Florida, one of the nation’s hotspots for Medicare and Medicaid fraud, is at particular risk as budget changes in Washington combine to force the layoff this year of 400 employees of the Inspector General’s office at the Department of Health and Human Services.
The Center for Public Integrity reports that the staff-shedding began in January and resulted in 1,200 complaints going without investigation last year. The sequester – automatic across-the-board cuts that went into effect because of Congress’ inability to resolve its internal disputes – is only part of the reason.
As the Center reports, the shedding of auditors and other investigative staff is penny-wise, pound-foolish because they recover an estimated $8 for every $1 they cost.
A good example of the kind of fraud that the investigators combat was on display last week as a jury in federal court in Miami convicted four top executives of Hollywood Pavilion of stealing $40 million from Medicare. As The Miami Herald reports, the CEO, chief clinical director and two others who ran the Broward psychiatric hospital and an outpatient center were convicted of conspiracy, health fraud, wire fraud and paying kickbacks.
Prosecutors said the hospital’s business model was to pay patient brokers to send phony “patients” for services. This was only the latest crackdown on operators of mental health facilities in South Florida. As the Herald reports, previous prosecutions have netted 80 clinic operators, doctors, therapists and patient recruiters from American Therapeutic, Biscayne Milieu and Health Care Solutions Network.