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$2 Billion in Florida Medicare Fraud Calls for Congressional Oversight

U.S. Attorney Acosta Tells Senate Committee That He's Absolutely Disgusted by Florida Scams.

The U.S. Senate Special Committee on Aging recently heard from U.S. Attorney Alexander Acosta at the Senate hearing on "Fraud in the Medicare and Medicaid Programs." Acosta provided testimony concerning the efforts of the Department of Justice to quell the increasing rate of Medicare and Medicaid Fraud in South Florida and across the U.S.

Acosta, stated that only 12 months after The Miami Strike Force's inception, the Health Care Fraud and Abuse Control Program (HCFAC) reduced Durable Medical Equipment (DME) fraud by $1.75 Billion in DME claim submissions, and $334 Million in DME claims paid, and last year prosecuted 245 individuals for more than $792 million in fraudulent Medicare billings. However, Acosta informed the Senate that prosecutions were not enough.

Acosta expressed in his statement, "If one wants to prevent traffic accidents, one puts up red lights, one puts up stop signs, one has good rules of the road that prevent accidents in the first place," he said. "The same applies for healthcare fraud. With additional resources my office could easily double or triple prosecutions ... but the best way by far to prevent fraud in the first place is to improve the rules of the road."

Acosta said, "When changes are going to be made, they should go beyond South Florida ... It's a problem in Florida, but in part because we are doing so much the problems have been identified. It has to be a nationwide set of solutions."

Acosta went on to say that though Florida has the highest rate of Medicare and Medicaid Fraud in the U.S., once prosecutors target the fraudulent activities of alleged criminals and criminal enterprises, they tend to spread out across the county to evade authorities.

Though the majority of concern was focused on Florida's enormous Home Health Care industry, Acosta provided startling facts; Even pharmaceutical giant Merck & Co., agreed to pay $399 million, with interest, for the fraudulent underpayment of Medicaid rebates for Zocor and Vioxx.

Daniel R. Levinson, of the U.S. Department of Health and Human Services stated, "We need to alter the criminals' cost-benefit analysis by increasing the risk of swift detection and the certainty of punishment."