Fla. Senate Considers Bill to Combat Medicaid Fraud

Published June 1, 2009

Florida’s state Senate is considering legislation aimed at combating Medicaid fraud in Miami-Dade County.

Senate Bill 1986 focuses on home health care clinics in the county, where state auditors say a large amount of state Medicaid dollars are possibly being fraudulently claimed.

Although providing an accurate estimate of dollars lost to Medicaid fraud is almost impossible, “statistics show there may be a considerable amount of fraud within home health agencies in Miami-Dade County,” said Peter Williams, inspector general of the Florida Agency for Health Care Administration.

Numbers Don’t Add Up

“For example,” said Williams, “in fiscal year 2007-08 Florida spent $196.1 million on home health agency claims; $85.8 million, or 43.8 percent, of this was in Miami-Dade. But the Medicaid recipient population of Miami-Dade is only 20 percent of the entire state Medicaid population.”

Also, “the information about Medicaid dollars spent on unskilled home health aide visits, which include services like assistance with bathing or taking medications, is telling,” Williams said. “Florida spent a total of $62.9 million in 2007-08 on unskilled home health aide visits, of which $55.8 million was in Miami-Dade, or 88.7 percent.”

Renewed Interest in Accountability

“As the Florida legislature has faced a tight budget, legislators [have shown] a renewed interest in cutting down on Medicaid fraud,” Williams added. “There are about as many home health agencies in Miami-Dade County alone as in the entire state of California—and all these statistics suggest something fishy is going on.”

“Medicaid fraud in Florida has been a growing problem since the program’s inception in 1970, and it likely costs Floridians substantial tax money,” said Thomas Perrin, director of public affairs for the Tallahassee-based James Madison Institute.

Perrin continued, “SB 1986 contains many excellent provisions that increase the penalties for those caught committing fraud, provide immunity for persons reporting suspected fraud, and work to keep practitioners’ licenses in the hands of only those who deserve them.”

Strengthening Penalties, Oversight

Among other provisions, SB 1986 would establish stricter penalties for Medicaid fraud, including larger fines and more substantial sentencing; mandate prescriptions for home health agencies be written by a doctor and include specific diagnoses; and offer rewards and civil immunity to Medicaid fraud whistleblowers.

The bill also would bring Florida’s health claims policy in line with the federal equivalent, which would increase the state’s share of the federal-state split of recovered Medicaid funds from 50 to 60 percent.

Jillian Melchior ([email protected]) writes from Michigan. Joe Emanuel ([email protected]) writes from Georgia.

For more information …

Senate Bill 1986: http://www.flsenate.gov/session/index.cfm?BI_Mode=ViewBillInfo&Mode=Bills&ElementID=JumpToBox&Sub