By Maureen Patterson

When Sylvia Gaddis became an SMP (formerly Senior Medicare Patrol) Project Manager five years ago, Florida SMP served four counties in central Florida. While the Florida Department of Elder Affairs (DOEA) managed the contract, Gaddis was kept busy with outreach and education in a state that houses almost 10% of the Medicare population, the highest percentage of any state in the United States.

By the time DOEA’s contract period was up in 2005, the U.S. Administration on Aging wanted statewide coverage for all of the SMPs. The Area Agency on Aging of Pasco-Pinellas was awarded the contract, and Gaddis had to expand her scope to include South Florida, a part of the country notorious for health care fraud. “There’s a light shining on the state right now because of how out of hand it’s gotten,” she says.

Fighting Medicare is still a relatively new concept. Safeguards weren’t put into place until 1996. “The program went unchecked for 30 years,” says Stephen Quindoza, Medicare operations coordinator at Jacksonville-based IntegriGuard LLC, a Program Safeguard Contractor (PSC). Those decades took their toll. Medicare recipients were scammed out of benefits without their knowledge. A criminal culture grew and perpetuated itself. Stealing from the system became easy and safe: Why sell drugs when you can make money without being shot?

It’s no surprise, then, that Gaddis went to South Florida often in her first years as a statewide SMP. She reached out to Sandra Colón, a health insurance specialist at the Centers for Medicare & Medicaid Services (CMS) Miami field office, the first such office in the nation. Colón was the outreach coordinator and now does investigations.

The two partnered at many events and presentations, working together sometimes and at other times sharing each others’ information. “She would call me up and ask, ‘Were you just on the radio or TV?’ because every time I was on the radio or TV it would generate a lot of calls to her,” Colón says with a laugh. Colón also gave a presentation at the 2008 Regional Conference in Orlando.

Most of the fraud is either in durable medical equipment (DME) or home health. Medicare is billed for products and services beneficiaries have not received. Wheelchairs were big at one time, then hospital beds, special mattresses, and wound care. The list goes on.