Medicare was billed about $75,000 last year by a company that claims it sent a nurse twice a day to a Westchester group home to inject an elderly diabetic with insulin.

Except that 92-year-old Maria C. Perez isn't diabetic. She says so. Her son says so. Her family doctor says so, and her medical records confirm it.

"I've never been diabetic, " Perez softly declares. "I've never had any of those problems."

Medicare suspects that taxpayers are footing the bill for thousands of homebound patients like Perez to receive unnecessary diabetic treatments -- unnecessary because the patient either doesn't have the disease or doesn't need a visiting nurse to inject the insulin.

It's "easy prey -- fast money, " said Perez's son, Rolando, a Coral Gables businessman who complained to Medicare for months about his mother's suspicious bills. "It's like a giant ATM machine and [the homecare operators] got the passwords, because the amount of money inside the ATM is unlimited."

In an unprecedented move, Medicare has suspended millions of dollars in payments to the top 10 home healthcare agencies in Miami-Dade County, including one called Home Care Services Provider -- the company that billed Medicare for insulin treatments that Perez said she has never needed and didn't receive.

Medicare issued the suspensions in October after finding that it spends one of every 15 dollars on home healthcare nationwide in one county -- Miami-Dade. Medicare's total budget: $16.5 billion.

Kendall-based Home Care Services Provider denies any wrongdoing. And it has challenged the payment suspension in federal court. A hearing is scheduled for Tuesday.

In August, a Miami Herald series exposed billions of dollars in fraudulent claims billed to the taxpayer-funded insurance program for medical equipment and HIV treatments in South Florida. Since then, Medicare has taken a hard look at billing practices in the home healthcare industry in Miami-Dade. The county is largely to blame for the region's reputation as the Medicare fraud capital of the nation.

'SOMETHING IS FISHY'

What Medicare found is that it is losing potentially hundreds of millions of dollars a year in Miami-Dade to fraud, abuse and waste in home healthcare. The situation has spun so out of control in recent years that authorities are about to file criminal indictments.

"No matter what we seem to do, it's not making the problem go away, " said Kimberly Brandt, Medicare's fraud watchdog. "Something is fishy."

Members of Congress have asked the General Accountability Office and the Office of the Inspector General of the U.S. Department of Health and Human Services to investigate.

Here's why the home healthcare system is so easy to exploit: The state has no limit on the number of home healthcare agencies -- as it does, say, with hospitals. Medicare doesn't require physicians to see the patients they refer to homecare providers for expensive treatments. And, perhaps most significantly, Medicare is notorious for paying bills quickly without verifying whether the claims are legitimate.

Since 2001, Medicare's payments for home healthcare in Miami-Dade have grown by a whopping 1,750 percent -- to $1.3 billion -- while the pool of people over 65 diagnosed with diabetes grew by just 30 percent.

Put another way, Medicare's Miami-Dade payments for home healthcare grew at a pace 13 times the national rate.

Los Angeles and Dallas, two other cities with high homecare billing activity, don't come close to Miami-Dade's. Medicare's average annual expense for a homecare patient is $19,230 in Miami-Dade -- 164 percent more than in Los Angeles and 91 percent more than in Dallas.

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