Page 2  Herb Kuhn 
BACKGROUND 
Medicare Coverage and Payment of Services for Nursing Home Residents 
In general, Medicare Part A covers inpatient hospitalizations and skilled nursing care for 
eligible beneficiaries, while Medicare Part B covers physician and outpatient services.  
Services provided under Part A are subject to different payment rules than services 
provided under Part B. 
Medicare Part A. Medicare Part A covers skilled care in a skilled nursing facility for up 
to 100 days for residents who meet certain conditions, such as a prior hospitalization.2 
For residents receiving skilled care, Part A covers almost all of the services provided to 
that resident, as well as room and board.  When Medicare Part A is covering a residents 
care, the resident is considered to be in a Medicare Part A covered stay.   
Most services provided to residents who are in a Medicare Part A covered stay are 
consolidated into a single bill, a process known as consolidated billing.  The Balanced 
Budget Act of 1997 (BBA) originally required consolidated billing for all nursing home 
residents receiving Medicare services in a skilled nursing facility.3  The Medicare, 
Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA)4 limited 
the consolidated billing requirement to residents in a Part A covered stay.  Consolidated 
billing was intended to enhance oversight by making a single entity responsible for 
coordinating services and submitting bills.     
Medicare Part B.  Medicare Part B covers many medical services provided to Medicare 
beneficiaries, including those residing in nursing homes.  These services include, but are 
not limited to, diagnostic laboratory tests, x rays, hospital outpatient services, ambulance 
services, rehabilitation services, the purchase and rental of durable medical equipment, 
orthotic/prosthetic devices, and surgical dressings.   
Most Part B services provided to nursing home residents who are not in a Part A covered 
stay are not subject to consolidated billing requirements.5  Rather, each service provider 
may submit a separate claim to Medicare for each service rendered.  Medicare pays for 
these Part B services using a fee schedule, which varies by locality.  
Medicare Part B Payment Vulnerabilities for Nursing Home Residents 
In the 1990s, OIG identified problems with Part B payments for services provided to 
nursing home residents. OIG found that the nursing home environment provides a unique  
2 42 U.S.C.  1395d(a)(2). 

3 Pub. L. No. 105-33  4432. Exceptions to the consolidated billing requirement include physician services 

and certain drugs. 

4 Pub. L. No. 106-554  313. 

5 Pursuant to 42 U.S.C.  1395u(b)(6)(E) and 1395yy(e)(2)(A)(ii), physical, occupational, or speech 

therapy services are an exception because these services are subject to consolidated billing requirements for 

all skilled nursing facility residents, including residents not in a Medicare Part A-covered stay. 
 Page 3  Herb Kuhn 
opportunity for fraudulent or excessive billing due to the high volume of services and 
supplies nursing home residents receive in conjunction with the fact that multiple 
providers could submit bills to Medicare.  For example, a 1994 OIG study found that 
Medicare was paying for incontinence supplies for nursing home residents that were  
never used.6  In addition, a 1996 OIG study found questionable physician/supplier billing 
practices.7 
The consolidated billing requirement, as modified by BIPA, became effective        
January 1, 2001.  The BIPA limited the consolidated billing requirement to Medicare 
services for nursing home residents who are not in a Part A covered stay.  To guard 
against excessive or duplicative payments, Congress required OIG to monitor Medicare 
Part B payments for skilled nursing facility residents not in a Part A covered stay.8 
METHODOLOGY 
Scope 
This study describes Medicare Part B services and allowed payments for nursing home 
residents not in a Medicare Part A covered stay during CY 2002, regardless of whether 
the nursing home is a skilled nursing facility or a nursing facility.  We chose to use         
CY 2002 data because they represent the first full year of claims data received after 
consolidated billing requirements became effective.  Only fee-for-service Medicare 
claims were included in the analysis.  This study does not include any analysis of 
Medicaid room and board payments.  Further, this study does not determine whether 
Medicare Part B services and allowed payments were appropriate.   
Data Collection 
No centralized data source provides information about Part B services received by 
nursing home residents. To identify all CY 2002 nursing home residents and to extract 
data for their services allowed under Part B, we matched information from the Long 
Term Care Minimum Data Set (MDS), the Medicare Enrollment Database (EDB), and 
National Claims History (NCH) files. 
First, we used the MDS9 to identify nursing home residents in CY 2002.  Using 
information from the MDS assessment records, we created one stay record for each 
resident identifying the dates he or she resided in the nursing home.  Each stay record 
contains a unique identifier.  Second, using the unique identifier for each resident, we 
matched the stay records from the MDS to the EDB10 to identify the Health Insurance 
6 OIG. Marketing of Incontinence Supplies,  OEI-03-94-00770.  December 1994. 

7 OIG. Part B Services in Nursing Homes:  An Overview,  OEI-06-92-000865.  March 1996. 

8 Pub. L. No. 106-554  313 (d).

9 The MDS contains assessment records that provide a variety of information about a resident, including 

demographic information and dates of stay.  

10 Medicares EDB contains information on all individuals entitled to Medicare, including enrollment dates 

and the unique Health Insurance Claim Number assigned to each resident. 
 Page 4  Herb Kuhn 
Claim Number (HICN) for each resident.11  Third, using all identified HICNs, we 
extracted claims for Part B services for each stay record from the NCH files.12  Using the 
dates on the stay record, only services that occurred while the beneficiary resided in a 
nursing home were included in the analysis. 
Data from the following files containing Part B claims were extracted from the NCH for  
analysis: (1) the physician/supplier file, which contains claims for services such as office 
visits, laboratory, and imaging; (2) the Durable Medical Equipment file, which contains 
claims for services such as enteral nutrition, wheelchairs, and prosthetic devices; and (3) 
the hospital outpatient file, which contains claims from hospital outpatient departments.   
Finally, the Skilled Nursing Facility (SNF) NCH file13 was used to identify and exclude 
from the analysis those nursing home residents who were in a Medicare Part A covered 
stay. Information from the SNF NCH file was merged with the claims information for 
nursing home residents to exclude claims for Part B services that occurred during a 
Medicare Part A covered stay. 
In total, we identified more than 124 million line items for Part B services provided to           
1.8 million nursing home residents from over 16,000 nursing homes. 
Data Analysis 
This population of Medicare Part B claims data for nursing home residents were analyzed 
to determine the total payments, the total number of nursing home residents receiving 
services, the types of services they received, and the allowed payments and services per 
resident per State. 
Allowed payment refers to the amount Medicare authorized for reimbursement for the 
service.  The allowed payment (hereafter referred to as payment) includes both the 
Medicare payment and any contribution from the nursing home resident in the form of 
copayment or deductible.  Part B services that were not allowed were excluded from the 
analysis. 
To describe the types of services provided to nursing home residents, we classified the 
data into categories of service and calculated the total payment for each category.  Our 
classification of the data was based on the Berenson-Eggers Type of Service (BETOS) 
system.  The BETOS system classifies all Healthcare Common Procedure Coding System 
11 For some records, we lacked a common variable on which to match the stay record to the EDB, which

may cause a slight underreporting of claims for Part B services.  

