WASHINGTON — While only 2 percent of Medicare beneficiaries live in South Florida, the area accounted for 17 percent of Medicare's total spending for inhalation drugs in 2007, according to an HHS Office of Inspector General report.
Released Tuesday, the report — "Aberrant Claim Patterns for Inhalation Drugs in South Florida" — said Medicare spent an average of five times more per beneficiary on inhalation drugs in South Florida compared to the rest of the country, with the greatest spending differences attributable to levalbuterol and budesonide.
In addition, the OIG said beneficiaries listed on 62 percent of the area's inhalation drug claims did not have an office visit with the prescribing physicians in the previous three years. Three-quarters of the beneficiaries receiving budesonide also frequently exceeded coverage guidelines set in the local coverage determination for a 90-day period.
Among paid inhalation drug claims, the report said Medicare spent $4,400 per South Florida beneficiary compared with $815 in the rest of the country. In Miami-Dade County in 2007, Medicare paid $143 million for inhalation drugs, 20 times more than the amount paid in Cook County (Chicago), Ill., the county with the next-highest total payments. But the report noted twice as many beneficiaries live in Cook County as Miami-Dade.
In its report, the OIG recommended "CMS ensure that its contractors are enforcing the coverage guidelines for inhalation drugs, eliminate Medicare's vulnerability to potentially fraudulent or excessive inhalation drug claims in South Florida and review cases where the DME supplier appears to be fraudulently billing Medicare for inhalation drugs."
In a response, CMS Acting Administrator Charlene Frizerra said the agency concurred with the recommendations and noted a "medically unlikely" edit for budesonide implemented in September 2008 had decreased improper payments for the drug by half in Miami-Dade and Broward counties. She also said the DME MAC "is in ithe process of reviewing its experiences with the edit to see whether the edit tolerances can be tightened."
Frizerra described the efforts by CMS' Miami and Los Angeles field offices to identify suppliers whose beneficiaries had no clinical relationship with the physicians listed on DME claims, and to revoke the Medicare billing numbers for suppliers not meeting supplier standards.