Miami Medicare Fraud Bust Easily Tops July 2010 Net

Who knew Miami was the Medicare fraud capital of the country? An enormous net of Medicare malfeasance was cast, involving over 100 nurses, physicians, and executives colluding to nab over a quarter of a billion dollars from the feds — topping a July ’10 bust in that and other regions.

Special Agent in Charge John Gillies said Medicare should conduct comprehensive criminal background checks on providers, stop the practice of paying claims within 14 days, suspend payments for questionable charges, and change the system of using Social Security numbers for beneficiaries to prevent identity theft.

No truer (or more obvious) words will be spoken about this problem. You can also add to that: reining in the extremely dynamic nature of CMS oversight of criteria for payment, establishing strict criteria for contractors which are involved in payment processes and audit recoveries, and shoring up reporting processes to include specific state agencies (IG offices, for example) in order to streamline signal from noise. Of course, naked publicity of the nature surrounding this story always helps.