Analysis Finds Medicare Spending on Drug Screening ‘Soaring’
Medicare is reimbursing physicians for their "soaring" use of tests that screen beneficiaries for use of illicit drugs, such as cocaine and heroin, the Wall Street Journal reports.
According to the Journal, the increasing numbers of such tests are linked to efforts to reduce painkiller misuse. Medical guidelines recommend that physicians test their patients when they are being treated for pain to ensure they are not misusing the prescriptions or not taking the medications, which could mean they are being resold.
However, a Journal analysis of 2012 billing data for 880,000 providers showed that some physicians are testing for a number of different drugs, including illicit drugs beneficiaries rarely use, and billing separately for each substance. The analysis found that some physicians received more income from performing the tests than they did from treating patients. For example, drug screenings accounted for 82% of the revenue from Medicare brought in at one North Carolina pain specialist's office.
Further, once Medicare became more stringent on what seemed to be overbilling for urine tests to screen for the drugs, some physicians began using different testing measures that are not subject to billing limits.
The practice resulted in Medicare spending on 22 high-tech drugs screening tests reaching $445 million in 2012, an increase of 1,423% over five years. For example, Medicare spent $14 million in 2012 for tests screening for "angel dust," despite reports from some experts that they had never discovered an individual over age 65 testing positive for the drug. In addition, many medical experts say that such tests should be used only to confirm the results of less-costly, low-tech screenings.
In a CMS proposal to change laboratory service payments, the agency said it is "concerned about the potential for overpayment when billing for each individual drug test." A CMS spokesperson said the agency is "evaluating public comments on our proposal and expects to make a final decision" soon (Weaver/Wilde Mathews, Wall Street Journal, 11/10).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.