A new OIG report, “Questionable Billing for Medicare Outpatient Therapy Services,” reviews 20 counties with the highest Medicare outpatient therapy payments per beneficiary and overall high outpatient utilization levels in 2009. The report also separately analyzes Miami-Dade County, Florida, because it had the highest average Medicare payments per beneficiary among the high-utilization counties (three times the national average) and the highest total Medicare payments for outpatient therapy in 2009. Each of these counties exhibited questionable billing characteristics, which the OIG identified as: (1) services for which providers indicated that an annual cap would be exceeded, (2) beneficiaries whose providers indicated that an annual cap would be exceeded on the beneficiaries’ first date of service, (3) payments for beneficiaries who received outpatient therapy from multiple providers, (4) payments for therapy services provided throughout the year, (5) payments for services that exceeded an annual cap, and (6) providers who were paid for more than 8 hours of outpatient therapy provided in a single day. The OIG recommended that CMS target for further review outpatient therapy claims in high-utilization areas and those with questionable billing characteristics. The OIG also called on CMS to revise the current therapy cap exception process. CMS concurred with the OIG’s recommendations.