Labs, doctors scrutinized over lucrative drug tests for pain-pill abuse

http://www.azcentral.com/story/news/arizona/investigations/2015/12/26/labs-doctors-scrutinized-over-lucrative-drug-tests-pain-pill-abuse/77181470/

The DEA/CDC and other bureaucratic agencies have created “guidelines” and everyone is treating these guidelines as “the law”. Now the DOJ – which the DEA is part of – is going after what is consider too frequent urine testing on chronic pain pts.. or other abusive lab testing on these pts. Medicare is changing its billing allowables over the next two years because of the actions of the DEA/CDC and the response from the medical community in doing urine testing. All of this is direct/indirect collateral damage of Congress’ “warped” mindset in 1914 when they passed the Harrison Narcotic Act which created the “black drug market” that we have been fighting every since.

Doctors frequently order patients to take urine drug tests to safeguard against prescription pain-pill abuse.

But federal investigators and Medicare say these routine tests — designed to ensure patients properly use opioid drugs — have led to questionable billing practices by some for-profit labs, doctors, and addiction-treatment centers.

Millennium Health, the nation’s largest lab and one that has conducted widespread testing in Arizona, agreed to pay $256 million to the federal government in October to settle claims that it conducted unnecessary testing.

The U.S. Department of Justice is cracking down on private labs that investigators say offer incentives to doctors to frequently refer patients for lucrative testing. And Medicare, citing the potential for billing abuses, is overhauling its billing codes and payment rates used for drug tests.

Consumers who have been hit with large bills for routine tests say that the cost can quickly become unaffordable.

Phoenix resident Eric Smith visited a local pain clinic in June for treatment of pain from a degenerative disc in his back. The doctor approved a 30-day prescription for Percocet  but also required Smith to submit a urine sample each month he sought a refill.

Weeks later, Smith received an itemized bill for a urine test that listed five separate charges for a total charge of $660. He decided monthly tests and other fees such as co-payments and prescription-drug charges would quickly become too expensive.

“This is something I’m dealing with long term,” Smith said. “For those of us with real pain who have to pay for these tests because of the few who abuse (prescription painkillers), it does not seem fair.”

Some tests can be even more expensive. A 75-year-old Fountain Hills man visited the same practice, Arizona Pain Specialists, which has seven clinics in Arizona. He had a urine test that checked for 10 substances, including illegal drugs such as methamphetamine, cocaine and phencyclidine, more commonly known as angel dust. The man was billed separately for each substance for a total bill of $1,048. His insurance plan paid $412.

Doctors who prescribe pain pills frequently say they must order screening tests to comply with medical guidelines.

Arizona Medical Board guidelines encourage doctors to conduct regular urine drug tests on patients who take prescription pain pills. The screens are designed to make sure patients take the prescribed drugs, don’t resell the drugs and don’t mix prescriptions with illegal street drugs. Frequent testing also is a hallmark of addiction-treatment centers, which also have been scrutinized by federal investigators and private insurers.

The medical board has suspended or revoked licenses of doctors who it determined prescribed opioids without proper oversight.

That oversight, according to the medical board’s guidelines, should include “regular toxicologic testing for drugs of abuse.” The guidelines don’t specify which drugs of abuse doctors should test, or how often tests should occur.

Too much testing a concern

Labs and clinics in Arizona and other states use sophisticated tests that measure multiple substances and charge for each individual substance tested, providing more revenue than basic screening tests. Too much testing has long been a concern of Medicare due to potential overbilling, a Centers for Medicare and Medicaid Services spokesman said.

That’s one reason Medicare, the federal health program for the disabled and those 65 and older, is overhauling the way it pays for these tests. Beginning in January 2016, labs and doctors must limit Medicare charges to two categories of billing codes. And in January 2017, Medicare will change payment rates for drug testing.

A Medicare official said the changes aim to remove the incentive for too much testing that has little or no medical benefit.

Medicare wants to reduce the frequent use of confirmation tests by labs that charge for follow-up tests when initial tests show no sign of an illegal substance. Medicare says that some confirmation tests are not medically necessary and inflate charges for taxpayers who support Medicare.

Private health insurers also are scrutinizing and changing payment policies for urine screens ordered or performed by pain doctors, addiction-treatment centers and labs.

“The lab industry has done a lot of over-testing,” said Jennifer Bolen, a former assistant U.S. Attorney in Knoxville, Tenn., who consults on proper opioid screening. “Some of it was encouraged by a lack of sound boundaries (through guidelines). Some of it was pure greed.”

