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Medicare oversight must improve, U.S. attorney tells Senate

South Florida's reputation as the capital of Medicare fraud came under the congressional spotlight Wednesday with U.S. Attorney R. Alexander Acosta telling a Senate panel the best tool for fighting scams is tightening oversight at the top.

Acosta, who since 2006 has prosecuted more than 700 people responsible for more than $2 billion in fraudulent Medicare billings, told the U.S. Senate Special Committee on Aging that he started focusing on fraud because he was "absolutely disgusted" by the level of scams in South Florida.

But he told the Senate panel that prosecutions aren't the solution.

"If one wants to prevent traffic accidents, one puts up red lights, one puts up stop signs, one has good rules of the road that prevent accidents in the first place," he said. "The same applies for healthcare fraud. With additional resources my office could easily double or triple prosecutions . . . but the best way by far to prevent fraud in the first place is to improve the rules of the road."

He called for changes at the Centers for Medicare and Medicaid Services "to ensure rapid payment, yet at the same time identify and deny fraudulent bills."

And he noted that as South Florida prosecutors crack down on fraudsters, they tend to migrate elsewhere. He said the Tampa and Orlando districts have noticed a spike in fraud and that he has been told Atlanta "has seen an increase as people leave South Florida and set up shop elsewhere."

Acosta suggested some fixes could be "common sense solutions."

He said he has directed his prosecutors to look for suppliers who provide medical equipment to a substantial number of patients who don't live near the supplier, "in the theory that most people don't travel a few hundred miles for an inhaler or wheelchair."

Florida Sen. Mel Martinez, the top Republican on the panel, noted that it was "embarrassing" that some of the most egregious cases of fraud originate in Florida. Noting South Florida was "unfortunately a leader in many kinds of fraud," Acosta said the scams are not confined to South Florida: "When changes are going to be made, they should go beyond South Florida," Acosta said. "It's a problem in Florida, but in part because we are doing so much the problems have been identified. It has to be a nationwide set of solutions."

James Frogue, project director for the Center for Health Transformation, a project launched by former House Speaker Newt Gingrich, noted that Miami-Dade County has 897 licensed home health agencies – more than the entire state of California. And in New York, he said, 55 men got maternity benefits over a two-year period.

Martinez has filed two bills aimed at cracking down on fraud, by, among other provisions, eliminating the use of Social Security numbers for Medicare beneficiaries and putting billing statements under increased scrutiny.

Daniel R. Levinson, inspector general at the U.S. Department of Health and Human Services, told the panel that healthcare attracts fraudsters because the penalties are lower than for other criminal offenses, schemes are easily replicated and there is a perception they won't be caught.

"We need to alter the criminals' cost-benefit analysis by increasing the risk of swift detection and the certainty of punishment," Levinson said.

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