12 The NCH files contain billing and utilization information for Medicare beneficiaries.  Each line item

contains the HICN, procedure codes, dates of services, and the allowed amount.  The NCH claims used in

this analysis represent final action data in which all adjustments have been resolved. 

13 The SNF NCH file contains information about demographics, diagnosis, length of stay, and provider. 
 Page 5  Herb Kuhn 
(HCPCS) codes used by CMS into 1 of 106 categories.  Each of the approximately       
124 million line items contains a HCPCS code describing the service provided.  Using 
the HCPCS codes, we applied the BETOS coding system to the data.  Then, to facilitate 
analysis of this high volume of claims, we combined like BETOS categories.14  In total, 
we created 34 categories of service.  We then calculated the total payment for each 
category of service.  See Appendix A for a listing of the 34 categories of service.   
As part of the analysis of total Part B payments per resident, we created a map of the 
United States showing five categories of median payment per resident.  The five 
categories were derived using the Jenks natural breaks classification.  The Jenks natural 
breaks classification uses a statistical technique to determine the best arrangement of 
values into classes. 
The data were also analyzed by nursing home resident, both overall and by category of 
service.  This analysis by resident was done at the State level.  For each State,15 we 
calculated the total payments for Part B services for each resident.  We also 
disaggregated this overall total into payments by category of service.  Finally, we 
determined the State median payment per resident for each category of service and for all 
Part B services. 
Limitations 
While this review identified Part B claims for the majority of nursing home residents, a 
lack of common variables on which to identify the HICN for each resident may cause 
underreporting of Part B services provided to nursing home residents.  
Due to complications in the way services are billed, this review was not able to determine 
the quantity of services provided. For some services, it is difficult to match the 
components of the service to obtain a definitive count of services provided.  For example, 
imaging may be split into two components, a technical component and a professional 
component, each provided by different providers.  While the resident received a single 
service, each provider may have legitimately billed a different date of service and service 
code for its component, thus making it difficult to match the components.   
14 For example, the BETOS system has 17 categories of major procedures. We combined these into a 
single category of major procedures. 
15 Claims for residents in all 50 States, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands 
were included in this study.  Hereafter, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands 
are referred to as States.  Page 6  Herb Kuhn 
RESULTS 
Medicare Allowed $5.3 Billion for Part B Services Provided to Nursing Home 
Residents in CY 2002 
Medicare allowed $5.3 billion for Part B services provided to 1.8 million nursing home 
residents who were not in a Part A covered stay in CY 2002.  The $5.3 billion represents 
5 percent of the total amount that Medicare allowed for all Part B services during  
CY 2002. 
Ten categories of service accounted for 79 percent of payments for Part B services for 
nursing home residents. The top 10 categories of service accounted for $4.1 billion in 
Part B payments for nursing home residents during CY 2002.  Table 1 shows the top 
10 categories of service based on total payments.  See Appendix B for a listing of 
payments for all 34 categories of service.  
Table 1. Top 10 Categories of Service:  Payments for Nursing Home Residents and 
Number of Nursing Home Residents Receiving Service 
Percentage 
of Part B 
Payments  
Percentage of 
Payments for  for Nursing 
Number of Nursing  Nursing Home 
Nursing Home  Home  Home Residents  Residents with 
Category of Service  Residents  Residents*  Receiving Service  Part B services* 
Minor procedure  $1,001,135,901  19%  1,061,574  60% 
Nursing home visit  $624,697,477  12%  1,441,150  82% 
Ambulance  $516,677,629  10%  697,491  40% 
Lab test  $393,179,098  8%  1,430,645  81% 
Specialist  $351,417,319  7%  922,557  53% 
Enteral nutrition  $333,895,544  6%  80,175  5% 
Dialysis  $267,515,557  5%  40,950  2% 
Durable medical equipment  $210,140,166  4%  381,923  22% 
Standard imaging  $203,744,389  4%  1,098,806  63% 
Hospital visit  $202,318,468  4%  616,830  35% 
Total  $4,104,721,548  79% 
Source:  OIG analysis of 2002 Medicare claims data, 2006. 
*Population is 1.8 million nursing home residents who received Part B services.  Page 7  Herb Kuhn 
As seen in Table 1, minor procedure, nursing home visit,16 and ambulance accounted for 
41 percent of payments for Part B services.  Medicare allowed more than $2.1 billion for 
nursing home residents in CY 2002 for these services. 
Payments Varied by State for Each of the Top 10 Categories 
The median payments per resident varied by State within the top 10 categories of service.  
Table 2 shows the range of State median payments per resident within each of the 
