South Florida bills billions for HIV

Doctors and clinics in three South Florida counties account for most of the billions of dollars charged to Medicare nationwide for HIV and AIDS drugs and services, billing records show.

Federal health care regulators call the lopsided billing patterns “egregious” and warn that South Florida — particularly Broward, Miami-Dade and Palm Beach counties — is a potential hotbed for health care fraud, waste and abuse.

“It”s all ultimately part of the money-driven, underground economy in Miami,” said Benson B. Weintraub, a health care fraud lawyer based in Fort Lauderdale.

According to a report this week by the Inspector General for the U.S. Department of Health and Human Services, health care providers in Broward, Miami-Dade and Palm Beach submitted $2.5 billion in claims to Medicare on behalf of HIV/AIDS patients in 2005.

By contrast, providers in the rest of the country submitted less than $1 billion in claims combined.

Suspected scams, which involve the recruitment of patients, kickbacks and unnecessary medical services, aren”t limited to HIV clinics.

In March, federal inspectors found dozens of wheelchair and electric scooter suppliers in Florida that ran afoul of federal rules, including phantom operations that billed the government but had no bricks-and-mortar locations.

“Medicare continues to be highly vulnerable to fraud and abuse and immediate steps must be taken,” Inspector General Daniel R. Levinson said of his office”s findings.

Mr. Levinson”s report also found that Medicare officials and contractors could not provide a “clinical explanation” for the high level of billing.

One common HIV/AIDS scam involves doctors and clinics employing “runners” who recruit HIV and AIDS patients, then pay kickbacks if patients get unneeded medical treatment. In turn, crooked providers bill Medicare for the services.

After getting shut down, some providers open different clinics under a new corporate name.

In a written response to Mr. Levinson”s report, Herb B. Kuhn, acting deputy administrator for Centers for Medicare and Medicaid Services (CMS), said Medicare officials have taken “aggressive recent actions” to crack down on fraud.

Though provider billings for HIV/AIDS in Southern Florida have increased from $1.5 billion in 2004 to $3.3 billion in 2006, CMS is getting tougher scrutinizing claims before providing reimbursement, Mr. Kuhn wrote.

In 2004, he wrote, Medicare reimbursed 66 percent of all claims and paid out $1 billion. But in 2006, CMS paid $890 million, approving just 27 percent of all claims submitted.

“In fact, many of the providers with aberrant billing activity … were referred to law enforcement and are now facing prosecution,” Mr. Kuhn wrote.

Story Continues →