KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Miami Medicare Case Spotlights Federal Probes Into HIV Therapy Fraud

A new Miami Medicare fraud case spotlights federal investigations of massive scams using HIV therapies.

The Miami Herald: Two Miami-Dade brothers, Ronald and Jose Nogueira, who have reportedly fled to Central America, have been charged "with submitting about $14 million in bogus bills to Medicare for HIV medical services that were never provided to patients, authorities said." Four others employed by the Nogueiras at the T&R Rehabilitation Clinic were arrested Wednesday. "Among them: Joaquin Vega, a 73-year-old physician accused of signing off on fraudulent prescriptions for Medicare patients who allegedly received $200 to $300 in kickbacks every week for more than two years." The charges are "an outgrowth of major investigations by the Justice Department and U.S. Attorney's Office in Miami into Medicare fraud involving rampant HIV infusion scams during the past decade, authorities said. Such schemes spun so out of control that the Health and Human Services' inspector general's office reported that South Florida clinics submitted $2.2 billion in claims for HIV therapy -- 22 times the total HIV bills filed by providers in the rest of the country combined. Medicare reimbursed hundreds of millions of dollars to the South Florida clinics. Medicare and its Florida billing contractor, First Coast Service Options, said they have stopped most of the payments for fraudulent HIV claims" (Weaver, 4/8).

Reuters: "The scheme was made possible because beneficiaries of Medicare, the federal health insurer for more than 43 million elderly and disabled Americans, were paid kickbacks to sign records saying they had received HIV infusion therapies when, in fact, they had not, the U.S. Attorney's Office said. ... The FBI estimates that fraud accounts for 3 percent to 10 percent of U.S. healthcare expenditure per year. A Thomson Reuters report released last October said that in 2007, when the United States spent nearly $2.3 trillion on healthcare and both public and private insurers processed more than 4 billion health insurance claims, fraud was estimated to reach as much as 10 percent of annual healthcare spending" (Brown, 4/7).

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