Florida Ranks First in Medicare Revocations, Seniors Urged to be Vigilant and Report Fraud By Tod Aronovitz | 06/20/13 | 0 Comment

Data recently released by the Centers for Medicare & Medicaid Services (CMS), shows that Florida topped the list in the number of revocations of Medicare licenses. According to the agency’s analysis, in the two years prior to an upsurge in screenings under the Affordable Care Act, CMS revoked 874 billing privileges in Florida. Since March 2011, Florida again had the highest amount of Medicare revocations with 2,064—more than double the number that was reported in the preceding time frame.

CMS has revoked a total of 14,663 providers’ and suppliers’ ability to bill in the Medicare program in the two years following tightened screenings by CMS. In this timeframe, there were six states reporting more than 600 revocations: Florida, Texas, Pennsylvania, California, New York and Ohio. Providers who were removed from the system had felony convictions, were not operational at the address CMS had on file, or were not in compliance with CMS rules.

The trend toward increased revocations is not unusual. Nationally, the number of revocations doubled in 35 states and quadrupled in 18 states under the Affordable Care Act. The CMS attributes this to better screenings, improved review practices, and the implementation of proactive data analysis to identify potential license discrepancies of enrolled individuals or entities.

In addition, the government is urging seniors to join in the fight against Medicare fraud. Redesigned Medicare Summary Notices will now be sent to Medicare beneficiaries across the country on a quarterly basis. These new, clearer statements will make it easier for people on Medicare to understand their benefits, file an appeal if a claim is denied, and spot claims for services they never received.

“A beneficiary’s best defense against fraud is to check their Medicare Summary Notices for accuracy and to diligently protect their health information for privacy,” said Peter Budetti, CMS deputy administrator for program integrity.

Medicare beneficiaries and caregivers are crucial partners in the fight against fraud. In April, CMS announced a proposal that would increase rewards— up to $9.9 million – paid to Medicare beneficiaries and others whose tips about suspected fraud lead to the successful recovery of funds.

How to Report Government Billing Fraud

Government employees or contractors who have inside knowledge of questionable billing practices can file a confidential legal claim under the False Claims Act. By acting as a “whistleblower” in what is known as a “qui tam” lawsuit, a private party may collect between 10 to 30 percent of the amount recovered, depending on how the case is prosecuted.

ARONOVITZ LAW: Miami Whistleblower / Qui Tam Law Firm

The Miami Qui Tam law firm of ARONOVITZ LAW routinely works with Miami whistleblowers to document Medicare fraud and other forms of fraud against the government. Contact Miami Whistleblower / Qui Tam lawyer Tod Aronovitz to discuss a case.