HHS Inspector General Daniel Levinson is recommending that the CMS treat South Florida as a high-risk area for Medicare fraud and abuse with mandated site visits for certain types of providers before issuing provider numbers.
The recommendation is based on a quantification of the disproportionate number of claims that are submitted to Medicare for payment of services for beneficiaries with HIV/AIDS in three South Florida counties, according to a news release. The three counties accounted for 50% of the nationwide charges and 37% of nationwide services between July and December 2006 although only 10% of Medicare beneficiaries with HIV/AIDS live in the three counties.
Drug claims represented 16% of submitted charges elsewhere, but 61% in South Florida. The inspector general's office said the average submitted charges per beneficiary with HIV/AIDS in South Florida were approximately nine times those in the rest of the country. Whats more, the office found that in the second half of 2006, 38% of total charges providers in the three counties submitted to Medicare were for HIV/AIDS patients, compared with fewer than 3% of providers submitted charges elsewhere in the country.
Medicare continues to be highly vulnerable to fraud and abuse, and immediate steps must be taken to protect the program and its beneficiaries, Levinson said in the news release. -- by Cinda Becker