Photo:David Moyé, former director of the Medicaid Fraud Control Unit, says state Medicaid fraud investigators count as victories arrests and convictions in which they played minor roles.
Special Report: Medicaid Fraud
Critics say Medicaid fraud investigators exaggerate their role in fighting fraud.
In July 2009, Plant City resident Ben Bane was accused of stealing $5 million from Medicare over four years beginning in 2001. A 16-page federal indictment said Bane was regularly billing Medicare, the federal health care benefit program for older Americans, for home oxygen supply services that either his company didn’t perform or were in violation of Medicare policies. He was convicted in 2011 following a trial.
Nowhere in the indictment is the word “Medicaid” used. That’s because Bane was only being accused of violating Medicare law, not Medicaid.
That didn’t stop Florida’s Medicaid Fraud Control Unit from including Bane’s guilty conviction in 2011, along with the convictions of two of his accomplices, on a tally of its investigative successes provided to Florida Trend. A spokesman for the Attorney General’s Office says it was within the bounds of federal rules to include Bane’s case as one of its own. While the original indictment doesn’t mention Medicaid fraud, spokesman John Lucas says state investigators spent 600 hours on the case. “From the beginning, it was a joint investigation with the U.S. Department of Health and Human Services and the FBI,” Lucas says. But somehow, Medicaid fraud charges were never brought against Bane. Lucas says because Medicaid dollars were included in the sentencing of Bane, the state could count the conviction.
Bane’s case illustrates a common criticism that state fraud investigators aren’t as successful as portrayed. The unit is required to keep track of its arrests and convictions and to submit data-driven reports to the Legislature each year. These statistics are used to keep tabs on the work of the unit.
“They are grossly exaggerated,” says David Moyé, a former assistant deputy attorney general in charge of the unit under then-Gov. Charlie Crist. He now works as an attorney in Tallahassee. Another former employee says “they are taking credit for work somebody else is doing,” calling the unit “massively overrated.”
According to the Attorney General’s Office, since January 2011 there have been 113 arrests and 119 convictions for Medicaid fraud. That tally includes nearly 30 cases on Medicaid patient abuse and neglect, which the unit is federally mandated to investigate. It isn’t clear how many of these cases were shared with federal or local investigators.
Moyé says in some cases Medicaid fraud investigators play an insignificant role but still count the arrests and convictions as an investigative victory.
U.S. Department of Health and Human Services’ Office of Inspector General spokesman Donald White says “there certainly are cases where the federal government is very involved and times when the federal government takes the lead.” Determining what agency gets “credit” on a case “is a difficult question to answer,” White says, because it varies depending on who is in charge. Lucas says investigative work is divided up on a case-by-case basis, taking into consideration subject expertise and jurisdictions.
State Medicaid Fraud Control Unit
» Established: 1982
» Employees: 147
» Law Enforcement Personnel: 63
» Budget: $15.9 million
2007-08: $121.7 million
2008-09: $118.0 million
2009-10: $175.0 million
2010-11: $67.3 million
2011-12 $42.8 million (first three quarters)
Note: Based on federal fiscal years, which start Oct. 1.