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OIG Targets FL Providers for Medicare Abuses

Cheryl Clark, for HealthLeaders Media, December 27, 2010

Those practices included services for which providers indicated that an annual cap would be exceeded, beneficiaries whose providers indicated that an annual therapy cap would be exceeded on the beneficiaries' first date of service, payments for beneficiaries who received outpatient therapy from multiple providers, payments for therapy services provided throughout the year, payments for services that exceeded an annual cap and providers who were paid for more than eight hours of outpatient therapy provided in a single day.

The OIG said questionable billing practices for five of these six practices occurred three to four times the national level.

The OIG report says that the Medicare per beneficiary spending on outpatient therapy services in Miami-Dade was three times the $1,078 national average, and each therapy beneficiary in the county received an average of 158 services in 2009, much higher than the national average of 49.

Therapy providers that served Miami-Dade beneficiaries received $83,867 on average, eight times what providers in other counties were paid.

"We found that per-beneficiary spending on outpatient therapy in Miami-Dade County was three times the national average in 2009," the agency said in the first report.  "We also found that Miami-Dade County had high levels of questionable billings for outpatient therapy.  Nineteen additional counties also exhibited questionable billing, but to a lesser extent than Miami-Dade."
It recommended that the Centers for Medicare and Medicaid Services target outpatient claims in high-utilization areas for further review and pay more attention to areas that exceed therapy caps.

According to Dartmouth Atlas researchers, the Miami area had the highest adjusted per capita Medicare spending, an example of geographic variation in medical costs without a correlating improvement in quality.


Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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