MedPAC finds large utilization gaps in Medicare

The utilization of Medicare services varies dramatically in different parts of the country, according to a new report by the Medicare Payment Advisory Commission. "We find that regional variation is particularly high for post-acute sector services, such as home health," the report states.

MedPAC also notes a gap of as much as 20 percent in drug utilization for Part D participants between high-use and low-use areas.
The biggest gaps are between South Florida and Wisconsin, and the report warns that darker issues may be driving the regional variations.

"At the extremes, there is nearly a twofold difference between the MSA with the greatest service use (the Miami, Fla., MSA) and the MSA with the least service use (the LaCrosse, Wis., MSA)," states the report. "Extremely high levels of service use in certain areas may be driven by overuse and, possibly, fraud and abuse. Additional policy measures may have to be taken in those areas beyond those used to address variation in general."

The U.S. Department of Justice and the Department of Health and Human Services has engaged in a crackdown of fraud involving Medicare providers in recent months. The agencies have held summits in areas it considers "hot spots" for fraud, including one in Miami last summer.

For more:
- read the AHA News Today article
- read the MedPAC report (.pdf)

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