Medicaid Expanding Fraud Control Unit in South Florida

By James Call, The Florida Current

Florida’s Medicaid Fraud Control Unit is establishing an operational headquarters in south Florida as part of a crackdown on white-collar crime. James Mann, the unit’s deputy director, on Wednesday told the Medicaid and Public Assistance Fraud Strike Force that he is being reassigned to south Florida to run it.

“The majority of the fraud seems to be coming out of south Florida (so) the attorney general has asked us to put an emphasis on criminal prosecution in that area,” Mann said.

The state Chief Financial Officer estimates that Medicaid fraud costs the state as much as $2.4 billion a year. Two years ago the Legislature created the strike force, a collaboration of state agencies to root out fraud. Mann, who works for Attorney General Pam Bondi, said his unit is searching for people who defraud the system through deceptive billing practices. The unit finds them by going “data mining” among the tens of millions of pieces of paperwork generated during treatment of Florida’s 3 million Medicaid patients, he said. Data mining is the use of computers to discover patterns in large data sets.

“Rather than waiting year after year and finding that we have a bad apple it should start to show within a month’s worth of work if you have the data,” CFO Jeff Atwater, the strike force chairman, said after Mann’s presentation. “This procedure, that location, that provider, that individual, there’s something in this here. Let’s go find out. That’s the idea.”

Medicaid is the fastest-growing component in the state budget. It accounts for about 28 percent — about $20 billion — of the state budget. Officials estimate that up to 10 percent of that is lost through schemes such as billing for services not provided, charging for unnecessary procedures, and providing medical equipment not needed.

Mann is looking to fill 43 positions as the attorney general’s Medicaid Fraud Control Unit prepares for a major shift in the Medicaid program, health care for the elderly and catastrophically sick. By 2014 all Medicaid services will be provided through managed care. The fraud unit is looking for analysts and auditors to dig into the reams of data and find suspicious patterns among the bills submitted for the care of patients.

“Although a law enforcement component is important we are looking at getting auditors, CPAs onboard to help us with the numbers and dissect everything,”  Mann said. “They can work with the investigators and give them the information. Point them in the direction they need to follow. Assist them when they do their interviews.”

The fraud unit staffs eight offices in Florida including one each in Miami-Dade and Broward counties. In the past year it handled 324 cases and recovered $161 million. Thirty-six of those cases were uncovered through data mining, Mann said.

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