Home Health & Hospice Week

Miami continues to have a high fraud risk profile for Medicare providers.

Per-beneficiary spending on outpatient therapy in Miami-Dade County was three times the national average in 2009, the HHS Office of Inspector General notes in a new report. And Miami-Dade County had high levels of questionable billing for outpatient therapy.

Plus: Medicare paid South Florida suppliers for up to 10 times more units of arformoterol than the drug's manufacturer and the three largest wholesalers distributed for sale in the area in 2008 and the first half of 2009, the OIG notes in a separate report. "Furthermore, the $62 million billed by South Florida suppliers for arformoterol during this period far exceeds the total possible sales in the area," the OIG blasts.

The excessive billing for inhalation drug arformoterol began when CMS cracked down on billing for budesonide with an edit. "Nearly 30 percent of suppliers that had billed for budesonide in the six months before the edit completely stopped billing for budesonide in the six months after the edit," the OIG notes. "However, these expenditure decreases were offset by increases in expenditures for arformoterol."

The OIG wants DME contractors to take fraud and abuse-fighting steps such as implementing utilization edits as soon as Medicare begins paying for a brand-name inhalation drug and performing site visits and documentation requests for the drugs.

The OIG's therapy report is at http://go.usa.gov/rc7 and the inhalation drug report is at http://go.usa.gov/rcs.