CMS says it won't review billings despite IG report that it overpays doctors

May 31 2014

The move comes even as a report points at $6.7 billion in overspending in Medicare. The HHS inspector general also says that the program paid $457 million in 2012 to detect drugs after a sharp increase in prescription drug abuse.

NPR: Medicare Frequently Overpays Doctors For Patients' Visits
Medicare spent $6.7 billion too much for office visits and other patient evaluations in 2010, according to a report from the inspector general of the Department of Health and Human Services. But in its reply to the findings, the Centers for Medicare and Medicaid Services, which runs Medicare, said it doesn't plan to review the billings of doctors who almost always charge for the most expensive visits because it isn't cost-effective to do so (Ornstein, 5/29).

MSNBC: Medicare Paid Millions Of Dollars For Wrongdoings, Report Finds
Medicare paid doctors $457 million in 2012 for 16 million tests to detect drugs -- from prescription narcotics to heroin, according to a new report from Reuters. A sharp rise in prescription drug abuse among older Americans has caused a nationwide increase in urine and blood tests, procedures that typically are potential areas of fraud among providers. The Office of the Inspector General of Health and Human Services, which heads Medicare, first started investigating scams in such tests in 2011 (Richinick, 5/29).

Reuters: Exclusive: Medicare On Drugs: 24,000 Tests For 145 Patients
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 (Pell and Begley, 4/29).