A half billion dollars to help homebound diabetics get insulin injections?

That's how much Medicare handed out in so-called outlier payments to Miami-Dade home-health care agencies treating diabetic patients in 2008. The $520 million in payments make up over half the $1 billion spent by Medicare for home care for diabetics in the 50 states last year.

In a county that houses only 2 percent of elderly diabetics on Medicare, the payment numbers don't add up to anything but fraud.

Even though Hispanics and African Americans -- the two top population groups in Miami-Dade -- are more likely to suffer from diabetes than non-Hispanic whites, there are many other Florida counties with higher diabetes rates and far lower treatment costs.

Thanks to an aggressive federal push to catch the fraud in medical equipment sales, HIV infusion therapy and fake diabetes treatments, dozens of scammers have been prosecuted the past two years in South Florida. But more can be done, starting with a new Medicare policy in January that will cap payments to home-health agencies treating diabetics to 10 percent of the bill for such services.

The cap is long overdue. It's similar to one used by the Centers for Medicare & Medicaid Services to limit payments to hospice agencies, based on the number of Medicare patients an agency serves.

As Medicare rules have allowed more home-health services, the costs have soared. Last year, Medicare paid about $15 billion for home-health services, covering all types of afflictions, according to a Health and Human Services Office of Inspector General study released this week. "However, the recent growth in home health care services relative to the number of eligible beneficiaries indicates that it may be subject to fraud," the I.G. report states.

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