Florida’s Lee County Will Be Forum For Medicaid Fraud Crackdown

Florida has remained a hub for Medicaid fraud, especially fraud in home healthcare services. An anti-fraud program launched in Miami-Dade to crack down on the problem of Medicaid fraud will now expand to Lee County and 33 other Florida counties.

Florida Program will Monitor for Medicaid Fraud.

The program requires nurses and home healthcare aides to call a toll-free number when they arrive and when they leave a patient’s home. The toll-free number will be associated with a particular home healthcare agency, and the employee will enter a unique staff identification number and will be matched to their number by a voice-verification program.

The purpose of the crackdown is to decrease spending on Medicaid fraud. Miami-Dade had a 50 percent reduction in Medicaid expenditures, so that $23 million was saved in that county alone. There is hope that the program will have a similar effect in other counties as it spreads.

But there is a second goal as well: to ensure that Medicaid patients are receiving adequate medical care as prescribed by their doctor. One of the most common forms of Medicaid fraud is to bill for services that are not provided. This means overbilling for Medicaid, and it also means a lack of adequate care for patients.

According to Naples News, however, not everyone is confident about the effectiveness of the new program. An administrator at Health Force, a home healthcare agency that primarily serves children with special medical needs, was involved in a similar monitoring program a decade ago. She describes that program as a disaster. She doesn’t see how it could work better now, when many clients don’t keep landline telephones and may not want staff to use their personal phones or understand why it is necessary. An alternative being batted around — having an electronic devise installed in the home — doesn’t seem likely to win over client support either.

Whistleblowers Remain Vital to Stopping Medicaid Fraud.

There has been increased interest lately in using software programs or monitoring systems to cut down on Medicaid fraud. No monitoring program is perfect, however. Computer programs and monitoring systems will not be able to stop Medicaid fraud all by themselves.

Whistleblowers still remain a vital part of the enforcement process. Information provided by whistleblowers is so important that the False Claims Act allows individual whistleblowers to file a qui tam lawsuit on behalf of the government and to receive a portion of any recovery.

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