Special Reports

MIAMI (CBS4 I-TEAM) ― Now to an I-Team investigation into your money: The federal government says if you live in South Florida and you're a taxpayer, you're supporting more Medicare fraud than the rest of the nation combined.

I-Team Investigator Stephen Stock has been leading this examination into the theft of 60 billion Medicare dollars.

Sixty billion dollars means about $200 dollars in tax dollars paid for every man, woman and child in the United States.

The report from the Office of Inspector General for the U.S. Department of Health and Human Services says the raw data shows that the fraud all starts in Miami-Dade County.

"South Florida is ground zero (for Medicare fraud,) said Omar Perez, a special agent for the US Department of Health and Human Services' Office of Inspector General's, Office of Investigations.

"It's where it (Medicare fraud) is developed, where it's tested, and once it's proven, (it is the origin of what) ships out to other parts of the country," Perez said.

That's what federal investigators on the streets have been saying for months about Medicare fraud in South Florida.

Now a report issued by the Department of Health and Human Services' Office of Inspector General (HHS OIG), in Washington, confirms it with raw numbers.

According to the report, "In 2008, Miami-Dade County Accounted for 52 % of the approximately $1 Billion Medicare paid nationally in home health outlier payments, while only 2 percent of all Medicare beneficiaries receiving home health services reside there."

"Miami-Dade has approximately 2% of the Medicare population, yet more than half of the payments went to that single county," said Stuart Wright, Deputy Inspector General for the Office of Evaluation and Inspections for HHS' OIG.

"Similar billing patterns were occurring in 23 other counties nationally. Although not to the same extent as Miami-Dade County," said Wright.

By crunching the numbers, the Inspector General found unusual or higher than normal Medicare home health payments for cases of individuals in extremely poor health, called outliers.

The Health and Human Service's OIG report found that "Miami-Dade County accounted for more home health outlier payments in 2008 than the rest of the Nation combined."

According to the report, the average outlier payment to a Medicare Provider was 14.28% times the National Average. And the average payments to individuals in Miami-Dade County were 31.56% more than the national average to individuals.

You can read the entire report by clicking here.

"It tells you that something is going on that warrants further investigation," said Wright.

"It (the data) suggests that something problematic is occurring (in Miami Dade)."

According to the OIG report, the biggest single medical issue where abuse appears to be rampant was the medical diagnosis or misdiagnosis of diabetes.

That confirms what theI-Team first reported. The I-Team talked to a man who once served as a Medicare recruiter, what is called on the street a "providores", who would recruit and drive elderly Medicare patients to clinics that pay them to "play the system", to appear to become diabetic. When the patient appeared to become diabetic, the clinic would then bill Medicare even more than usual because of the diabetic condition. The clinic would get payments for fraudulent services for a condition the patient did not have.

The former "providores" asked to remain anonymous for fear he might be harmed by those he used to work for, perpetuating this scam.

"Here's how it worked," said the former "providores": "You would go to an elderly patient and say 'I've got a deal for you.'"

The "providores" went on with his description.

He would tell the potential Medicare patient "I'm going to give you a thousand dollars a month. (All you have to do is) just drink a little malt in the morning and a little condensed milk and we'll get you to be a diabetic," the "providores" said.

"Some people don't agree to it (the scam) but 70% do agree to it. And they'll go and take the test, and the doctor will see them, and the sugar level is way up there," said the "providores."

The HHS Inspector General's report shows that in 2008, Miami-Dade County's questionable diabetes payments were eight times the national average.

In all, Miami-Dade County accounted 67% of ALL questionable National Home Health Medicare Payments of $1 million or more.

"Clearly there is a problem with fraud in South Florida," said Deputy Inspector General Stuart Wright. "The analysis of the home health care outlier payments suggests that that area in particular needs to be addressed."

The HHS's Inspector General is calling on changes to the rules to prevent this.

The report makes three recommendations to the group that oversees Medicare and issues Medicare payments, which the Inspector General suggests might help fix the problems:

1) Continue with efforts to institute a cap on total outlier payments
2) Review home health care providers that exhibit aberrant outlier payment patterns
3) Continue with efforts to strengthen enrollment standards for home health care providers to prevent illegitimate home health care agencies from obtaining billing privileges

In its report the Inspector General identified 33 home health care providers here in Miami-Dade that officials will be investigating further.

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