Florida Medicaid Probes Oxygen Providers

MIAMI — Florida’s Agency for Health Care Administration said
last week it is zeroing in on home oxygen providers suspected of
defrauding the Medicaid program.

“Investigators have found that Medicaid paid for equipment that
is missing, unused or was never received by the patient,” an
AHCA press release announced. As well, some
beneficiaries may have received kickbacks from providers, officials
said.

Holly Benson, secretary of AHCA, told reporters at a press
conference on Thursday that a team of state investigators conducted
site visits at 12 providers and visited more than 120 beneficiaries
who had received oxygen concentrators in Miami-Dade County. Now
they will evaluate the results to figure out whether the
discrepancies are the result of billing errors, abuse of the system
or Medicaid fraud.

AHCA focused on oxygen providers because concentrators were
Florida’s top durable medical equipment expenditure. The Miami-Dade
County area was targeted because of its high reimbursement levels
for oxygen concentrators, Benson said. Last year, Medicaid
reimbursements for concentrators tallied more than $1.4 million in
the county, about 17 percent of the statewide total of $8.5
million.

In all, Medicaid spent $90 million in 2008 on HME for 150,000
beneficiaries, according to ACHA.

“As the cost of health care continues to rise, it is important
that we ensure the integrity of the Medicaid program stays intact,”
Benson said. The goal of the investigation, she continued, is to
ensure that appropriate services are being delivered and billed
correctly, as well as to determine that beneficiaries have been
trained how to use their equipment.

The Miami-Dade investigation follows another earlier this month
that focused on the Tallahassee area and Escambia County.

“Escambia County was targeted for the current investigation
because it ranks seventh in the state in billing for oxygen
concentrators, even though its Medicaid population represents only
a small percentage of total recipients,” according to an AHCA
release.

Last Monday, Florida Gov. Charlie Crist signed a bill declaring
Miami-Dade a crisis area for health care fraud and tightening
regulations on home health agencies, HME providers and health care
clinics.

In May, the federal government announced a new Health Care Fraud Prevention and
Enforcement Action Team that will increase anti-fraud
enforcement efforts in Miami and Los Angeles.