The time has come for people to see the truth, and the truth is simple and is transparent. The truth is that since 1995, $7 billion have been lost to Medicaid fraud in the state of Florida and every attempt to stop the existing accounting practices and to change the way the cost of services is being estimated have met with great opposition by some elected officials. Enron, World Com and the rest of the private sector are not the only ones with cavalier accounting practices which lend themselves to mismanagement and abuses. Enron, World Com and the private sector have caught the attention of the media because of the implications on the Stock Market, but the accounting challenges do not stop there. Just like in the case of Enron, no one is truly looking at the real numbers, and year after year monitors give agencies a clean bill of financial health after just a couple of hours’ visit.

This clean bill of financial health is used as a shield to protect the company from public scrutiny. But just like Enron, sooner of later the mirage will begin to disappear and a more transparent picture will emerge. Even in cases when agencies are fined $300,000 for creative billing practices, those agencies are forgiven and given opportunities not to decrease, but to increase their government contracts. This is happening now 2004 in West Palm Beach, Florida with the Nursing Home Diversion contracts and with the Managed Long Term Care program.

In the meantime, while the eyes of the nation are on Enron, Martha and WorldCom, some agencies in the not for profit sector are receiving a bonanza. They control a big block of voters (the elders and the caregivers) and their political clout with the current administration, has made them untouchable. It is time to ask our elected officials when it will be the right time to audit those books in an objective fashion, without political protection. When do you think will be time to think about frail persons waiting to receive services or waiting to get the additional meal so critical to their survival? What about them? What about the widow who now finds herself in a nursing home, perhaps several years prematurely because there is a waiting list for community based services in her area? What about that widow? Who is holding hearings in Florida to determine if the existing accounting practices for some not for profit and for profit entities are capturing and properly recording the true cost of services? Who is demanding that independent auditors look at expenditures allocated to allowable and non allowable expenses to verify that those expenditures truly belong there? The answer to those questions is very simple, no one is holding hearings, investigating or even asking the right questions. You see, when it comes to our elders, to our disabled adults, our veterans or to our children, no one is taking the time to protect them unless it is election time.

What the public doesn’t realize is that for every Medicaid dollar the system overpays a service provider, for every Medicaid dollar accounting methodologies allow for non service related activities, one person is experiencing hunger every day or one person may be dying alone without the services he or she needs to live and die with dignity. In a system that allows $4 Billion of Medicaid overpayments, double payments, payments for services not given, payments given to dead individuals or payments for non service related activities, too many people are being affected, too many people are suffering as a direct result of lack of accountability and proper fiscal controls.

The Medicaid overpayment is not a secret. Senator Burt Saunders in Florida acknowledged the problem in an interview with the Ft. Myers News Press where he is quoted as saying “there are potentially hundreds of million of dollars lost in Medicaid fraud, and we should do everything we can to recoup those dollars”. If this problem is so well known, why is there no hearing? Why not bring the issue to the general public so it can be transparent and clear? It took Governor Bush almost one year after the General Accounting Office identified Medicaid abuses to him to quasi admit there is a problem in Florida.

In times like this when we need every single dollar to educate our children, every single dollar to prevent the placement of elders and disabled adults in nursing homes, we cannot afford to look the other way and allow the practice to continue. We must ask our elected officials to do not only what is right but what is ethical.

Four Billion dollars in Medicaid fraud may or may not have an immediate effect on the Stock Market, but it sure has an effect in the lives of hundreds of Floridians old and young, living in rural and metropolitan areas, and for their sake and for ours we need to stop the practice from continuing, we need to stop the beat from going on and on and on.

Dr. Gema Hernández


  • Dr. Gema G. Hernández, the founder of Aging & Cultural Consultants, Inc. and Access Ready: Communities for Life program is the former Secretary of the Department of Elder Affairs in the State of Florida, a professor and management consultant to many organizations nationwide and a caregiver for her parents for 18>
    Dr. Hernandez established Aging & Cultural Consultants, Inc. consulting firm to provide alternatives to nursing homes and to facilitate the creation of an elder friendly environment nationwide in which the private corporation understands the unique needs of its mature customers and uses that knowledge for entrepreneurial ideas to expand their businesses and to carve a niche for their companies in the mature adult market.