categories of service.  The national median payment per resident is included as a point of 
reference. 
Table 2. Top 10 Categories of Service:  Range of State Median Payments per Nursing 
Home Resident 
Lowest State Median 
per Nursing Home  Highest State Median per  National Median per 
Category of Service  Resident  Nursing Home Resident  Nursing Home Resident 
Minor procedure  $64  $588  $269 
Nursing home visit  $29  $544  $329 
Ambulance  $158  $634  $429 
Lab test  $39  $233  $142 
Specialist  $98  $199  $152 
Enteral nutrition  $519  $5,855  $3,911 
Dialysis   $604  $6,212  $2,910 
Durable medical equipment  $122  $542  $205 
Standard imaging  $24  $191  $119 
Hospital visit  $115  $245  $167 
Source:  OIG analysis of 2002 Medicare Claims data, 2006. 
For example, as seen in Table 2, the median payment per resident for enteral nutrition 
ranged from $519 in one State to $5,855 in another State.  See Appendix C for a listing of 
median payments per resident for each of the 10 categories by State.  
In addition to varying by category, overall State median payments per resident varied as 
well. The State median payments per resident for all Part B services ranged from $366 to  
16 A nursing home visit is a physicians visit to a nursing home resident for evaluation and management.  Page 8  Herb Kuhn 
$2,349 across States.  See Appendix D for a map of the United States showing the 
median payments per resident. 
Both overall and within categories, variation was broadly distributed among States.  State 
median payments per resident were not attributed to clustering of States at the high or 
low end. 
DISCUSSION 
This analysis found variation in State median payments per resident among the top        
10 categories of service. Variation across States may reflect differences in populations or 
differences in care provided, or may be an indication of inappropriate services.  
Following is a general framework for understanding variation that may help inform future 
analysis to determine if potentially excessive or duplicative billing patterns exist for 
particular services or in particular States or nursing homes. 
Variation across States is the result of differences in the allowed amount, type, and 
quantity of service billed.  Within a particular service, some variation across States in 
allowed reimbursement may be explained by geographic variation in the Medicare fee 
schedule.  For example, in 2002, Medicare allowed $38 for a nursing home visit in one 
State compared to $50 in another.  
Variation across States due to differences in the type and quantity of service billed may 
reflect differences in the residents needs.  For example, the health status of nursing home 
residents may vary by State, requiring different services at different levels of intensity.  In 
addition, practice patterns of physicians may also vary by State, resulting in different 
mixes of services provided.  
In contrast, variation in the type and quantity of services billed across States may be due 
to inappropriate billing practices.  Some providers may bill for more intensive services 
than were actually rendered. Instead of billing for cleaning a wound, which is reimbursed 
at a rate of $26, some providers may inappropriately bill for repairing a wound, which is 
reimbursed at a rate of $262.  In addition, providers may bill for a higher quantity of 
service than was actually provided or needed.  As previously noted, past OIG studies 
have identified suppliers billing for incontinence supplies for nursing home residents 
that were never used. 
As a baseline review, this analysis did not determine whether variation was due to 
differences in care provided or due to inappropriate billing practices.  Making such a 
determination would require further, more in-depth review.  Page 9  Herb Kuhn 
If you have any questions about this memorandum report, please do not hesitate to 
contact me, or one of your staff may contact Claire Barnard, Director, External Affairs, at 
(202) 619-1665 or through e-mail [Claire.Barnard@oig.hhs.gov].  To facilitate 
identification, please refer to memorandum report number OEI-05-06-00240 in all 
correspondence.  Page 10  Herb Kuhn 
Appendix A 
Table 3. Listing of Categories of Service 
PROCEDURES 
Anesthesia 
Major procedure 
Eye 
Ambulatory 
Minor procedure 
Oncology 
Endoscopy 
Dialysis 
EVALUATION AND MANAGEMENT 
Office visit 
Hospital visit 
Emergency room visit 
Home visit 
Nursing home visit 
Specialist 
Consultation 
OTHER 
Ambulance 
Chiropractic 
Enteral and parenteral 
Chemotherapy 
Other drugs 
Hearing and speech 
Immunization/vaccination 
Other code 
DURABLE MEDICAL EQUIPMENT 
Durable medical equipment 
Enteral nutrition 
TESTS 
Lab test 
Other test 
IMAGING 
Standard imaging 
Advanced imaging 
Echnography 
Other imaging 
EXCEPTIONS/UNCLASSIFIED 
Other 
Local and undefined codes 
Blank  Page 11  Herb Kuhn 
Appendix B 
Table 4. Payments for Medicare Part B Services for Nursing Home Residents, by Category of 
Service 
Category of Service  Payment  % of Total Payment 
PROCEDURES 
Anesthesia  $23,369,213  0% 
Major procedure  $129,266,897  2% 
Eye  $61,444,162  1% 
Ambulatory  $85,662,566  2% 
Minor procedure  $1,001,135,901  19% 
Oncology  $21,648,308  0% 
Endoscopy  $42,031,117  1% 
Dialysis  $267,515,557  5% 
