MIAMI — Medical fraud is an old story in Miami.
The Feds announcing arrests is not uncommon, despite a nationwide reduction in cases since 2016.
But how about Miami? Here is what a recent survey found:
“Yeah, Miami jumped off the page. The number one city in the U.S. for Health Care Exclusions,” said Christian Worstell, the Senior Staff Writer for MedicareAdvantage who produced the survey.
Exclusions mean being barred from federal health programs usually—in South Florida’s case—fraud, felony drug crimes, patient abuse.
Between 2010 and through most of this year, Miami has seen 818 health care fraud penalties that included jail time. Los Angeles is a distant second with 246 and Chicago is third with 181.
“Doctors getting caught up in prescription drug trafficking drugs out of the office, pill mill doctors, medicare fraud all that doctors all over the country going to prison for those crimes make up a good portion of those South Florida and Miami cases. Many of the prosecutions involve nurses who abuse patients who are on Medicare,” said Worstell.
So, nationally how does Florida stack up when it comes to penalties including prison in the last decade?
California leads the pack with over 3,800, Florida not far behind at 3,500 and Texas with 2,300.
So, why Florida, why Miami?
Christian Worstell says, “Miami has a population of elderly people for whom English is not a first language and both of those demographics are popular targets for people attempting to commit insurance fraud.”
Add to that brew Miami’s high rate of white-collar crime and where fraud has become institutionalized.
Christian Worstell told CBSMiami, “A health care clinic where you know malicious billing and coding against insurance and Medicare just becomes common practice and often there is more than one individual in on it.”
The bottom line, major fraud drives up health insurance premiums.
The Feds are constantly on the trail of the crooks.
“I think there is a silver lining in the data. The exclusions are high. Obviously, it means they are on top of it and come down pretty hard.”
CBSMiami reached out to federal law enforcement about the survey. They have not gotten back to us.
