Drug screening becomes provider 'money spigot'
Medicare paid three Connecticut physicians for nearly 24,000 drug tests on 145 patients in 2102, according to an analysis of publicly-released provider payment data. That averaged out to one test per patient every other day, Reuters reported.
"Those numbers are ridiculously high," Stuart Gitlow, M.D., acting president of the American Society of Addiction Medicine, told Reuters. "There is no medical indication I can think of that would require such frequency of testing."
Medicare guidelines for urine and blood drug screens are "vague," so provider judgment drives test frequency. And with growing rates of prescription drug abuse in the Medicare population, utilization spikes in blood and urine testing are showing up nationwide, Reuters reported.
Last February, for example, the federal government settled false claims allegations against a Kentucky addiction clinic, clinical lab and two doctors. They agreed to repay $15.75 million for billing Medicare and Medicaid for drug tests that were unnecessary, more expensive than those performed or billed in violation of the Stark Law, the U.S. Department of Justice announced.
While drug testing is appropriate to see if an addict relapsed or ensure beneficiaries are taking instead of selling prescribed opiates, drug tests have become a business boon for some practitioners.
"In some parts of the country every doctor and his cousin is hanging out a shingle to do [addiction] treatment," Bill Mahon, former president of the National Health Care Anti-Fraud Association, told Reuters. "There's a tailor-made opportunity for ordering a profusion of tests instead of one. It's like turning on a spigot of money."
Connecticut addiction psychiatrist Erum Shahab, for example, derived 95 percent of her 2012 Medicare payments from 8,518 drug tests on 43 people, Reuters found. Addiction specialist Bassam Awwa, M.D., earned $983,894 for 13,260 tests on 90 patients. His associate Ammar Traboulsi, M.D., received $159,107 for 2,142 tests on 12 patients.
These doctors billed for the costliest drug screen. And separate billing for each drug tested resulted in higher per-claim allowances, even though such billing violates Medicare rules, Reuters noted.
For more:
- here's the Reuters article
- read the DOJ announcement
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