TOTAL PROCEDURES  $1,632,073,720  31% 
EVALUATION AND MANAGEMENT 
Office visit  $108,105,067  2% 
Hospital visit  $202,318,468  4% 
Emergency room visit  $157,044,647  3% 
Home visit  $1,446,498  0% 
Nursing home visit  $624,697,477  12% 
Specialist  $351,417,319  7% 
Consultation  $103,678,412  2% 
TOTAL EVALUATION AND MANAGEMENT  $1,548,707,889  29% 
OTHER 
Ambulance  $516,677,629  10% 
Chiropractic  $1,353,210  0% 
Enteral and parenteral  $28,049  0% 
Chemotherapy  $42,194,423  1% 
Other drugs  $84,053,248  2% 
Hearing and speech   $351,104  0% 
Immunization/vaccination  $7,361,207  0% 
Other Code  $1,649,668  0% 
TOTAL OTHER  $653,668,538  12% 
DURABLE MEDICAL EQUIPMENT 
Durable medical equipment  $210,140,166  4% 
Enteral nutrition  $333,895,544  6% 
TOTAL DURABLE MEDICAL EQUIPMENT  $544,035,710  10% 
TESTS 
Lab test  $393,179,098  8% 
Other test  $41,587,130  1% 
TOTAL TESTS  $434,766,228  9% 
IMAGING 
Standard imaging  $203,744,389  4% 
Advanced imaging  $82,380,067  2% 
Echnography  $46,239,292  1% 
Other imaging  $12,064,703  0% 
TOTAL IMAGING  $344,428,451  7% 
EXCEPTIONS/UNCLASSIFIED 
Other  $61,822,543  1% 
Local and undefined codes  $33,243,458  1% 
Blank  $185  0% 
TOTAL EXCEPTIONS/UNCLASSIFIED  $95,066,186  2%
   TOTAL ALLOWED PAYMENTS  $5,252,746,722  100% 
Figures are rounded to the nearest whole dollar.  Source:  OIG analysis of 2002 Medicare claims data, 2006.  Page 12  Herb Kuhn 
Appendix C 
Table 5. Minor Procedure:  Total Payments and Median, Minimum, and Maximum Allowed 
Payment per Resident by State   
State  Total Payments  Median  Minimum  Maximum 
Alabama  $14,289,601  $247  $3  $29,605 
Alaska  $210,126  $230  $10  $12,085 
Arizona  $5,212,257  $220  $4  $27,844 
Arkansas  $9,881,728  $206  $3  $21,810 
California  $58,613,762  $188  $0  $46,810 
Colorado  $9,480,498  $410  $2  $24,556 
Connecticut  $18,221,361  $423  $2  $25,969 
Delaware  $2,219,088  $221  $7  $23,553 
District of Columbia  $1,689,655  $214  $5  $20,491 
Florida  $71,794,437  $443  $1  $40,923 
Georgia  $18,031,994  $200  $4  $29,607 
Hawaii  $906,667  $183  $4  $16,372 
Idaho  $4,200,058  $494  $3  $15,955 
Illinois  $43,870,914  $216  $1  $35,949 
Indiana  $45,087,057  $438  $3  $36,657 
Iowa  $12,853,619  $211  $1  $41,171 
Kansas  $13,412,467  $278  $3  $21,062 
Kentucky  $22,160,560  $343  $3  $42,449 
Louisiana  $31,299,523  $588  $0  $32,129 
Maine  $2,272,122  $144  $1  $13,296 
Maryland  $13,851,116  $238  $1  $26,339 
Massachusetts  $22,900,198  $317  $4  $42,301 
Michigan  $32,606,707  $226  $3  $44,130 
Minnesota  $16,148,084  $315  $0  $26,742 
Mississippi  $19,914,321  $586  $3  $38,054 
Missouri  $29,317,415  $295  $3  $30,181 
Montana  $2,503,870  $206  $3  $22,385 
Nebraska  $6,540,657  $205  $3  $18,452 
Nevada  $2,758,392  $225  $4  $57,037 
New Hampshire  $4,102,915  $289  $3  $18,600 
New Jersey  $29,187,995  $213  $4  $29,340 
New Mexico  $4,547,870  $298  $7  $27,060 
New York  $52,825,301  $154  $1  $55,420 
North Carolina  $27,876,713  $402  $2  $42,883 
North Dakota  $1,726,584  $186  $3  $28,225 
Ohio  $80,913,775  $400  $2  $51,058 
Oklahoma  $13,304,256  $326  $0  $41,290 
Oregon  $3,243,274  $283  $4  $19,371 
Pennsylvania  $66,940,750  $360  $1  $32,650 
Puerto Rico  $4,114  $76  $3  $973 
Rhode Island  $2,809,653  $293  $3  $20,960 
South Carolina  $9,566,187  $174  $3  $25,463 
South Dakota  $2,264,793  $214  $3  $19,279 
Tennessee  $24,053,409  $336  $3  $31,785 
Texas  $69,495,527  $246  $3  $38,236 
Utah  $4,017,774  $197  $4  $30,733 
Vermont  $1,630,081  $281  $4  $17,179 
Virgin Islands  $349  $64  $44  $178 
Virginia  $24,695,035  $446  $4  $32,877 
Washington  $11,317,664  $287  $2  $22,008 
West Virginia  $9,594,955  $277  $4  $34,529 
Wisconsin  $23,310,843  $277  $4  $42,895 
Wyoming  $1,457,833  $291  $7  $15,524 
   National Total  $1,001,135,901  $269  $0  $57,037 
Figures are rounded to the nearest whole dollar.  Source:  OIG analysis of 2002 Medicare claims data, 2006.  Page 13  Herb Kuhn 
Table 6. Nursing Home Visit:  Total Payments and Median, Minimum, and Maximum 
Allowed Payment per Resident by State  
State  Total Payments  Median  Minimum  Maximum 
Alabama  $10,061,650  $350  $24  $3,819 
Alaska  $128,651  $176  $31  $4,421 
Arizona  $3,618,410  $269  $25  $8,063 
Arkansas  $5,418,009  $256  $11  $4,800 
California  $49,892,141  $434  $13  $19,252 
Colorado  $4,657,855  $267  $25  $4,006 
Connecticut  $10,716,836  $347  $24  $3,919 
Delaware  $2,436,068  $398  $26  $5,572 
District of Columbia  $1,607,634  $493  $27  $3,578 
Florida  $41,721,313  $409  $22  $10,351 
Georgia  $13,184,038  $336  $3  $7,932 
Hawaii  $843,620  $267  $26  $2,068 
Idaho  $957,066  $186  $24  $1,479 
Illinois  $32,176,741  $317  $0  $7,075 
Indiana  $14,511,187  $267  $24  $7,236 
Iowa  $5,974,316  $201  $6  $2,801 
Kansas  $4,798,000  $214  $24  $5,294 
Kentucky  $9,627,772  $287  $24  $6,136 
Louisiana  $8,814,582  $288  $15  $10,208 
Maine  $2,480,054  $258  $24  $2,920 
Maryland  $13,314,847  $431  $16  $11,581 
Massachusetts  $18,046,711  $344  $24  $6,429 
Michigan  $28,103,183  $458  $25  $7,666 
Minnesota  $7,515,530  $217  $21  $2,085 
Mississippi  $5,726,869  $313  $24  $2,478 
Missouri  $12,971,539  $302  $20  $3,160 
Montana  $1,427,464  $185  $24  $1,752 
Nebraska  $3,149,886  $202  $22  $2,613 
