WASHINGTON – If there ever was any question that Miami is the champ when it comes to health care fraud, a peek inside Medicare's list of banned providers should settle it.
Of all the people and businesses in the federal government's "exclusions database," Miami tops the list — by a long shot, according to a McClatchy analysis.
Of the medical providers in the database, 1,491 list Miami addresses. Second place: Los Angeles, with a relatively meager 522 names. They're followed by Phoenix, Brooklyn and Houston in the top five.
"Despite our measurable successes in combating fraud, South Florida continues to be a hot spot of health care fraud, and Miami is considered 'ground zero,' " Brian Martens, a federal health care fraud investigator responsible for combating Medicare crimes in Florida, recently told a Senate panel.
To help root out fraud and abuse, the federal government maintains a "list of excluded individuals/entities," aiming to provide information to the health care industry, patients and the public about people or businesses currently excluded from participating in Medicare, Medicaid and all other federal health care programs.
As of April, there were more than 57,000 entries on the list.
And more join each year. In fiscal 2013, a total of 3,214 names were added to the database, according to the annual report from the Department of Health and Human Services' inspector general. Of those, 1,132 were added because they'd been convicted of crimes related to Medicare or Medicaid, a higher level than at any time in the past 17 years for which records were available.
"A lot of this has to do with greater enforcement, but part also could be an increase in fraud itself," said Louis Saccoccio, the chief executive officer of the National Health Care Anti-Fraud Association. "In some places, you've seen an explosion in health care fraud: in Miami, Houston, Detroit, Southern California. And there is more aggressive law enforcement there. They're getting convictions, and they're getting exclusions."
In Florida, for example, one of the fraud exclusions took place on Feb. 20, 2013, representing one of the final steps in prosecuting a South Florida man who helped run a series of clinics that trafficked in oxycodone and oxymorphone, the powerful pain medications.
Juan De Dios Gomez owned and operated clinics in Hialeah, Miami and Plantation. Federal prosecutors say Gomez and his co-conspirators began their operation as early as November 2007. Physicians who worked at the clinics would prescribe the painkillers for people who didn't need the drugs but did qualify for Medicare or other health insurance plans.
Complicit pharmacies would fill the prescriptions, the insurance plans would be billed and the pills would be sold elsewhere.
Gomez pleaded guilty in 2012 and was sentenced to more than 16 years in prison; in 2013, he was kicked out of the Medicare program for a minimum of 50 years.
Why there's so much Medicare and Medicaid fraud in Florida is tough to determine. But the people who monitor the issue say it's always been so.
Sen. Bill Nelson, D-Fla., pointed to the large number of retirees in the state — "and so lots of Medicare."
He also mentioned the ability of long-criminal elements there, as for those anywhere, to change tactics.
"A lot of these criminals used to deal in drugs, and they were facing long jail terms," Nelson said. "Now they can use a variety of easier tools. Instead of sticking people up or breaking into their homes, they can use laptops. And because it's not violent crime, if they're caught they face shorter sentences."
