Miami Herald Editorial: Stop the Medicare scams

Aug. 16, 2009 — Some lucky ”patients” get flat-screen televisions as gifts from home care providers. It’s the cost of doing business in South Florida — Medicare fraud that’s robbing taxpayers hundreds of millions, even billions, of dollars.

This particular scheme involves home visits to inject insulin for elderly patients with diabetes — a rare service in most of the nation.

But not in Miami-Dade, where such services are out of control.

Many of these patients don’t have diabetes — they’re not even sick. They were created by crooked providers who bribe doctors for referrals and then pay Medicare patients a kickback — anything from cash, groceries or fancy TVs — to use their Medicare ID.

Now, finally, Medicare plans to step up its enforcement — not after millions of dollars have been stolen in false claims, but at the front end of the billing process. The government wants to cap Medicare payments to 10 percent of the bill for agencies treating homebound diabetics starting in January.

That approach requires careful vetting. It’s a way to control fraud, but it’s not fair to the real diabetics, relatively few in number, who simply cannot treat themselves. They should not pay the price for the greed of others.

It’s way past time to get serious about Medicare fraud, particularly as Congress considers healthcare reform. If Medicare is an example of how a public option for insurance might work, then the federal government must first clean up Miami-Dade, which has become ground zero for fraud. Most of these ”outlier patients,” as those who need the extra home visits are called, aren’t diabetic or if they are, they don’t need a nurse to inject them. They’re simply part of the scam.

Consider that nowhere else in the country are such billings as commonplace as in Miami-Dade even though there are fewer diabetic patients in this county by percent of population than in retiree-rich Palm Beach County or the Tampa Bay area. The average cost of home healthcare runs at $19,230 per patient in Miami-Dade. In Chicago, it’s $635.

The proposed national cap would save about $340 million a year in Miami-Dade — money that could be spent on truly sick patients.

Federal prosecutors have been cracking down on Miami-Dade’s $1.5 billion home health industry the past couple years. But until recently Medicare payments continued to flow to fraudulent providers because the government had only been checking suspicious claims after payments had been made and, often, the enriched scammers had fled.

Tougher scrutiny is warranted. The up-and-up providers that follow the rules and treat real patients will survive. For the others, good riddance.