Nevada  $2,422,730  $436  $26  $7,149 
New Hampshire  $3,256,688  $360  $25  $3,014 
New Jersey  $30,287,187  $544  $16  $9,148 
New Mexico  $2,052,929  $282  $24  $2,439 
New York  $72,475,733  $470  $9  $14,307 
North Carolina  $13,337,821  $279  $24  $4,631 
North Dakota  $1,178,256  $178  $24  $2,618 
Ohio  $36,936,806  $374  $20  $9,952 
Oklahoma  $5,527,571  $221  $6  $3,448 
Oregon  $1,482,544  $182  $24  $1,512 
Pennsylvania  $42,593,532  $407  $25  $10,219 
Puerto Rico  $23,035  $165  $25  $2,229 
Rhode Island  $3,010,070  $320  $26  $2,190 
South Carolina  $5,715,132  $311  $24  $5,855 
South Dakota  $1,192,540  $182  $23  $1,761 
Tennessee  $15,829,528  $335  $24  $4,437 
Texas  $39,423,648  $332  $18  $15,398 
Utah  $1,333,023  $230  $25  $1,869 
Vermont  $1,006,009  $224  $25  $2,599 
Virgin Islands  $29  $29  $29  $29 
Virginia  $10,251,557  $288  $23  $4,404 
Washington  $6,000,678  $233  $25  $3,632 
West Virginia  $3,453,774  $324  $23  $2,605 
Wisconsin  $11,476,576  $243  $20  $7,139 
Wyoming  $548,112  $209  $24  $1,841 
   National Total  $624,697,477  $329  $0  $19,252 
Source: OIG analysis of 2002 Medicare claims data, 2006.  Page 14  Herb Kuhn 
Table 7. Ambulance:  Total Payments and Median, Minimum, and Maximum Allowed 
Payment per Resident by State 
State  Total Payments  Median  Minimum  Maximum 
Alabama  $8,696,449  $360  $3  $106,638 
Alaska  $148,652  $501  $241  $22,017 
Arizona  $2,665,308  $404  $5  $32,468 
Arkansas  $7,746,224  $447  $3  $31,988 
California  $43,053,857  $579  $8  $136,156 
Colorado  $2,653,773  $410  $5  $15,585 
Connecticut  $12,518,596  $559  $5  $124,801 
Delaware  $1,572,516  $348  $66  $58,292 
District of Columbia  $585,266  $331  $116  $44,377 
Florida  $18,263,934  $331  $2  $57,037 
Georgia  $11,759,207  $368  $3  $72,524 
Hawaii  $310,015  $370  $7  $5,892 
Idaho  $425,080  $236  $3  $11,312 
Illinois  $27,735,671  $382  $3  $72,404 
Indiana  $13,391,496  $370  $3  $67,966 
Iowa  $5,637,138  $374  $3  $12,032 
Kansas  $3,726,200  $370  $4  $28,056 
Kentucky  $11,314,984  $409  $4  $76,093 
Louisiana  $18,089,430  $609  $4  $97,392 
Maine  $2,621,534  $409  $11  $51,767 
Maryland  $5,080,514  $336  $4  $59,160 
Massachusetts  $27,580,300  $634  $8  $189,198 
Michigan  $13,312,640  $424  $4  $101,834 
Minnesota  $5,501,355  $447  $0  $33,230 
Mississippi  $6,842,754  $438  $4  $79,272 
Missouri  $10,670,715  $403  $2  $76,380 
Montana  $637,843  $321  $4  $10,923 
Nebraska  $1,456,325  $316  $4  $11,180 
Nevada  $915,624  $448  $6  $6,318 
New Hampshire  $2,123,114  $419  $14  $95,479 
New Jersey  $22,426,923  $441  $1  $111,531 
New Mexico  $1,000,684  $309  $3  $8,710 
New York  $37,211,618  $503  $5  $91,001 
North Carolina  $12,193,903  $282  $2  $88,516 
North Dakota  $541,861  $336  $4  $5,526 
Ohio  $34,727,521  $488  $3  $111,018 
Oklahoma  $8,785,235  $458  $3  $79,881 
Oregon  $2,007,356  $561  $5  $28,137 
Pennsylvania  $30,054,618  $448  $4  $83,355 
Puerto Rico  $4,001  $158  $19  $358 
Rhode Island  $3,730,289  $451  $5  $84,137 
South Carolina  $8,225,365  $354  $1  $78,625 
South Dakota  $598,146  $266  $8  $8,628 
Tennessee  $17,549,287  $392  $4  $101,424 
Texas  $41,943,492  $439  $1  $93,535 
Utah  $966,708  $512  $104  $8,667 
Vermont  $1,112,188  $379  $6  $88,677 
Virgin Islands  $3,242  $260  $175  $521 
Virginia  $7,187,234  $299  $4  $77,190 
Washington  $6,767,722  $511  $5  $154,164 
West Virginia  $5,010,659  $394  $3  $61,894 
Wisconsin  $7,213,508  $390  $0  $68,931 
Wyoming  $379,556  $334  $5  $5,419 
   National Total  $516,677,629  $429  $0  $189,198 
Source: OIG analysis of 2002 Medicare claims data, 2006.  Page 15  Herb Kuhn 
Table 8. Lab Test:  Total Payments and Median, Minimum, and Maximum Allowed 
Payment per Resident by State  
State  Total Payments  Median  Minimum  Maximum 
Alabama  $8,288,668  $158  $3  $8,608 
Alaska  $234,396  $233  $5  $6,832 
Arizona  $2,084,639  $112  $3  $8,638 
Arkansas  $5,036,405  $129  $2  $71,192 
California  $31,763,032  $146  $1  $18,374 
Colorado  $3,162,253  $120  $3  $5,408 
Connecticut  $5,651,638  $125  $2  $25,252 
Delaware  $1,067,150  $147  $3  $5,555 
District of Columbia  $800,912  $142  $3  $10,093 
Florida  $19,696,006  $143  $1  $8,106 
Georgia  $10,256,592  $140  $2  $9,723 
Hawaii  $580,992  $112  $2  $7,784 
Idaho  $1,367,168  $117  $3  $6,528 
Illinois  $17,997,382  $136  $1  $13,621 
Indiana  $12,786,283  $152  $0  $20,996 
Iowa  $7,166,439  $119  $3  $17,351 
Kansas  $6,015,828  $143  $3  $11,343 
Kentucky  $7,250,219  $148  $2  $12,082 
Louisiana  $9,591,632  $166  $2  $8,636 
Maine  $1,986,180  $124  $3  $5,730 
Maryland  $6,857,644  $160  $0  $24,301 
Massachusetts  $12,426,519  $172  $0  $12,545 
Michigan  $10,368,336  $141  $2  $15,677 
Minnesota  $7,652,744  $109  $3  $16,894 
Mississippi  $4,420,163  $124  $1  $9,492 
Missouri  $9,524,258  $139  $3  $14,092 
Montana  $1,767,588  $126  $3  $16,797 
Nebraska  $4,835,699  $143  $3  $6,800 
Nevada  $850,093  $112  $3  $4,684 
New Hampshire  $1,923,219  $136  $3  $5,717 
New Jersey  $11,420,346  $147  $3  $11,462 
New Mexico  $1,506,715  $123  $3  $5,004 
New York  $25,233,048  $146  $0  $11,186 
North Carolina  $9,992,029  $123  $0  $59,415 
North Dakota  $1,314,370  $113  $3  $10,897 
Ohio  $20,992,042  $150  $1  $12,826 
