Doctors Charging Medicare Millions To Test Seniors for PCP, Says Consumer Watchdog
http://www.cnbc.com/id/102175134#.
From the article:
Doctors are charging Medicare millions for apparently unnecessary tests of seniors for illegal drugs like cocaine and PCP according to a Wall Street Journal analysis of Medicare payment data.
“Testing seniors for PCP and ecstasy is a comic but all too common example of skyrocketing costs generated by doctors who order unnecessary but profitable tests and treatments,” said Carmen Balber, executive director of Consumer Watchdog. “Doctors like to blame patients and lawsuits for the proliferation of unnecessary tests and procedures, but the truth is that more tests mean more revenue.”
The WSJ analyzed 2012 Medicare billing data and found that dozens of pain management doctors were making more money from Medicare payments for drug testing than from treating patients. A New York Times analysis earlier this year found that just two percent of doctors receiving Medicare payments received 25% – or $15 billion – of all Medicare payments.
Since Medicare cracked down on abusive billing practices for simple urine tests four years ago, doctors began to use higher-tech drug tests that are far more profitable. Medical experts have said that these more expensive higher-tech drug tests should only be used to confirm results from cheaper, lower-tech options.
Use of illegal drugs like heroin, cocaine, and marijuana is extremely rare among seniors. According to a 2012 survey by the federal Substance Abuse and Mental Health Services Administration, only about one in 1,000 seniors abuse or are addicted to illegal drugs. However, there remains an enormous profit-incentive for physicians to bill for unnecessary tests.
Filed under: General Problems
Btw, I had to agree in writing that I would pay for test if Medicare didn’t. More-much more than I get in disability each month.
I am a grandmother of 4 and yes I was tested for$1400 worth and thanks to the great state of Tennessee Medicare is being charged every 3 months or so for this stupidity. I need relief from pain for the diseases that I have that can’t be cured. If I didn’t need help I would not be in the doctor’s office every 30 days. Would I be stupid enough to go for a drug test with illegal products showing up? If Violently has evidence of crime then that should be reported.
Steve, as an RPh who worked 1/2 hr from the IL border, I noticed that with several Sudafed buyers, they had both IL and IN licenses. I was told by IN BMV you’re only allowed one drivers license or state identification (if license suspended or minor) and thats your primary state of residence. And I know I’ve mentioned my ex SIL who works for IN ABC sees several names pop up on both drivers licenses and SS#s when people apply for bartenders licenses and BMV is not interested in this huge potential ID theft.
Guidelines for opioid treatment recommend that physicians test ALL patients on opioids once per year. And these same guidelines suggest testing more often if patients are young or have history that makes them higher risk — i.e. Test them more often if they are NOT grandma. Physicians ignore guidelines at their own peril. The DEA, CMS, and state medical board could request an audit anytime. So grandma gets a test once a year in my practice.
There are vanishingly few physicians that own a laboratory suitable for LCMS verification of urine (the expensive, extremely accurate test) because of the high cost to set up and the need for hundreds of urines per month to justify operating costs. This is not to mention the Stark issues.
I’m not saying physicians wouldn’t order lab tests to make money. They would. And in some cases they do. But urine testing grandma, in general, is not a case of the “fleecing of America” by physicians. These “dozens” of docs mentioned above are a very small percentage of the thousands of pain management physicians (and PCPs) who write opioids.
Steve, I am on board with a lot of your healthcare critique but this analysis is misleading
IMO… if healthcare professional had access to the BMV on line database to validate the license presented.. and scanning the license would also request a PMP report.. prescribers would know if they had a new bogus pt trying to get into the practice.. Pharmacists would be putting the correct driver’s license number into the PMP… if a forged RX got pass one… the accurate pt’s data points would be in the PMP.. If the PMP would do some data mining and send reports to those writing/filling Rxs for pts of interest.. It would make drug testing almost unnecessary. It is claimed that there are 6-7 million people abusing some substance – other than alcohol & tobacco.. I have yet to see a estimate on how many diverters we have “working the system”. Those are the ones we need to focus on.. my money is on the fact that they have multiple ID’s and only one may match up with the BMV’s database.
Once a year? Ha. I get tested every month for a full panel of drugs, including cocaine, PCP, MDMA, etc. This is EVEN THOUGH I have never once tested positive for any illegal drug. I don’t even drink or smoke, and those are legal!!
I don’t know why medicare is paying it. They won’t even cover a test for Hep C. My ex-husband had it later on and in fact died from it. I wanted to make sure I did not have it, so the doctor ordered a test. I just got the bill from Labcorp saying Medicare will not cover it