Traditional Medicine vs Modern Medicine

Citing Miami’s ignominious status as a national Medicare fraud “hot spot,’’ federal health officials Friday said they will temporarily ban new home health agencies in Miami-Dade and Monroe counties from enrolling in Medicare and Medicaid, in an effort to stem scams and abuse. It will freeze new and pending applications for home health agencies in the two South Florida counties and Chicago, and for ambulance providers in Houston. During the moratorium, officials with the federal Centers for Medicare & Medicaid Services will continue to monitor home health billing from enrolled providers to root out fraud, according to the agency’s announcement. Home health agencies provide nursing, physical therapy and other services to Medicare and Medicaid beneficiaries who are confined to their homes because of a disability or illness. The new moratorium also will apply to providers seeking reimbursement from the Children’s Health Insurance Program, known as CHIP. The moratorium does not apply to existing home health providers. CMS found that there were a disproportionate number of home health agencies relative to beneficiaries in Miami and Chicago. The ratio ranged from 327 percent higher in Chicago, to 1,960 percent higher in Miami. The Miami area, where schemes involving home health care, diabetic care, mental health and physical therapy fraud have flourished for years, has stood out as the nation’s epicenter of Medicare corruption. The U.S. Attorney’s Office routinely prosecutes high-profile cases of Medicare fraud. In May, a patient recruiter for a Miami home health agency was sentenced to 37 months in prison for his role in a $20 million Medicare fraud scheme. And in February, the owners and operators of two Miami home health agencies were sentenced to prison and ordered to pay millions in restitution for perpetrating a $48 million fraud on Medicare by billing for unnecessary services. Given the large number of elderly Medicare beneficiaries who live in South Florida, it’s not a surprise that the region is home to a large number of home health agencies. In 2008, Medicare paid $520 million to Miami-Dade home healthcare agencies for treating diabetic patients — more than what the agency spent on diabetics in the rest of the country combined, according to federal authorities. Federal officials identified Miami, Chicago and Houston as fraud “hot spots’’ by mining data that showed these cities as significant outliers compared to other areas of the country when it comes to home health providers and ground ambulance services.