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Average HIV/AIDS-Related Medicare Claim Nine Times Higher in South Florida Than Nationwide in Second Half of 2006, HHS Report Finds

September 21, 2007

The average Medicare beneficiary living with HIV/AIDS in South Florida in the second half of 2006 had nine times more Medicare claims than HIV-positive beneficiaries nationwide, according to a report released this week by the HHS Office of Inspector General, the South Florida Business Journal reports. Federal health authorities attributed the difference to fraud in billing practices, according to the Business Journal.

Although only 10% of HIV-positive people enrolled in Medicare live in South Florida's Miami-Dade, Broward and Palm Beach counties, providers in those counties billed Medicare for $487 million in HIV/AIDS-related claims during the last six months of 2006, compared with $489 million in claims for the rest of the country, the Business Journal reports. The claims from the three counties accounted for 79% of all claims nationwide for infusion drug treatments for HIV/AIDS, the report found.

In addition, the report found that claims for drug treatments represented 16% of all claims submitted on behalf of HIV-positive beneficiaries nationwide but that such claims represented 61% of HIV-positive beneficiaries' claims in South Florida (South Florida Business Journal, 9/19).

Recommendations, Reaction
According to the report, Medicare officials and contractors were unable to provide a "clinical explanation" for the high billing level in the three counties, the Washington Times reports (McElhatton, Washington Times, 9/21). "We recommend that [CMS] treat South Florida as a high-risk area and mandate site visits for certain types of providers before issuing provider numbers," HHS Inspector General Daniel Levinson said, adding, "Medicare continues to be highly vulnerable to fraud and abuse, and immediate steps must be taken to protect the program and its beneficiaries" (South Florida Business Journal, 9/19).

Herb Kuhn, acting deputy administrator for CMS, in a written response to the report said that the agency has taken "aggressive recent actions" to reduce potential fraud in South Florida and is scrutinizing provider claims for HIV/AIDS before providing reimbursement. CMS reimbursed 66% of all claims in the region in 2004 and 27% of claims in 2006, Kuhn wrote.

According to the Times, officials said a federal task force on Medicare fraud has resulted in 34 criminal cases in the region involving $142 million in Medicare bills (Washington Times, 9/21). Ten Florida medical clinic owners in April were indicted for allegedly defrauding Medicare by improperly billing the program for HIV/AIDS treatments and medical equipment. The alleged leaders of the group, Armando Arias and Raul Rodriquez, are accused of committing fraud through Coral Way Professional Services and other companies in Miami-Dade County. They also are accused of laundering money and attempting to bribe witnesses to lie to authorities about their actions (Kaiser Daily HIV/AIDS Report, 4/5).

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Reprinted with permission from You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, or sign up for email delivery at The Kaiser Daily HIV/AIDS Report is published for, a free service of the Kaiser Family Foundation, by The Advisory Board Company. © 2007 by The Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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