Medicare spending shifts suggest fraud migrates

Medicare expenditures on durable medical equipment and home health vary widely in contiguous Florida counties, according to a newly released Medpac report. Once again, Miami-Dade County has outdone itself. In this case, the report reveals that home health spending per capita in the county doubled to $5,318 between 2006 and 2008. Meanwhile, spending in nearby Broward grew by just 39 percent to $1,390, and Collier County saw home health spending climb by about 30 percent to $395.

"Variation at the level found in Miami-Dade cannot be explained by simple differences in practice patterns, prices or health status," the report says. "Rather, it is likely evidence of fraud, as is suggested by many OIG reports on the topic."

It's possible the trends in Miami-Dade DME and home health spending are evidence of the migration of healthcare fraud, the report suggests. DME spending for the county fell from $2,043 to $828 between 2006 and 2008.

Lewis Morris, chief counsel for HHS' Office of the Inspector General, recently testified that healthcare fraud migrates. As law enforcement cracks down on a particular sector, the criminals may shift where they commit fraud or even relocate geographically. For example, it's possible that suppliers who fraudulently billed for DME have shifted to fraudulent billing for home health services.

To learn more:
- read the Medpac report

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