December 15, 2009

Aberrant Medicare Home Health Outlier Payment Patterns in Miami-Dade County & Other Geographic Areas in 2008

The Department of Health and Human Services Office of the Inspector General (OIG) found that, of the approximately of the $1 billion CMS paid in 2008 for Medicare home health outlier payments, 52% went to home health provider organizations serving Miami-Dade County, Florida, although the county is home to only two percent of all Medicare beneficiaries receiving home health services. The OIG analyzed all Medicare home health claims that were submitted and fully paid in 2008 to identify geographic areas that exhibited aberrant Medicare home health outlier payment patterns. OIG defined "aberrant" to be at least twice the national average for three or more of the five payment characteristics reviewed.