Doctors say they follow guidelines

Doctors who treat patients for chronic pain say they must adhere to state and federal guidelines on how to safely prescribe pain pills. They say they also must keep patients safe from the ravages of pain-pill addiction.

Overdose deaths from opioid prescriptions surged fourfold nationally from 1999 through 2010. Arizona had the fifth-highest opioid prescription rates in the nation in 2010 and was sixth highest in drug overdose deaths.

Arizona has since made small strides in reducing the death rate from drug overdoses. A total of 1,211 Arizonans died from drug overdoses in 2014, a slight drop from 2013. Thirteen states had a higher overdose rate than Arizona in 2014, according to the federal Centers for Disease Control and Prevention.

The CDC recently drafted guidelines that recommended urine testing for pain patients. Arizona doctors who treat chronic-pain patients say state and federal guidelines are instructive.

“Right now, urine testing is really not an option. It is (a) standard of care,” said Patrick Hogan, an anesthesiologist who runs a Glendale pain clinic. “If you are failing to test and you have a patient who has a complication, there is a high likelihood that you would face some disciplinary action from regulatory agencies.”

Doctors who frequently order drug tests for patients will need to navigate Medicare’s new billing requirements.

Medicare billing records show that Hogan ordered the most urine drug screens of any Arizona doctor in 2013. He billed Medicare for 1,943 tests on 368 patients — an average of 5.3 drug screens per patient that year, Medicare records show.

Hogan said that he does not know of any guidelines that limit how often a doctor should order a drug test for a patient. Some larger doctor groups may have their own testing frequency requirements. Hogan said he does not want limits on how often doctors can test.

“How often do you test somebody? I don’t know that there are clear guidelines that exist for something like that,” Hogan said. “I would hate to see something that would usurp provider judgment on that.”

Lisa Sparks, an addiction-medicine doctor and medical director of the Arizona Pain Institute in Glendale, said she decides how often each patient should be tested based on their circumstances. However, Sparks believes routine testing makes “patients realize they can’t cheat the system very easily” by misusing or selling their prescribed drugs.

She often orders panels that tests for multiple substances for patients who are on pain medications, but those tests vary based on the patient. For example, she said she does not test patients for the illegal street drug angel dust because it’s so rarely found in the community.

“We try to avoid overbilling and (limit panels) to do the tests that really need to be done,” said Sparks, who billed Medicare for 741 drug screens on 232 patient in 2013, Medicare records show.

Doctors in other states have been more prolific in billing for these tests. For example, one Connecticut doctor charged Medicare for an average of 198 tests per patient in 2013, Medicare billing records show.

Labs face closer scrutiny 

Labs that market tests in Arizona and elsewhere have been subject to enforcement actions and legal settlements.

Millennium Health, a San Diego-based laboratory, in October agreed to pay the federal government $256 million to settle claims that it billed Medicare for improper testing.

The U.S. Department of Justice said that Millennium billed Medicare and Medicaid for unnecessary urine and genetic tests over a seven-year period through May 2015. The company gave doctors free testing cups in exchange for patient referrals, resulting in unnecessary and lucrative testing, federal investigators said.

Millennium Health, previously known as Millennium Laboratory, was the subject of multiple civil lawsuits — including one in Arizona — that alleged billing improprieties. One Arizona-based regional sales manager alleged that sales representatives routinely offered medical practices free urine-testing cups to encourage doctors to order tests.

The lawsuit filed in U.S. District Court in Arizona alleged Millennium gave gifts such as Starbucks gift cards to doctors offices “to both retain existing business and assist in generating additional business.” At the time of the 2012 lawsuit, Millennium denied offering such inducements. The case was dismissed in April with no award to the sales manager.

Millennium officials said the company decided to settle the Justice Department’s multiyear investigation. The company filed for Chapter 11 bankruptcy in November.

“While Millennium may debate some of the merits of the DOJ’s allegations, we respect the government’s role in health care oversight and enforcement,” Millennium CEO Brock Hardaway said in a statement about the settlement. “At the end of the day, it was time to bring closure to an investigation that began nearly four years ago.”

Millennium isn’t the only lab that has caught the attention of investigators and health insurers.

In July, Cigna exited the Affordable Care Act individual marketplace in Florida for 2016 due to an “exponential increase in fraudulent and abusive care delivery practices” among substance-abuse clinics and labs, a Cigna spokesman said.

Cigna also sued Sky Toxicology and two related labs and alleged a “lucrative and improper patient-referral kickback scheme” that connected health clinics with out-of-network labs that resulted in $20 million in excess payments.

Filed under: General Problems