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Global Business Forum Panel Explores Health Care Fraud’s Ground Zero: South Florida

January 14, 2011
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      Health care fraud panel

 Pictured (l-r) Wifredo Ferrer, U.S. Attorney,
Southern District of Florida, Cecilia Franco, Miami
Field Office Director, Centers for Medicare and
Medicaid Fraud, and John V. Gillies, Special Agent in
Charge, Miami Division, FBI

                  
Each day, $164 million is lost to heath care fraud, FBI Special Agent in Charge John V. Gillies told a stunned crowd today at the University of Miami Global Business Forum. Gillies, head of the FBI office in Miami, put into perspective the pervasive problem of health care fraud in South Florida. He was joined by the U.S. Attorney for South Florida and the director of the local field office of the Centers for Medicare and Medicaid services as they outlined the pervasive problem of health care fraud in South Florida during a panel that was both funny and frustrating. The lively discussion was one of the highlights of the final day of the Forum, which the School of Business organized. The “Health Care Fraud” session was moderated by Brian Keeley, president and CEO of Baptist Health South Florida.

The discussion was particularly relevant to South Florida, which is an epicenter of Medicare fraud, with far more cases than other regions. The U.S. Attorney’s office started focusing on the cases in 2005 and established a strike force to target Medicare fraud in 2007, U.S. Attorney Wifredo Ferrer told the audience. In five years, 1,000 people responsible for a total of $3 billion in fraudulent billings have been prosecuted, he said.

“Our job in these cases is not to second-guess medical judgment,” he said. “This fraud is so blatant.”

He described fake medical clinics that are little more than a desk and a computer, durable medical equipment suppliers who disappear right before investigators arrive to raid their sham operations, Medicare beneficiaries who get kickbacks for allowing others to use their Medicare number to submit bills for 10 or even 20 clinics in a month and a variety of other scams that are common in South Florida.

Cecilia Franco, of CMS, drew gasps from the audience when she showed a map of Medicare beneficiary identification numbers that had been compromised. In South Florida, only the Everglades was visible – the rest of the map was covered with dots representing compromised ID numbers.

crowd    

 The panel drew a standing room only crowd.

Gillies spoke about another looming fraud threat posed by the electronic record-keeping that health care reform will require. Security for electronic medical records has not been fully fleshed out. “We expect with the rush to get these records up and the security following, we’re going to see fraud go up, and more identity fraud,” he warned.

Modern Healthcare magazine sponsored the panel.

The three-day Global Business Forum featured some of the world’s most prominent health care industry thought leaders. In addition to the keynote addresses, the Forum included more than 30 panel sessions organized in six tracks, including economics and health care, aging, innovation, wellness and prevention, global health issues and hospital design, technology and delivery systems of the future.

The Forum's key sponsors included BlueCross BlueShield of Florida and Bank of America Merrill Lynch. You can look back through the Forum conversation by searching hash tag #GBF2011 on Twitter. Additional updates are also be posted here on the School of Business website. You can also view photos of the Forum on Facebook.

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