Insurance fraud costs us all
Why are criminals so far ahead in this game, when everyone knows how it happened and where the vulnerabilities in the system? The same type of scheme – organized recruitment networks aided and assisted by medical clinics – is the reason Miami-Dade leads the state in Medicaid fraud, which is about $ 2 billion a year from state coffers bleeding. Prosecutions are an important tool in the arsenal, to be sure. But to be meaningful target white-collar fraud to be found to prevent crimes – not after – they occur.
Impose stiff civil penalties on violators.Problem is, there are many points where fraud is entering the system. A government agency issues the patient Medicaid card. Another regulates medical clinics. Other licenses doctors. A lack of coordination makes it too easy for scammers to act as providers, and then stolen patient names and Medicaid numbers to bill for phantom services use.
A Medicaid Fraud Strike Force, created by the legislature met for the first time last month, with the purpose of coordinating state and local partners in prevention, detection and prosecution. Good idea. Even better that the group Miami-Dade police and prosecutors, Hollywood police and the Palm Beach County Sheriff covers. They should focus on spotting dubious claims earlier in the payment process.