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Testing Seniors for Drugs - Doctors Charging Medicare Millions

Author: Consumer Watchdog : Contact: www.consumerwatchdog.org

Published: 2014-11-12

Synopsis:

Doctors are charging Medicare millions for apparently unnecessary tests of seniors for illegal drugs like cocaine and PCP.

Main Digest

A San Diego company, Millennium Laboratories, was paid $190 million from Medicare in 2012 including $4.5 million for PCP tests, more than any other California company.

"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 Wall Street Journal analysis of payment data found that Medicare spent $445 million in 2012 on high-tech tests for drugs, up 1,423% in five years.

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.

A 2012 analysis by former Centers for Medicare and Medicaid Services (CMS) administrator Donald M. Berwick and Andrew D. Hackbarth of RAND estimated unnecessary treatment costs the nation $158 to $226 billion a year.

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.

Read the Wall Street Journal report here: online.wsj.com/articles/doctors-cash-in-on-drug-tests-for-seniors-and-medicare-pays-the-bill-1415676782

See the Wall Street Journal analysis of 2012 Medicare billing data here: projects.wsj.com/medicarebilling/

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