Miami physicians sentenced for Medicare fraud

From BizJournals.com:

Two Miami physicians were sentenced to prison on Thursday for their roles in an HIV infusion scheme that defrauded the Medicare program out of $6.8 million.
A Miami federal court judge sentenced Carlos Contreras, 61, to three years and Ramon Pichardo, 58, to four years in prison. They also were ordered to repay $4.2 million in restitution to the Medicare trust fund.
Contreras and Pichardo each pleaded guilty to one count of conspiracy to commit health care fraud. Contreras was owner and a doctor at CNC Medical Corp. in Miami. Pichardo was a doctor there.
Contreras and Pichardo admitted that, between November 2002 and April 2004, they conspired with others to file $6.8 million in false claims to the Medicare program for HIV infusion services that were not provided or medically necessary.

Thirteen Recommendations for Eliminating Medicare Fraud

Medicare fraud schemes are very common in this day and age. The American Association for Homecare has announced 13 recommendations in this post that could potentially eliminate most of Medicare fraud that relates to the home medical equipment (HME) sector. This association works alongside with Congress to implement these recommendations to combat Medicare fraud.

Here are the recommendations set forth by the American Association for Homecare:

Mandate Site Inspections for All New Home Medical Equipment Providers
Require Site Inspections for All HME Provider Renewals
Improve Validation of New Homecare Providers
Require Two Additional Random, Unannounced Site Visits for All New Providers
Require a Six-Month Trial Period for New Providers
Establish an Anti-Fraud Office at Medicare
Ensure Proper Federal Funding for Fraud Prevention
Require Post-Payment Audit Reviews for All New Providers
Conduct Real-Time Claims Analysis and a Refocus on Audit Resources
Ensure All Providers Are Qualified to Offer the Services They Bill
Establish Due Process Procedures for Suppliers
Increase Penalties and Fines for Fraud
Establish More Rigorous Quality Standards

Dade County of Miami suspends some Medicare payments

According to the Miami Herald, the government is suspending payments to the top 10 home health care agencies suspected of Medicare fraud. Medicare is taking an offensive position to find fraudulent businesses, targeting suspicious claims, most having to do with treating diabetic patients at home. The suspension may last up to six months, and 6,500 patients will immediately be affected due to the the impact on skilled nursing visits. These patients will be transferred to other agencies. Read more about the investigation here.