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.