Physicians, Fraud & COPD

md.jpg There has been a substantial crackdown by federal and state authorities in Florida over the last several years with regard to Medicare and Medicaid payments related to respiratory conditions such as COPD. The enforcement has typically focused on the durable medical equipment (DME) providers. However, after a large number of indictments related to DME companies and with Medicare moving toward a bidding process for DME suppliers, the focus has been turning to the physicians who prescribe DME and the often expensive medications associated with respiratory illness. According to a recent report by Medicare (via the Miami Herald), there was some cause for concern.
“Although South Florida is home to 2 percent of the nation’s Medicare beneficiaries, the region accounts for 17 percent of the government program’s total spending on inhalation drugs because of potential fraud, a new federal study says. In 2007, Medicare spent $143 million on claims for drugs to treat respiratory ailments in Miami-Dade County, according to the report by the Department of Health and Human Services released Tuesday. That’s 20 times more than the amount Medicare spent in the Chicago area, which has twice as many beneficiaries.”
And this: “”In Florida alone, approximately 60 percent of the top 100 ordering physicians are the subject of administrative actions by [Medicare] or its contractors or are the subject of law enforcement investigations,” acting administrator Charlene Frizzera wrote Inspector General Daniel R. Levinson in March.
The Miami Herald has been doing a fantastic job in recent months reporting the recent health care fraud enforcement efforts. Click here for the full report.

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