Home Health & Hospice Week

Number of Miami HHAs nearly 2,000% higher than average.

The feds are using data mining like never before to pinpoint fraud hot spots. These are the 2012 stats the Centers for Medicare & Medicaid Services used to help determine whether and where to impose a moratorium on new enrollment for home health agencies:

• The 25 U.S. counties other than Miami-Dade with at least 200,000 Medicare beneficiaries had an average of 1.8 HHAs per 10,000 Medicare FFS beneficiaries.
• Miami-Dade County had 37.6 HHAs per 10,000 beneficiaries— 1,960 percent greater than in the comparison counties.
• Cook County, Ill. had 7.7 HHAs per 10,000 benes — 327 percent more than in the comparison counties.
• From 2008 through 2012, the number of operational HHAs in Miami-Dade County increased from 385 to 662. That annual growth rate of 15 percent is double the national average of 7 percent.
• The number of HHAs in Cook County during that period increased from 301 to 509. That annual growth rate of 14 percent is double the national average of 7 percent.
• In the comparison counties, 32 percent of HHAs had not been continuously billing since 2008.
• In Miami-Dade, 56 percent of HHAs had not been billing continuously since 2008, "a strong indicator of churn."
• HHAs in the comparison counties received payments of $5,783-$5,900 per average Medicare home health user per year.
• Agencies in Miami-Dade County received annual payments of $10,287 per user — 77 percent greater than the average for the comparison counties.
• HHAs in Cook County received annual payments of $6,884 per user — 17 percent higher than HHAs in the comparison counties.
• The number of HHAs in Cook County was 280 percent greater than the comparison counties.
• Miami-Dade County had 96 home health providers per 1,000 Medicaid beneficiaries — three times the Florida-wide rate of 35 providers per 1,000 Medicaid benes.

Source: CMS July 31 Federal Register notice, www.gpo.gov/fdsys/pkg/FR-2013-07-31/pdf/2013-18394.pdf.