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ADVANCE Voice: NP

"Miami NP Vice"

Published September 22, 2008 3:18 PM by Jennifer Ford

An NP in miami tracks and cracks down on health care providers committing Medicare fraud, according to an article on Nurse.com

Peggy Sposado, NP, works with agents to root out fraudulent claims in Miami, where one-quarter of the country's Medicare fraud occurs. She works in a unique center:

She works at the only healthcare fraud fusion center of its kind in the country, collaborating with prosecutors, agents from the FBI, the Office of Inspector General of the Health & Human Services department, and other law enforcement agents. They share access to documents, and the team often interviews people at the center.

Sposato's work pays off:

The process has been effective. Last year, the office prosecuted 120 cases, alleging more than $638 million in healthcare fraud. Bustillo expects to exceed that in 2008. Nationwide, U.S. Attorney's offices filed 434 cases in 2007.

"We're always investigating; there is no downtime," Sposato says. "There is a constant turnover. You just finish one case, and you are getting ready to charge three or four more. There are dozens of ongoing investigations at one time."

...

"She's a superstar," Bustillo says. "A lot of our great success starts with Peggy. Her nursing background is invaluable."

Bustillo says Sposato's work has allowed the task force to more quickly process cases, seize the funds, and return them to the Medicare trust fund.

"We can charge people within weeks after they submit their last fraudulent claim," Bustillo says. "Historically, it would take months, maybe even a year, to put the case together. Now we can do many cases in a handful of weeks. And a lot of it is due to Peggy looking at the data and quickly giving us what we need to stop this fraudulent activity."

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