Home > DocuBase > Article

« All DocuBase Articles

 

Follow DocuTicker on Twitter Bookmark and Share   Feed

Thursday, 23rd December 2010

Questionable Billing for Medicare Outpatient Therapy Services

Questionable Billing for Medicare Outpatient Therapy Services (PDF)

Source:  U.S. Department of Health and Human Services, Office of Inspector General

We found that per-beneficiary spending on outpatient therapy in Miami-Dade County was three times the national average in 2009. We also found that Miami-Dade County had high levels of questionable billing for outpatient therapy. Nineteen additional counties also exhibited questionable billing, but to a lesser extent than Miami-Dade County.

Medicare paid $4.9 billion for outpatient therapy services provided to 4.5 million beneficiaries in 2009. South Florida, and Miami-Dade County in particular, has been the focus of efforts to combat Medicare fraud, waste, and abuse in recent years. We identified 20 high-utilization counties that had in 2009 (1) the highest average Medicare payment per beneficiary and (2) more than $1 million in total Medicare payments for outpatient therapy. Miami-Dade County had the highest average Medicare payment per beneficiary among the 20 high-utilization counties and the highest total Medicare payments for outpatient therapy services in 2009. We analyzed Medicare claims data to compare patterns of billing for outpatient therapy in Miami-Dade County, in the 19 other high-utilization counties, and nationally. We also examined claims for the presence of six questionable characteristics that may indicate fraud.

We found that Medicare per-beneficiary spending on outpatient therapy services in Miami-Dade County was three times the national average in 2009. We also found that Miami-Dade County had at least three times the national levels for five of the six questionable billing characteristics. In the 19 other high-utilization counties, Medicare's per-beneficiary payment on outpatient therapy services was 72 percent greater than the national average. These 19 counties also exhibited questionable billing but to a lesser extent than Miami-Dade County. As a group, these counties had at least twice the national level for five of the six questionable billing characteristics.

We recommend that CMS (1) target outpatient therapy claims in high-utilization areas for further review, (2) target outpatient therapy claims with questionable billing characteristics for further review, (3) review geographic areas and providers with questionable billing and take appropriate action based on results, and (4) revise the current therapy cap exception process. CMS concurred with all four recommendations.

See also:  Questionable Billing for Brand-Name Inhalation Drugs in South Florida (PDF)


Category:

Source:

Views: 1916




Please note: DocuTicker's editors collect citations for full-text PDF reports freely available on the web but we do not archive these reports. When you click a link to find and/or download the report, you are leaving the DocuTicker site. DocuTicker makes no representations regarding the ongoing availability of any report or any external resource. Links were accurate as of the date of posting.

« All DocuBase Articles

 

FreePint

FreePint supports the value of information in the enterprise. Read more »


FeedLatest FreePint Content:


  • Click to view the article Making Your Intranet Unusable
    Friday, 24th October 2014

    James Mullan has written a number of FreePint articles about some of the tools and techniques you can use to make your intranet more effective. Now in what some people might think is a cruel twist of fate, he's decided to look at some of the ways in which you can make your intranet unusable.

  • Click to view the article Assessing the Credibility of Crowdsourced Content
    Friday, 24th October 2014

    Libby Trudell investigates the role of crowdsourcing in enterprise information. She defines the term, provides an overview of quality control and gives some examples of crowdsourced research services in areas from company data to intellectual property. Finally she identifies key questions to ask if you are incorporating such resources into your research portfolio.

  • Click to view the article InfoDesk Eases the Push of Relevant Real-Time Content
    Friday, 24th October 2014

    InfoDesk is a content integration and information management solution company with an emphasis on current awareness content delivery. The company defines itself as content neutral, meaning it will integrate any electronic content to provide organisations with a custom search and content delivery system that makes the most of their information assets.

  • ... more ...

All FreePint Content »
FreePint Topics »


A FreePint Subscription delivers articles and reports that support your organisation's information practice, content and strategy.

Find out more and order a FreePint Subscription by visiting the
completing our online form: Subscription Order page.


FreePint Testimonials

"Loved it. Very impressed. It was great. A very high calibre event. The people participating were of a very high calibre. Felt that the topics ..."

Read more testimonials and supply yours »







 

 
 
 

Subscribe

Receive the DocuTicker Newsletter each week.

Find out more »

Article Categories

All Article Categories »

Sources

All DocuBase Sources »

Source Categories

All Source Categories »

Archive

All Archives »