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AHCA gets warning on fraud

By Christine Jordan Sexton
12/9/2009 © Health News Florida
Frustrated with Florida’s subpar efforts to snuff out Medicaid fraud, legislators on Tuesday threatened to stall the confirmation of Tom Arnold as the new Secretary for the Agency for Health Care Administration.

AHCA and Florida Department of Health staff on Tuesday updated the Senate Health Regulation Committee on efforts to crack down on fraudulent billing in the state’s $18-billion health care program for the poor, elderly and disabled.
 
Lawmakers last spring passed a sweeping bill intended to go after fraud (SB 1986). The bill focused on home health care and prescription drug fraud, among other things. 

Since the bill passed, AHCA has made 68 referrals for alleged prescription drug abuse to the Federal Bureau of Investigation, the Florida Department of Law Enforcement and other state and federal agencies. 

The referrals were made after agency staff reviewed 18 months of prescription drug data from the Tampa Bay area, which was the first part of the state to be targeted, according to Jim Hampton of the Medicaid fraud control unit. The state narrowed its scope to the prescribing and dispensing of Oxycodone, Hydrocodone and Xanax. 

But these initial results did not impress state legislators. 

“I think Barney Fife could have done better than that,” Sen. Michael Bennett, a Bradenton Republican known for his mercurial behavior. “Who investigated these?” 

Frustrated by the testimony, committee chairman and fraud-bill sponsor Sen. Don Gaetz is asking Arnold, now acting Secretary for AHCA, and DOH Secretary Ana Viamonte Ros to put in writing where the state is on implementing each provision of the bill. 

Arnold was appointed by Gov. Charlie Crist Oct. 28 to replace former secretary Holly Benson, who resigned to run for State Attorney General. Arnold, 60, must be confirmed by the Florida Senate. 

Bennett said he won’t confirm Arnold—or anybody—until he sees progress on the fraud and abuse front. 

“I would lead up the charge not to confirm,” said Bennett. ”In fact, I would probably lead the charge to have him replaced if we can’t get any results. I’ve just fought this thing too long, and I think it’s time we actually see some results.” 

Arnold was not there, but attended a Senate budget meeting later in the day. Sen. Durell Peaden and other committee members gave Arnold a round of applause, thanking him for serving as acting secretary. 

“I am honored to be in this position; I was flattered that the governor offered it to me. I don’t take it likely,” said Arnold, a long-time state employee who has worked at AHCA in a number of positions, including Medicaid director, as well as at DOH. 

“You have my commitment to work with you anyway I can to ensure that the agency is doing all that you think we should do,” Arnold said. 

Spurring the health regulation committee’s anger was a story on home-health fraud in Medicare, which is not funded with state dollars, only federal. 

A report by the Office of Inspector General of the Department of Health and Human Services concluded that Miami-Dade County received accounted for more than half the Medicare home health-care claims nationwide even though just 2 percent of the patients receiving home health care live there.
 
Medicaid—the sister program to Medicare –is funded with state and federal dollars, but actuaries have had a hard time estimating the amount of fraud and abuse. The Office of Program Policy Analysis and Government Accountability last year estimated the range to be anywhere from 5 to 20 percent of total program costs. If it were the average of the two, 12.5 percent, it would amount to $2 billion a year. 

The money becomes all the more important in a year in which the state is facing additional shortfalls and could lose stimulus funding by the end of 2010. The latest estimates put the deficit in the Medicaid program alone at $462.2 million deficit in the Medicaid program for the current year, which ends July 30. 
 
--Christine Jordan Sexton is co-founder of TallahasseeReporters.com.