HHS Agencies Fight Infusion Therapy Fraud with Special Consumer Hotline
Public Service Announcements Target Fraudulent
Business Practices in South Florida

The Centers for Medicare & Medicaid (CMS) today announced a new awareness program featuring a special fraud hotline (1-866-417-2078) that Medicare beneficiaries in South Florida can call to report suspected infusion therapy fraud.

Infusion fraud may occur when Medicare is billed for services provided to beneficiaries who do not need them or when the services are not provided at all. It often involves HIV/AIDS patients who get medication and fluids intravenously at a doctors’ office or in a clinic. It may also involve identity theft — where Medicare beneficiaries’ and/or physicians’ identities are compromised when their identification numbers are used without their knowledge or consent.

“Our goal is to strengthen the methods used to identify and stop those who defraud Medicare,” said CMS Acting Administrator Kerry Weems. “South Florida is a high-risk area for many types of Medicare fraud, and we are seeing an increase in infusion therapy fraud cases. It is important to provide consumers resources focused on this type of fraud and, as such, CMS is promoting a special hotline number Medicare beneficiaries can use to report infusion therapy fraud.”

CMS is conducting a two-year demonstration project that targets infusion fraud in the South Florida area. In addition to the toll-free hotline, CMS is issuing Medicare Summary Notices to beneficiaries in Miami-Dade and Broward Counties monthly, instead of quarterly, so beneficiaries can review what services they are being charged more frequently. The notices provide information about how to read the notices and how Medicare beneficiaries can report suspected fraud.

As part of the awareness effort, CMS and the Administration on Aging (AoA) developed TV and radio public service announcements to promote the new hotline to Medicare beneficiaries in Miami-Dade, Broward and Palm Beach Counties and to encourage beneficiaries to check their Medicare statements for accuracy. The English and Spanish public service announcements feature U.S. Assistant Secretary for Aging Josefina G. Carbonell, a native of Florida and a spokesperson for the Department of Health and Human Services (HHS) on issues that affect Hispanic beneficiaries.

“Raising awareness among Medicare beneficiaries in South Florida about these illegal practices, how they can protect themselves from fraud, and how to identify possible fraudulent billing practices, is critical to combating infusion scams,” said Carbonell.

HHS also has several programs to help people with Medicare protect themselves against fraud. SMP (formerly known as Senior Medicare Patrol) projects, established by the AoA, educate and assist beneficiaries in protecting their Medicare information, detecting Medicare billing errors and reporting potential health care fraud and abuse. For more information, visit http://www.smpresource.org.

In addition to providing consumer-oriented fraud prevention tools, the demonstration project that began in August 2007 requires all high-risk infusion providers in South Florida to reapply to be a qualified Medicare infusion therapy provider. Those who fail to reapply within 30 days of receiving a notice to reapply from CMS may have their Medicare billing privileges revoked. Billing privileges may be revoked if infusion therapy providers that fail to report a change in ownership; have owners, partners, directors or managing employees who have committed a felony; or no longer meet any of the provider enrollment requirements. Infusion providers that successfully complete the reapplication process may be subject to an enhanced review, including unannounced site visits, to verify compliance with Medicare requirements.

“CMS has taken and will continue to take aggressive action to curb infusion therapy fraud and address the other areas of fraudulent activity which exist in South Florida,” Weems said.

Since January 2008, CMS efforts have resulted in more than $139 million in savings through this demonstration. These savings are from denials of claims that were identified as high vulnerabilities; overpayments identified for suspended providers; and costs avoided due to provider enrollment actions (for example, deactivation or revocation of provider billing privileges or denial of initial enrollment). The total savings are significantly more than CMS anticipated and have already surpassed its annual savings target for the initial demonstration period.