Zealous Anti-Fraud Activities Reap Millions for Florida

TALLAHASSEE, Fla.–The U.S. Attorney ‘s Office for the Southern
District of Florida has filed 23 False Claims Act lawsuits against
clinics and DME companies, alleging some $30 million in fraudulent
Medicare claims.

The lawsuits are the latest move in “Operation Equity Excise,”
an anti-fraud effort undertaken by the U.S. Attorney’s Office, the
Department of Health and Human Services and the FBI in southern
Florida.

“Operation Equity Excise has already recovered more than $10
million in fraudulently paid health care claims,” said U.S.
Attorney Alex Acosta. “Through the 23 lawsuits … we hope to
recover an additional $30 million to help replenish the scarce
resources of the Medicare system.”

Government officials said they recovered $10.5 million in
fraudulent Medicare funds that were lodged in bank accounts. Many
of the accounts had been set up by nominee owners of clinics or DME
companies that were engaged in Medicare fraud, officials said. In
some cases, the companies had abruptly closed and abandoned the
bank accounts. In other instances, the signatories on the accounts
denied any knowledge of the companies and any claim to the
accounts.

When federal agents could not locate anyone who admitted having
any responsibility for the bank accounts or operation of the
businesses, investigation of those companies resulted in the
lawsuits.

“The amount of taxpayer money that is stolen by criminals
abusing the Medicare reimbursement system is substantial,
particularly in southern Florida,” said Jonathan Solomon, FBI
special agent in charge. “However, with the success of Operation
Equity Excise, we hope to continue recovering stolen funds. The FBI
has devoted significant resources to address health care fraud and
it will continue to be a top priority for the Miami FBI
office.”

Meanwhile, concentrated efforts by Florida fraud teams saved
Medicaid $37 million in avoided costs or overpayments during fiscal
year 2005-2006, according to a joint report by the Florida Agency
for Health Care Administration and the Office of Attorney
General.

Audits and investigations of more than 1,200 Medicaid providers
reaped another $28 million in overpayments, according to the
report. And more than $112 million was recovered in funds related
to claims in which a third-party payer, not Medicaid, was
responsible.

The 44-page report details efforts of AHCA’s Medicaid Program
Integrity and the Medicaid Fraud and Control Unit of the OAG to
harness the overpayments. “Close monitoring of Medicaid billing,
aggressive prevention measures and increased efforts to recover
overpayments have strengthened the state’s ability to combat fraud
and abuse more than ever before,” said Christa Calamas, AHCA
secretary.

MPI has employed a variety of prevention measures, including
prepayment reviews to identify improper claims and deny payment and
recommendations for termination of providers suspected of abusing
the Medicaid program. AHCA’s Division of Medicaid also has
implemented prevention initiatives ranging from provider site
visits to identifying payment errors and inappropriate billing,
according to the report.

Overall, the report said, 245 providers were placed on
prepayment review during the year, thus preventing $5.5 million
from being paid out to “abusive” providers, and 194 were
terminated.