In 2007, the government set up a law enforcement group known as the Health Care Fraud Prevention and Enforcement Action Team, shortened to HEAT. The group now has branch offices in nine cities, including Miami. Since its inception, HEAT Task Force agents have charged nearly 1,500 people with health care fraud totaling $4.8 billion. More than 50 percent of the fraud cases identified by HEAT were originated from the Miami office. Law enforcement has repeatedly labeled Miami as the epicenter of all health care fraud activity in the United States.
According to HEAT special agent in charge, health care fraud schemes "are typically started here - vetted, proven here - and farmed out to other parts of the country." In many ways, the war against Medicare and Medicaid fraud began in earnest in 2007. Florida may owe its status as the heart of health care fraud due to the large number of Medicare and Medicaid eligible people who make the State their home.
In many ways, the Medicare system was designed to encourage fraud. While technology has long existed to flag suspicious transactions and prevent fraudulent activity from proceeding, the government has instead chosen a policy called "pay-and-chase." That means the government pays virtually every claim and does not address whether the claim was appropriate until a potentially fraudulent situation has existed for some time.
Health care fraud is a complicated matter. Medicare and Medicaid billing requirements are dense and confusing. Law enforcement officials and prosecutors, as well as health care providers, may have significant difficulty determining if a transaction was fraudulent. Given the situation, anyone accused of health care fraud needs knowledgeable advice to deal with the situation.
Source: LA Weekly News, "How Medicare Fraud Became the Nation's Most Lucrative Crime," by Chris Parker, 25 April 2013