Exclusive: Medicare On Drugs: 24,000 Tests For 145 Patients --Maybe they were especially complicated cases

By M.B. Pell and Sharon Begley, May 29, 2014

(Reuters) - Three Connecticut doctors billed Medicare for nearly 24,000 drug tests in 2012 - on just 145 patients. Despite the extraordinary number, Medicare administrators paid the doctors a total of $1.4 million, according to a Reuters analysis of government payments to health providers.

The three physicians stand out in the Medicare data released last month because they conducted three to four times more drug tests per patient than any other provider in the country. In fact, they ordered so many individual tests, their patients averaged one every other day.

A surge in prescription drug abuse among older Americans has been accompanied by a big increase in urine and blood tests nationwide. Part of an effort to detect that abuse, the tests generate millions of dollars for providers. Medicare, the government insurance system for the disabled and people 65 years and older, is footing the bill.

Medicare administrators declined to comment on the doctors' bills or to say whether they were investigating. But experts in laboratory billing said the high frequency of tests was extremely unusual and underscored the need for Medicare to improve oversight of potentially lucrative drug tests to guard against billing for unnecessary procedures.

"Those numbers are ridiculously high," said Dr Stuart Gitlow, acting president of the American Society of Addiction Medicine. "There is no medical indication I can think of that would require such frequency of testing. I can't come up with a scenario at all."

Two of the doctors work together in New London, Connecticut. The third doctor works in Ellington, about 60 miles away. Two of the three, contacted by Reuters, denied any wrongdoing, with one saying he was simply following Medicare's billing rules as he understood them. The third declined to comment.

Each of the doctors requested only the most expensive and comprehensive drug test, for as much as $94, rather than the simpler $19 one. This was done to improve the accuracy of the results, one said.

"SPIGOT OF MONEY"

Medicare paid medical providers $457 million in 2012 for 16 million tests to detect everything from prescription narcotics to cocaine and heroin, according to the Reuters analysis.

"In some parts of the country every doctor and his cousin is hanging out a shingle to do (addiction) treatment. There’s a tailor-made opportunity for ordering a profusion of tests instead of one," said Bill Mahon, former executive director of the National Health Care Anti-Fraud Association.

"It's like turning on a spigot of money," he said.

Urine and blood tests are potential areas of fraud and abuse because guidelines for drug testing are vague, leaving the frequency of testing to the discretion of the provider. Unlike private insurance companies, which sometimes dispute charges and pay providers only when they have vetted a claim, Medicare almost always pays first and asks questions later.

There is often a legitimate need for such drug tests, to determine whether an addict has relapsed or to ensure that patients prescribed painkillers are taking them rather than selling them.

In 2011, the average number of older Americans misusing or dependent on prescription pain relievers grew to about 336,000, up from 132,000 a decade earlier, according to the Substance Abuse and Mental Health Services Administration.

Read the full story:  www.reuters.com

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