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Miami Tops List of Providers Banned by Medicare

Of all of Medicare's banned providers, Miami tops the list with nearly 1,500 addresses.

Miami comes in first place on the federal government's "exclusion database," which contains more than 57,000 entries.

And Miami tops the list by a long shot. Following Miami's 1,491 entries, Los Angeles comes in second place with 522. Phoenix, Brooklyn and Houston round out the top five.

However, this does not come as much as a surprise.

In 2007, Miami was the first city to get a Medicare fraud strike force. Now, there are eight others in cities such as Tampa, Dallas, Houston, Detroit and Brooklyn.

While nationwide the biggest share of exclusions are due to revoked medical licenses, in Florida the biggest share of exclusions are for Medicare or Medicaid-related crime.

A recent example of Medicare fraud is Juan De Dios Gomez who operated clinics in Hialeah, Miami and Plantation and prescribed painkillers for people who didn't need the drugs, but qualified for Medicare.

The patients, who Gomez bribed with kickback and other incentives, would present the prescriptions to complicit pharmacies, bill insurance and the pills would be sold elsewhere.

Gomez pleaded guilty in 2012, and was sentenced to 16 years in prison.

Currently in Miami there are 11 fraud teams, with the mission to change the mindset of Medicaid fraud from healthcare fraud to theft of government funds, according to federal healthcare fraud investigator Brian Martens.

"Despite our measurable successes in combating fraud, South Florida continues to be a hot spot of healthcare fraud and Miami is considered 'ground zero,'" Martens said.

For more information, please contact us.

Source: The Miami Herald, "Miami, by far, tops list of banned Medicare providers," April 23, 2014


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