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.