Oklahoma  $5,414,963  $128  $0  $9,043 
Oregon  $1,540,792  $98  $3  $14,833 
Pennsylvania  $25,249,010  $166  $0  $23,386 
Puerto Rico  $4,308  $49  $3  $597 
Rhode Island  $2,321,505  $172  $3  $8,238 
South Carolina  $3,638,933  $112  $2  $6,897 
South Dakota  $1,783,580  $119  $3  $15,671 
Tennessee  $9,666,120  $134  $0  $10,404 
Texas  $29,678,067  $174  $1  $28,680 
Utah  $1,591,459  $109  $0  $10,578 
Vermont  $670,713  $98  $2  $5,785 
Virgin Islands  $186  $39  $24  $84 
Virginia  $8,240,545  $137  $1  $40,466 
Washington  $5,557,119  $124  $3  $18,173 
West Virginia  $2,861,683  $145  $3  $15,831 
Wisconsin  $10,531,427  $127  $3  $34,809 
Wyoming  $560,060  $114  $3  $4,396 
   National Total  $393,179,098  $142  $0  $71,192 
Source: OIG analysis of 2002 Medicare claims data, 2006.  Page 16  Herb Kuhn 
Table 9. Specialist: Total Payments and Median, Minimum, and Maximum Allowed 
Payment per Resident by State  
State  Total Payments  Median  Minimum  Maximum 
Alabama  $3,654,461  $125  $3  $12,947 
Alaska  $48,121  $122  $10  $1,293 
Arizona  $1,048,587  $124  $4  $14,178 
Arkansas  $2,150,973  $121  $4  $10,799 
California  $21,482,021  $161  $1  $45,767 
Colorado  $6,022,634  $161  $4  $11,314 
Connecticut  $6,518,005  $179  $5  $33,528 
Delaware  $701,750  $143  $8  $5,022 
District of Columbia  $573,346  $157  $11  $5,522 
Florida  $21,344,341  $169  $5  $31,341 
Georgia  $3,250,680  $106  $4  $17,370 
Hawaii  $642,091  $138  $5  $10,385 
Idaho  $950,788  $123  $5  $5,546 
Illinois  $25,564,539  $159  $0  $36,393 
Indiana  $12,791,533  $173  $4  $29,356 
Iowa  $4,080,268  $126  $4  $31,219 
Kansas  $4,738,425  $152  $4  $29,682 
Kentucky  $4,310,379  $132  $4  $34,534 
Louisiana  $8,396,204  $131  $3  $38,119 
Maine  $872,593  $103  $4  $9,347 
Maryland  $6,250,199  $175  $5  $25,736 
Massachusetts  $11,981,622  $199  $5  $18,356 
Michigan  $7,534,954  $145  $5  $10,940 
Minnesota  $4,775,551  $133  $4  $15,170 
Mississippi  $4,183,796  $168  $4  $9,492 
Missouri  $5,819,599  $124  $3  $45,204 
Montana  $599,587  $101  $4  $9,597 
Nebraska  $2,058,366  $120  $4  $7,881 
Nevada  $996,173  $170  $5  $11,133 
New Hampshire  $1,860,141  $170  $5  $18,947 
New Jersey  $12,324,609  $192  $5  $24,727 
New Mexico  $2,201,247  $176  $7  $19,097 
New York  $30,586,387  $181  $3  $21,372 
North Carolina  $7,497,952  $134  $0  $14,331 
North Dakota  $922,306  $129  $10  $2,761 
Ohio  $19,936,372  $175  $4  $16,741 
Oklahoma  $2,879,861  $106  $4  $21,552 
Oregon  $760,945  $116  $4  $5,159 
Pennsylvania  $20,504,160  $172  $1  $16,818 
Puerto Rico  $4,437  $98  $5  $558 
Rhode Island  $1,502,059  $174  $5  $4,338 
South Carolina  $1,607,283  $112  $4  $9,804 
South Dakota  $791,941  $121  $4  $4,860 
Tennessee  $12,254,310  $189  $4  $14,894 
Texas  $43,157,718  $195  $4  $53,738 
Utah  $1,322,172  $130  $11  $31,061 
Vermont  $354,580  $109  $2  $6,193 
Virginia  $5,464,997  $140  $4  $14,185 
Washington  $4,251,691  $123  $5  $11,339 
West Virginia  $1,402,659  $129  $5  $13,440 
Wisconsin  $5,988,574  $133  $0  $9,360 
Wyoming  $499,330  $130  $4  $4,908 
   National Total  $351,417,319  $152  $0  $53,738 
Source: OIG analysis of 2002 Medicare claims data, 2006.  Page 17  Herb Kuhn 
Table 10. Enteral Nutrition: Total Payments and Median, Minimum, and Maximum 
Allowed Payment per Resident by State  
State  Total Payments  Median  Minimum  Maximum 
Alabama  $12,462,442  $4,627  $6  $16,224 
Alaska  $52,138  $5,855  $1,087  $8,536 
Arizona  $886,864  $2,792  $11  $12,137 
Arkansas  $5,017,544  $4,070  $24  $18,789 
California  $35,690,268  $3,778  $5  $15,762 
Colorado  $744,201  $3,176  $6  $13,973 
Connecticut  $3,575,034  $3,640  $13  $12,728 
Delaware  $1,156,020  $4,369  $40  $14,919 
District of Columbia  $1,109,554  $3,974  $15  $12,506 
Florida  $19,248,716  $3,594  $13  $22,124 
Georgia  $10,441,416  $4,095  $16  $18,929 
Hawaii  $1,297,346  $4,068  $39  $9,205 
Idaho  $238,273  $2,243  $51  $8,886 
Illinois  $12,650,897  $3,138  $11  $16,765 
Indiana  $6,676,856  $3,625  $12  $14,383 
Iowa  $1,348,648  $2,974  $22  $9,360 
Kansas  $1,332,905  $3,392  $30  $11,641 
Kentucky  $9,551,478  $4,419  $19  $17,945 
Louisiana  $12,644,840  $3,798  $17  $16,953 
Maine  $450,704  $3,903  $69  $10,133 
Maryland  $5,904,307  $3,693  $25  $12,707 
Massachusetts  $4,248,019  $3,871  $24  $13,275 
Michigan  $6,283,765  $3,310  $7  $15,050 
Minnesota  $1,624,921  $3,895  $6  $11,537 
Mississippi  $8,399,582  $4,244  $15  $14,946 
Missouri  $4,459,523  $3,131  $19  $18,093 
Montana  $284,705  $3,509  $11  $8,717 
Nebraska  $1,254,267  $4,088  $16  $11,543 
Nevada  $815,408  $3,321  $20  $11,682 
New Hampshire  $308,859  $2,690  $20  $12,291 
New Jersey  $11,746,447  $3,987  $12  $16,315 
New Mexico  $591,749  $4,496  $109  $15,326 
New York  $33,906,662  $4,132  $1  $18,311 
North Carolina  $14,536,707  $4,578  $8  $16,142 
North Dakota  $460,898  $5,360  $20  $9,005 
Ohio  $16,906,791  $3,754  $4  $16,771 
Oklahoma  $5,180,740  $3,303  $14  $20,116 
Oregon  $835,120  $4,590  $17  $9,431 
Pennsylvania  $16,509,851  $4,181  $7  $26,033 
Puerto Rico  $2,548  $519  $132  $1,379 
Rhode Island  $998,323  $4,061  $50  $10,271 
South Carolina  $7,263,696  $4,628  $2  $15,538 
South Dakota  $548,365  $4,847  $109  $10,255 
