The Justice Department and HHS will try to cleanse Medicares billing system of infusion-therapy enterprises that are cheating the government in South Florida, where officials say the crime is rampant.
Within 30 days of receiving notice, all infusion providers must reapply for their billing privileges, and even sites that submit successful applications will be subject to site visits for further scrutiny. Medicare beneficiaries in the areaBroward, Miami-Dade and Palm Beach countieswill get more frequent statements and would be encouraged to report suspicious claims.
The program mirrors efforts to combat home health fraud in the Houston and Los Angeles areas and durable medical equipment providers in South Florida and Southern California. All of the initiatives are cast as demonstrations that could be duplicated elsewhere.
Alex Acosta, U.S. attorney for the Southern District of Florida, said in a news conference that the average infusion therapy tab for a patient in Florida is $16,000, compared with $2,000 in New York. The state has fewer HIV/AIDS patients than New York or California yet racked up several times as much as either state in Medicare claims for infusion therapy supposedly treating HIV/AIDS in 2004, according to HHS.
Acosta noted a dramatic increase in prosecutions of healthcare fraud as a result of a strike force of federal, state and local investigators. He announced charges filed against Rita Campos Ramirez, who operated a billing company for 75 infusion clinics. Campos, who prosecutors said has agreed to plead guilty, allegedly billed Medicare $170 million for infusions of HIV/AIDS medications in impossibly high amounts and received $105 million in payments. -- by Gregg Blesch
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