OIG Targets FL Providers for Medicare Abuses

Cheryl Clark, for HealthLeaders Media , December 27, 2010

"South Florida is known for its susceptibility to Medicare fraud, particularly by DME suppliers," the report continued. "A previous Office of Inspector General (OIG) report identified potential fraud related to billings for budesonide (another inhaler drug) by South Florida suppliers." 

In September, 2008, a Medicare contractor implemented a computerized system, called an "edit" to detect and deny claims that exceed the maximum milligrams that a physician can safely prescribe to a beneficiary for budesonide, and the edit did decrease these billings by and Medicare payments to South Florida durable medical equipment suppliers.

"However, South Florida suppliers instead began billing for another brand-name inhalation drug, arformoterol.  The substantial difference between the sales data provided by arformoterol's manufacturer and the claims data for South Florida suppliers suggests that these suppliers were billing for drugs that may not have been actually purchased."

In the report that looked at questionable billing for outpatient therapy, the OIG said that Miami-Dade had "the highest average Medicare payments per beneficiary" and the highest total Medicare payments for outpatient therapy in the country in 2009. 

It then identified "six questionable billing characteristics that may indicate fraud."

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