Tennessee  $12,749,541  $4,494  $18  $19,021 
Texas  $26,064,392  $3,830  $11  $17,018 
Utah  $196,636  $2,712  $146  $10,233 
Vermont  $168,984  $3,928  $283  $8,298 
Virginia  $6,923,740  $3,570  $16  $15,626 
Washington  $2,987,803  $4,271  $15  $12,445 
West Virginia  $1,619,915  $3,153  $15  $14,882 
Wisconsin  $3,469,632  $4,017  $19  $13,890 
Wyoming  $67,505  $4,658  $1,095  $8,497 
   National Total  $333,895,544  $3,911  $1  $26,033 
Source: OIG analysis of 2002 Medicare claims data, 2006.  Page 18  Herb Kuhn 
Table 11. Dialysis:  Total Payments and Median, Minimum, and Maximum Allowed 
Payment per Resident by State  
State  Total Payments  Median  Minimum  Maximum 
Alabama  $4,111,514  $3,115  $9  $23,322 
Alaska  $82,124  $2,283  $5  $21,569 
Arizona  $2,253,960  $1,844  $1  $26,054 
Arkansas  $1,917,817  $2,746  $69  $25,134 
California  $23,104,326  $2,991  $0  $32,190 
Colorado  $2,240,159  $3,703  $18  $27,673 
Connecticut  $5,051,398  $3,126  $1  $26,066 
Delaware  $1,202,826  $3,813  $76  $23,949 
District of Columbia  $1,362,202  $4,851  $10  $25,312 
Florida  $12,741,999  $1,791  $1  $25,725 
Georgia  $9,598,523  $4,500  $1  $23,075 
Hawaii  $879,542  $6,212  $81  $25,461 
Idaho  $839,790  $2,481  $73  $27,520 
Illinois  $13,506,739  $2,496  $2  $26,330 
Indiana  $7,193,238  $3,518  $9  $29,684 
Iowa  $3,403,061  $3,536  $17  $25,133 
Kansas  $2,131,783  $3,441  $2  $28,540 
Kentucky  $2,856,157  $2,438  $0  $28,150 
Louisiana  $7,759,603  $5,225  $0  $24,956 
Maine  $638,533  $2,259  $75  $25,830 
Maryland  $6,972,120  $2,285  $10  $25,254 
Massachusetts  $5,614,691  $2,498  $0  $24,533 
Michigan  $7,150,127  $2,306  $1  $27,072 
Minnesota  $5,621,446  $3,114  $3  $71,819 
Mississippi  $2,816,828  $4,317  $1  $22,833 
Missouri  $5,285,097  $2,457  $1  $26,302 
Montana  $366,222  $1,764  $34  $22,584 
Nebraska  $1,621,885  $2,261  $66  $24,085 
Nevada  $321,404  $1,631  $78  $24,902 
New Hampshire  $686,728  $2,431  $13  $23,856 
New Jersey  $9,619,092  $2,051  $3  $27,478 
New Mexico  $1,618,920  $4,348  $71  $25,233 
New York  $24,960,984  $3,850  $1  $119,561 
North Carolina  $8,780,749  $3,585  $2  $24,318 
North Dakota  $904,195  $4,256  $70  $25,295 
Ohio  $16,418,988  $2,684  $0  $28,792 
Oklahoma  $3,349,452  $3,621  $69  $25,714 
Oregon  $1,213,559  $1,772  $3  $25,204 
Pennsylvania  $13,946,054  $2,710  $1  $25,454 
Puerto Rico  $15,260  $604  $1  $2,053 
Rhode Island  $1,128,637  $3,296  $4  $23,591 
South Carolina  $3,560,091  $4,225  $6  $25,234 
South Dakota  $997,219  $3,544  $69  $25,273 
Tennessee  $6,053,203  $3,388  $9  $26,069 
Texas  $17,236,207  $3,807  $1  $26,312 
Utah  $789,550  $1,634  $2  $28,981 
Vermont  $422,036  $3,837  $77  $19,273 
Virgin Islands  $3,241  $3,241  $3,241  $3,241 
Virginia  $7,130,583  $2,727  $4  $27,671 
Washington  $2,732,364  $2,466  $3  $24,069 
West Virginia  $1,528,633  $2,354  $1  $25,539 
Wisconsin  $5,567,868  $3,115  $9  $47,346 
Wyoming  $206,830  $1,671  $53  $23,827 
   National Total  $267,515,557  $2,910  $0  $119,561 
Source: OIG analysis of 2002 Medicare claims data, 2006.  Page 19  Herb Kuhn 
Table 12. Durable Medical Equipment (DME):  Total Payments and Median, Minimum, and 
Maximum Allowed Payment per Resident by State 
State  Total Payments  Median  Minimum  Maximum 
Alabama  $3,241,319  $188  $0  $101,589 
Alaska  $70,824  $260  $12  $11,576 
Arizona  $1,651,713  $185  $0  $32,539 
Arkansas  $2,760,844  $201  $0  $42,554 
California  $23,440,732  $230  $0  $44,567 
Colorado  $1,802,973  $230  $0  $20,911 
Connecticut  $2,977,175  $207  $0  $27,943 
Delaware  $423,644  $188  $0  $16,969 
District of Columbia  $372,916  $261  $0  $11,449 
Florida  $12,766,283  $214  $0  $94,183 
Georgia  $3,903,720  $182  $0  $35,815 
Hawaii  $188,174  $139  $1  $12,486 
Idaho  $638,537  $138  $0  $17,236 
Illinois  $9,408,205  $200  $0  $37,984 
Indiana  $6,518,023  $181  $0  $85,784 
Iowa  $2,877,255  $163  $0  $51,115 
Kansas  $2,322,844  $174  $0  $37,614 
Kentucky  $3,178,494  $157  $0  $33,244 
Louisiana  $6,061,930  $248  $0  $28,625 
Maine  $637,921  $138  $0  $9,544 
Maryland  $2,631,071  $189  $0  $26,716 
Massachusetts  $4,755,487  $224  $0  $19,613 
Michigan  $6,384,977  $243  $0  $47,633 
Minnesota  $2,791,318  $145  $0  $94,173 
Mississippi  $2,514,494  $231  $0  $46,453 
Missouri  $4,667,595  $213  $0  $120,501 
Montana  $710,425  $125  $0  $21,781 
Nebraska  $1,577,091  $152  $0  $32,574 
Nevada  $668,718  $205  $0  $65,637 
New Hampshire  $743,724  $203  $0  $11,177 
New Jersey  $6,922,168  $266  $0  $22,413 
New Mexico  $1,063,956  $242  $1  $16,834 
New York  $14,585,356  $240  $0  $58,475 
North Carolina  $6,116,289  $183  $0  $25,387 
North Dakota  $453,632  $143  $0  $9,608 
Ohio  $12,288,510  $210  $0  $47,909 
Oklahoma  $4,995,347  $269  $0  $27,955 
Oregon  $1,109,501  $179  $0  $16,945 
Pennsylvania  $10,322,429  $198  $0  $81,709 
Puerto Rico  $36,430  $221  $12  $6,687 
Rhode Island  $847,012  $215  $0  $14,683 
South Carolina  $2,524,440  $193  $0  $26,634 
South Dakota  $451,927  $138  $0  $12,005 
Tennessee  $4,814,894  $184  $0  $46,417 
Texas  $17,959,431  $225  $0  $90,610 
Utah  $889,810  $122  $0  $15,653 
Vermont  $265,536  $137  $0  $12,342 
Virgin Islands  $9,794  $542  $82  $4,985 
Virginia  $3,880,106  $206  $0  $19,200 
