Florida Fraud Squads Protect Seniors From Medicare Scams

Back in the 1980s, the words FBI, sting, and Miami conjured up images of Colombian cartels and suitcases full of unmarked bills.

Today, the more appropriate picture might be one of tongue depressors, stethoscopes, and X-rays. Here in a state that is often seen as a haven for the elderly, big FBI stings that used to target drug cartels and corrupt bankers are now targeting complex health-care scams that are sapping the nation's Medicare system.

In Florida, roughly 10 percent of the $16 billion that the state received for Medicare last year is lost when doctors and health-care organizations inflated bills or charged the government for care they didn't give. But Florida is fighting back. State and federal agencies nationwide are cracking down on health-care fraud more than any time in history, and the Sunshine State is leading the way by increasing the number of agents on the beat and tracking down offenders more vigorously.

"At last the FBI and interrelated government agencies are seeing that the caliber of crime is important enough to devote this type of resources," says Michael Papantonio, whose Pensacola law firm formed an investigative unit to find Medicare fraud. "For the first time they understand that it can wreck the entire Medicare program."

Indeed, new health-care fraud units in US attorneys' offices in Florida are tackling a growing number of Medicare fraud cases. The office in Tampa, for instance, has also prosecuted 26 cases, put 15 people behind bars, and got back nearly $37 million in fraudulently claimed Medicare dollars during the past two years. Recently, it also secured the first indictment in the ongoing investigation into health-care giant Columbia HCA Healthcare Corp.

Florida's aggressiveness reflects a commitment on the national level. Attorney General Janet Reno has made whittling the $23 billion Medicare loses to fraud every year a priority. A big push came last year when Congress allocated $104 million to investigating and prosecuting Medicare fraud - more than ever before. "It's amazing the amount of increased resources we've gotten," says Assistant US Attorney Adrienne Rabinowitz in Miami.

Florida has always been considered fertile ground for fraud because of its elderly population and Medicare dollars. Today, it has 2.6 million Medicare enrollees, almost 7 percent of the national total. But it wasn't until recently that the government started paying attention.

"People realized you can make a lot of money and the chances of being caught are very slim," says Ms. Rabinowitz. "It was worth the gamble." In the early '90s, it wasn't uncommon to see vans picking up seniors off the street and offering them money to go and have blood tests done.

Much of the government push is motivated by money. The Department of Health and Human Services estimates it recovers $23 for every $1 spent on fighting abuse in home health-care agencies and nursing homes. Wanting a piece of that money, a growing number of whistleblowers have cropped up to help the government root out fraud. If the government gets involved in their cases and wins, informants can be awarded up to 30 percent of the fines, with the average reward being $200,000.

At Michael Papantonio's law firm in Pensacola, 40 people call every day - from billing clerks to radiologists - reporting questionable practices in their hospitals, labs, and ambulance firms. "There's more fraud in Florida than anywhere we've seen," says Papantonio, whose firm this year has investigated 127 "solid" cases, he says. "Three years ago, we'd be amazed if we had 85."

Florida's legal record on fraud cases is impressive. "But what's important is how the health-care providers are responding to it," says Jean Damirgian, the first prosecutor to tackle health fraud full time in Miami. The crackdown has "put the health-care community on notice that anything and everything they do could - and probably will - come under scrutiny."

Those in the health-care field, however, say they are under siege. They condemn the government's attempt to criminalize what in the past might have passed for billing errors. "To make everything illegal across the board is a problem," says James Blumstein, director of Vanderbilt University's Health Policy Center.

Still, many observers welcome the government's aggressiveness. The scams and schemes, particularly in Florida, are getting ever more sophisticated, and Malcolm Sparrow, author of "License to Steal: Why Fraud Plagues America's Health Care System," predicts that Florida will remain the focus of attention. "I hope ... we can sustain the momentum the government has built," he says. "The health care industry has been able to bill whatever it likes for too long without any attention to morality or truthfulness."