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 resident’s 

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 Medicare’s 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 

Category of Service 

Minor procedure 

Payments for 

Nursing Home 

Residents 

$1,001,135,901 

Percentage 

of Part B 

Payments 

for Nursing 

Home 

Residents* 

19% 

Number of Nursing 

Home Residents 

Receiving Service 

1,061,574 

Percentage of 

Nursing Home 

Residents with 

Part B services* 

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 physician’s 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 

EXCEPTIONS/UNCLASSIFIED 

Other 

$344,428,451 

$61,822,543 

7% 

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.