Florida's Medicaid fraud investigator unit is faced with reduced budget because of the weakened economy
05 01 09 - 14:17
Medicaid fraud increasing throughout state, but economy forcing cutbacks in investigations
By LIZ FREEMAN
The state’s Medicaid fraud investigators have collected nearly $57 million this year in court judgments, fines and civil penalties as a result of probes to unravel wrongful billing and other fraudulent practices against the government insurance program, according to the Florida Attorney General’s Office.
A breakdown shows $51 million came from civil recoveries, including settlements to resolve whistleblower cases under Florida’s False Claims Act. Another $5.6 million was recovered from criminal cases.
The total recouped is less than the $70 million recovered last year. The fraud unit faced a reduced budget because of the weakened economy. The state Agency for Health Care Administration collaborates with the fraud team.
Florida’s Medicaid program provides medical care to the state’s neediest residents and is one of the largest state Medicaid programs in the United States. The program serves 2.1 million residents each month with $16 billion appropriated this year, according to the attorney general’s office.
Fraud in the program is rampant and is largely concentrated in South Florida. A state report in February said fraud, abuse and waste accounts for as much as 20 percent of Medicaid expenditures. The losses could be $2 billion a year.
The fraud unit’s probes are concentrated on false billing practices and patient abuse and neglect, with complaints serving as the basis of most investigations.
In Southwest Florida this past year, one case that captured attention involved the arrest of the owner of Collier Connections, a Naples company that served the developmentally disabled.
The owner, Timothy Timmer, 15340 Lattitude Drive, Bonita Springs, was arrested in late June for billing Medicaid for $45,000 more than three years for Medicaid services not provided, according to the attorney general’s office. His employee, Lisa Lewis, 2296 Clipper Way, also was arrested.
Both were charged with three counts of Medicaid fraud, one count of second-degree grand theft and two counts of third-degree grand theft. Their cases are pending in Collier County Circuit Court.
While much of the Medicaid fraud has occurred in South Florida, accounting for millions of dollars each year, the fraud team is beefing up efforts in Southwest Florida, said Victoria Heller, spokeswoman for the attorney general’s office.
“We have added additional staff to our office in Fort Myers, and consequently increased the number of our investigations and increased our recoveries in Southwest Florida,” she said.
How many fraud investigators are assigned to the Fort Myers office was not readily available.
In total, the Medicaid fraud team this year received 1,094 complaints statewide, a 20 percent increase from last year’s 911 complaints. Despite that, the fraud unit opened 377 investigations, a drop from last year’s 568 investigations. The decline is a result of a policy change to open an investigation only when something criminal or a civil infraction is suspected. Previously the state’s investigators would begin a new probe whenever possible.
“The (unit) has instituted an investigative strategy that insures the limited resources of the unit are effectively applied,” Heller said. “There is not any specific dollar amount below which our policy prohibits opening an investigation into a matter. All legitimate cases that come to the unit’s attention will be dealt with effectively. That may include a referral to (the state healthcare agency) for administrative action rather than civil or criminal action.”
Citizens also lodge complaints to the abuse hotline run by the state Department of Children and Families, with the fraud team reviewing 1,375 calls this year. Many of the calls concern abuse and neglect in nursing homes.
During the past year, the fraud unit closed 464 cases, where 289 cases involved Medicaid payment fraud and the remaining 175 cases involved abuse and neglect. A total of 62 cases were referred to criminal prosecution.