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Report: Medicare overbilling rampant in South Florida HIV claims
  South Florida Business Journal - 4:54 PM EDT Wednesday, September 19, 2007 by Brian Bandell
The average beneficiary with HIV/AIDS in South Florida had nine times the average Medicare claims as beneficiaries in the rest of the county in the last half of 2006, a report by the Office of Inspector General for the Department of Health & Human Services showed.
Billing fraud was blamed for the inflated charges.
Miami-Dade, Broward and Palm Beach counties contain only 10 percent of the nation's Medicare beneficiaries with HIV/AIDS, but they billed Medicare for $487 million in the last half of 2006, compared to $489 million in Medicare billings for these patients in the rest of the country. South Florida beneficiaries also took up 79 percent of the billings for infusion drug treatments for the disease.
In most geographic areas, the drug claims represented 16 percent of total HIV/AIDS beneficiary charges, but drug claims took up 61 percent of the charges in South Florida.
The problem was actually worse in 2005, when the $2.5 billion in HIV/AIDS claims submitted by South Florida providers accounted for 72 percent of the national total.
"We recommend that the Centers for Medicare & Medicaid Services treat South Florida as a high-risk area and mandate site visits for certain types of providers before issuing provider numbers," Inspector General Daniel Levinson said. "Medicare continues to be highly vulnerable to fraud and abuse and immediate steps must be taken to protect the program and its beneficiaries."
In August, CMS started a demonstration project to counter infusion billing fraud in South Florida. Providers must resubmit applications to participate in Medicare to prove their qualifications and CMS will step up site visits. Medicare beneficiaries will get claims summary notices monthly, rather than quarterly.
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