The Centers for Medicare & Medicaid Services (CMS) will now require infusion providers who operate in several South Florida counties to immediately resubmit applications to be a qualified Medicare infusion therapy provider. Those who fail to reapply within 30 days of receiving a notice to reapply from CMS will have their Medicare billing privileges revoked. 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 each and every provider enrollment requirement; will have their billing privileges revoked. Infusion providers that successfully complete the reapplication process may be subject to an enhanced review, including site visits, based on risk assessment.

CMS will also issue Medicare Summary Notices to beneficiaries in South Florida on a monthly basis, instead of quarterly, to support more frequent scrutiny of infusion provider billings.


"We want to test and compare different fraud prevention tools in these demonstration projects," explains CMS Acting Deputy Administrator Herb Kuhn. "Enhancing our review of these providers will go a long way toward eliminating those who do not meet the needs of beneficiaries and the promises of the program."

The Medicare infusion therapy scam includes recruitment of HIV/AIDS patients by paying them to come to clinics and receive non-rendered or medically unnecessary infusion services. In 2004, Florida had fewer reported AIDS cases than California and New York, yet its total submitted Medicare charges for these cases was three times higher than California and five times higher than New York. And the number of infusion services billed in Florida tripled from 2004 to 2005, jumping from 4.3 percent to 15 percent of national billing.

Steps have been implemented in Florida to control fraudulent activities including joint Federal and State site visits, prepayment edits and automatic denial of clinically unbelievable dosages, payment suspensions, provider enrollment onsite visits and other activities. Corrective actions from these steps have resulted in denial of fraudulent and medically unnecessary Medicare infusion claims with charges in excess of $1.8 billion in 2005 and 2006.

"CMS has taken and will continue to take aggressive action to curb infusion therapy fraud and other organized fraud activities" Kuhn said.

This week, the Strike Force filed charges against a medical biller who submitted approximately $170 million in fraudulent medical bills on behalf of approximately 75 health clinics that purported to specialize in treating patients with HIV. From roughly October 2002 through April 2006, HIV clinics in South Florida serviced by this biller, Rita Campos and her company R and I Billing, allegedly provided bills to Medicare that indicated patients were being injected with excessive amounts of HIV medications. Based on the claims filed by Campos, Medicare paid more than $100 million for these fraudulent services. This investigation remains ongoing. Eight other defendants, including Eduardo Moreno, owner of RTC of Miami, an infusion clinic that billed Medicare for more than $5.2 million between August 2006 and March 2007, are fugitives. Moreno, who also owns multiple DME companies in addition to the infusion clinic, was arrested on April 7 after being named in a six-count indictment on fraud charges but fled following his release on bail.

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