Miami Serves As Model In Medicare Fraud Crackdown Three years ago, the federal government began setting up special Medicare fraud strike forces. The first was in Miami, and it was an immediate success, saving billions of dollars in fraudulent claims in one county alone. Similar strike forces have now been set up in cities around the country.
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Miami Serves As Model In Medicare Fraud Crackdown

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Miami Serves As Model In Medicare Fraud Crackdown

Miami Serves As Model In Medicare Fraud Crackdown

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STEVE INSKEEP, Host:

NPR's Greg Allen reports from Miami, where fraud is a particular problem.

GREG ALLEN: It was a big arrest even for Miami. In December, federal authorities broke up a $40-million Medicare fraud scheme involving home health care services, covered here by Miami TV station CBS 4.

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ALLEN: A van carrying some of the 19 people rounded up in this latest Medicare fraud sting left South Florida's FBI headquarters Tuesday morning, bound for court appearances and Federal detention.

ALLEN: Eric Bustillo, head of the economic crime section at the U.S. Attorney's Office in Miami, says last year alone, his lawyers prosecuted nearly a billion dollars in fraudulent Medicare claims.

ERIC BUSTILLO: Right now, we have as many as eight different teams that are full-time, doing nothing but investigating and prosecuting Medicare fraud cases.

ALLEN: Assistant Attorney General Lanny Breuer says similar strike forces have now been set up in cities around the country.

LANNY BREUER: What we're looking for are quick cases, resolve them fast, and for the sentences to be long. People who are defrauding the Medicare program and are stealing from taxpayers need to go to jail, and they need to go to jail for substantial periods of time.

ALLEN: Recently, strike forces were started in Detroit and Brooklyn, because that's where Medicare fraud was turning up. Eric Bustillo with the South Florida U.S. Attorney's Office says it turns out that many of those schemes were developed by criminals from Miami.

BUSTILLO: In many instances, these individuals knew that the likelihood that law enforcement was going to catch wind of it was fairly significant. And so they that decided, you know what, let me take it to another state where there's not the same level of scrutiny.

ALLEN: Calvin Sneed is a former investigator with Health and Human Services who now helps combat fraud as a consultant to Blue Cross and Blue Shield. He believes the federal government might learn a lot from the way private insurance companies guard against fraud, such as analyzing claims submitted by doctors and other health care providers before they're paid.

SNEED: The enforcement is very, very expensive. And if you are paying and chasing, the dollars that you're spending to pay and chase is exponentially higher to go after that money and then recover it, than it is to invest that money on the front end and catch that money before it goes out the door.

ALLEN: Greg Allen, NPR News, Miami.

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