Negative reputations are hard to shake. And unfortunately, hard work isn’t enough to change it. That is what Florida is finding. Despite rolling out strike forces and using all available tools, South Florida still ranks as the nation’s de facto healthcare fraud capital. Medicare fraud permeates across the United States. Medical equipment scams involving knee and back braces continue to flourish. Billing schemes have exploded in the expanding field of telemedicine and genetic cancer testing. Large-scale hacks of hospitals and insurers for patient identities have resulted in the rampant theft of Medicare IDs sold openly on the internet. No state is left out. It just happens more in South Florida. Since 2007, at least half of all the Justice Department’s strike-force prosecutions of healthcare fraud were filed in South Florida.
Authorities say the root of the problem is Medicare’s “pay-and-chase” system, which involves paying claims from clinic owners, doctors and other medical professionals within thirty days and then pursuing them afterward if their bills look suspicious. “We’re doing our best to keep up and we’re dedicating significant resources to not only stop the bleeding, but to recover as much of the ill-gained funds as we can before it disappears,” said Lynnette Alvarez-Karnes, an FBI supervisory special agent who has been fighting healthcare-fraud rackets in South Florida for nearly 25 years. But once the money is cashed out, it’s hard to trace and recover it.
Another problem is the nature of Medicare fraud: It’s like a game of “Whac-a-Mole,” in which authorities can target one type of scammer who is overbilling for costly cancer drugs only to see other kinds pop up involving fraudulent claims for home insulin shots or COVID-19 testing during the pandemic. Is it strange that Medicare fraud is characterized by childhood games?
Shout out to the Florida Agency for Health Care Administration in their continual efforts to fight fraud. Fraud is never a fun game.
Today’s Fraud of The Day is based on article “As Medicare fraud spreads, SFla tops US for billions lost; some spent on Lambos and luxe watches” published by the Miami Herald on October 6, 2024.
U.S. Attorney General Merrick Garland announces on June 27, 2024, how 193 business operators, medical doctors and other licensed professionals were charged with submitting $2.75 billion in fake Medicare claims. Among those arrested over a two-week period were 38 people in South Florida.
For two decades the Justice Department has spent a sizable fortune cracking down on criminals ripping off Medicare, but the federal health insurance program still bleeds billions of dollars a year due to persistent fraud in Miami and other hot spots across the country.
