Suspecting widespread fraud, Medicare has suspended payments to Miami-Dade County's top 10 home healthcare agencies and ordered all local home healthcare providers to reapply to the federal insurance program.

After potentially losing hundreds of millions to fraud, Medicare officials launched the offensive this month, targeting suspicious claims -- mostly for treating diabetic patients at home.

Medicare's regulatory crackdown in Miami-Dade -- a first of its kind in the country -- follows a series of Miami Herald articles that exposed billions of dollars in similar Medicare fraud in South Florida. Miami-Dade is widely considered the Medicare fraud capital of the nation.

Since last year, Medicare officials have been acutely aware of billing irregularities in Miami-Dade's estimated $1.3 billion home healthcare industry. That total represents a 1,300 percent spike in billings over the last five years -- about 20 times higher than the national rate.

Medicare's suspension of payments to the 10 agencies, which received more than $100 million from the federal program last year, will immediately affect services such as skilled nursing visits for about 6,500 elderly and disabled patients. Some, however, are suspected of being illegitimate Medicare beneficiaries receiving kickbacks from the local agencies.

Some legitimate patients with medically necessary services will have to be transferred to other agencies, officials said.

The suspensions could last from six months to a year as Medicare's auditors review claims dating back to 2004. The list of agencies could also grow over the course of the audits. Medicare would not identify the targeted 10 healthcare agencies, citing privacy issues.

''We wanted to focus on these top 10 because this is where the greatest vulnerability in the program is,'' Kimberly Brandt, Medicare's director of program integrity, said Tuesday. ``These are so outside the norm.''

Medicare officials said that home healthcare agencies in other metropolitan areas, such as Dallas and Los Angeles, have generated their share of questionable claims -- but they don't come close to the depth of the problem in Miami-Dade.

NO OTHER COUNTY

No other county in Florida or the nation has experienced such a phenomenon, officials said. ''I think it is clear that the situation in Miami-Dade is very different from our other 66 counties -- even when you compare it to Broward,'' said Jeff Gregg, a senior regulatory official at the Florida Agency for Health Care Administration, which issues licenses for Medicare and Medicaid home healthcare agencies.

''I would have to attribute a lot of this activity to fraud,'' he said, ``to extract money from the system.''

But it took months for Medicare to adopt an anti-fraud policy -- including audits of major home healthcare agencies and re-enrollment of all 334 certified agencies in Miami-Dade -- because officials said the program was hamstrung by a lack of resources.

Brandt said Medicare was too busy with two other major areas of fraud in Miami-Dade -- medical equipment suppliers and HIV therapy clinics -- to investigate the home healthcare field. The Miami Herald reported in a series of articles published since August that those two areas of Medicare fraud alone totaled at least $2.5 billion yearly in Miami-Dade. Home healthcare could account for hundreds of millions in additional fraudulent claims, Brandt said.

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