Washington  $2,732,357  $157  $0  $122,009 
West Virginia  $1,251,991  $230  $0  $19,626 
Wisconsin  $3,595,259  $142  $0  $18,481 
Wyoming  $335,566  $128  $0  $18,705 
   National Total  $210,140,166  $205  $0  $122,009 
Source: OIG analysis of 2002 Medicare claims data, 2006.  Page 20  Herb Kuhn 
Table 13. Standard Imaging:  Total Payments and Median, Minimum, and Maximum 
Allowed Payment per Resident by State  
State  Total Payments  Median  Minimum  Maximum 
Alabama  $3,374,007  $134  $6  $2,140 
Alaska  $46,633  $61  $9  $960 
Arizona  $1,592,605  $145  $4  $9,267 
Arkansas  $1,963,056  $87  $7  $1,718 
California  $12,336,465  $116  $1  $5,799 
Colorado  $1,599,183  $100  $7  $3,245 
Connecticut  $4,612,282  $191  $7  $3,382 
Delaware  $874,974  $174  $7  $2,001 
District of Columbia  $460,352  $140  $8  $3,868 
Florida  $12,755,252  $131  $7  $5,012 
Georgia  $3,910,394  $99  $7  $2,785 
Hawaii  $144,122  $56  $9  $1,503 
Idaho  $419,863  $82  $7  $1,678 
Illinois  $9,037,209  $105  $7  $5,191 
Indiana  $5,537,328  $100  $1  $5,209 
Iowa  $2,661,054  $83  $7  $4,067 
Kansas  $2,474,767  $94  $6  $2,386 
Kentucky  $3,275,516  $99  $6  $2,799 
Louisiana  $4,684,486  $146  $7  $3,745 
Maine  $620,961  $84  $6  $1,767 
Maryland  $3,829,170  $138  $7  $10,299 
Massachusetts  $6,725,791  $151  $7  $14,833 
Michigan  $8,156,749  $171  $7  $3,611 
Minnesota  $3,598,176  $100  $1  $8,314 
Mississippi  $1,549,683  $74  $7  $2,508 
Missouri  $4,636,137  $109  $1  $2,449 
Montana  $492,737  $78  $8  $2,794 
Nebraska  $1,306,972  $76  $1  $2,888 
Nevada  $736,436  $150  $7  $2,452 
New Hampshire  $642,773  $94  $7  $1,542 
New Jersey  $8,186,097  $155  $4  $3,808 
New Mexico  $655,072  $97  $7  $2,861 
New York  $18,747,957  $153  $5  $6,842 
North Carolina  $3,946,275  $88  $6  $2,237 
North Dakota  $460,973  $69  $6  $1,512 
Ohio  $13,669,679  $134  $1  $3,036 
Oklahoma  $3,464,897  $134  $4  $4,335 
Oregon  $804,759  $99  $7  $3,157 
Pennsylvania  $13,914,336  $148  $0  $4,301 
Puerto Rico  $3,687  $24  $7  $823 
Rhode Island  $774,084  $86  $8  $2,368 
South Carolina  $1,768,404  $96  $6  $2,074 
South Dakota  $541,608  $72  $6  $4,325 
Tennessee  $4,067,278  $103  $6  $4,165 
Texas  $16,073,096  $137  $1  $5,544 
Utah  $489,524  $97  $7  $1,539 
Vermont  $147,165  $49  $8  $1,024 
Virgin Islands  $1,198  $128  $11  $309 
Virginia  $3,038,102  $92  $3  $3,684 
Washington  $2,765,400  $144  $4  $2,503 
West Virginia  $1,533,764  $112  $7  $3,799 
Wisconsin  $4,436,021  $106  $7  $4,144 
Wyoming  $199,880  $74  $7  $2,372 
   National Total  $203,744,389  $119  $0  $14,833 
Source: OIG analysis of 2002 Medicare claims data, 2006.  Page 21 Herb Kuhn 
Table 14. Hospital Visit: Total Payments and Median, Minimum, and Maximum Allowed 
Payment per Resident by State 
State  Total Payments  Median  Minimum  Maximum 
Alabama  $2,640,003  $143  $11  $23,688 
Alaska  $57,144  $179  $36  $3,273 
Arizona  $1,344,385  $150  $27  $10,209 
Arkansas  $3,421,399  $198  $7  $11,086 
California  $20,921,446  $207  $2  $45,486 
Colorado  $1,242,998  $148  $30  $17,191 
Connecticut  $2,125,289  $162  $3  $10,300 
Delaware  $557,664  $177  $31  $9,102 
District of Columbia  $557,404  $245  $23  $8,862 
Florida  $13,809,683  $179  $13  $21,509 
Georgia  $4,655,649  $175  $1  $11,640 
Hawaii  $200,064  $155  $33  $6,009 
Idaho  $374,016  $140  $26  $5,896 
Illinois  $13,911,988  $175  $2  $33,098 
Indiana  $4,967,884  $144  $11  $9,106 
Iowa  $2,743,467  $142  $5  $8,260 
Kansas  $2,635,856  $164  $19  $10,152 
Kentucky  $3,438,850  $163  $26  $14,724 
Louisiana  $5,683,839  $205  $15  $14,114 
Maine  $529,576  $147  $1  $2,410 
Maryland  $4,283,904  $197  $15  $34,613 
Massachusetts  $4,863,165  $172  $8  $9,763 
Michigan  $4,933,971  $163  $3  $15,452 
Minnesota  $2,469,156  $147  $14  $7,055 
Mississippi  $2,337,473  $161  $4  $5,916 
Missouri  $5,068,547  $153  $5  $20,138 
Montana  $460,967  $140  $11  $3,481 
Nebraska  $1,582,515  $148  $14  $9,041 
Nevada  $459,283  $154  $28  $15,365 
New Hampshire  $499,017  $150  $3  $5,882 
New Jersey  $11,601,770  $227  $16  $31,628 
New Mexico  $594,810  $164  $11  $5,140 
New York  $14,047,267  $172  $6  $30,538 
North Carolina  $4,230,750  $155  $1  $13,765 
North Dakota  $542,822  $140  $26  $4,697 
Ohio  $9,129,881  $158  $6  $17,808 
Oklahoma  $3,563,789  $178  $15  $6,278 
Oregon  $623,076  $142  $12  $4,469 
Pennsylvania  $9,900,786  $169  $2  $15,477 
Puerto Rico  $19,128  $115  $27  $1,591 
Rhode Island  $726,606  $155  $14  $10,577 
South Carolina  $2,093,072  $164  $4  $10,104 
South Dakota  $483,835  $137  $8  $6,824 
Tennessee  $5,266,894  $186  $2  $13,901 
Texas  $17,383,964  $205  $7  $22,683 
Utah  $359,488  $145  $27  $4,071 
Vermont  $198,735  $146  $32  $1,795 
Virgin Islands  $2,315  $213  $141  $1,235 
Virginia  $3,092,749  $163  $3  $20,282 
Washington  $1,559,819  $147  $15  $8,982 
West Virginia  $1,265,440  $158  $26  $11,156 
Wisconsin  $2,678,898  $146  $5  $15,311 
Wyoming  $175,973  $143  $25  $2,558 
   National Total  $202,318,468  $167  $1  $45,486 
Source: OIG analysis of 2002 Medicare claims data, 2006.  Page 22  Herb Kuhn 
Appendix D 
Below is a map of the United States showing the median payments per resident for Part B 
services in each State.