suppliers do.
Historically, Hialeah churned out garments for the clothing industry and staffed its factories with immigrants who fled Cuba's Fidel Castro. The young immigrants of the 1960s are now elderly and still loyal to friends and family, says Talamo.
In 2004, the NSC identified 208 active HME suppliers in Hialeah. An HME is considered active if it has filed a claim for reimbursement with Medicare in the one of the last four quarters. In zip code 33012, there were 77 HME suppliers in the 2004 compilation, In a single year, the NSC tally inexplicably jumped by 40% in Hialeah's 33012, though presumably the demographics hardly changed.
HME News tried to contact more than a dozen HME suppliers with Hialeah zip codes for this report. Many listed phone numbers actually turned out to be fax numbers, or numbers out of service. Despite the NSC tally, some say the churn in Hialeah is huge.
"About five or six years ago, I had 100 different dealers that hadn't paid their bill," said Norm Grunst, a distributor with AAA Medical Supplies in neighboring Miami. "I checked with 22 to 23 of them. They were all in Hialeah, and they had all closed their doors."
Historically, Miami-Dade County flares across the nation's stage as a hotbed of Medicare fraud and abuse. Last summer, a jury found several Hialeah residents affiliated with Ocean Medical Supplies guilty of a $10 million fraud scheme. Last June 21, several HME scam artists met at a Hialeah gas station to launder money in a fraud scheme that has since landed them in jail. There was a $4 million fraud scheme at a Hialeah rehab clinic in 2002.
Legitimate suppliers hate the taint of that reputation.
"One of the largest fraud rings was Wheeler Dealer in Texas," said Raul Lopez, president of FAMES and director of operations at Bay Shore Medical in Miami. "People forget about the Medicare fraud in New York and tend to focus here."