Unnecessary tests potentially cost Massachusetts millions

Unnecessary imaging tests and high reimbursement rates on those tests may have cost MassHealth--the Massachusetts Medicaid program--millions of dollars, an auditor for the state has found. 

In 2009 alone, MassHealth paid more than $30 million for 582,000 advanced imaging claims, according to a 47-page report published by auditor Joe DeNucci this week. Many of the patients who underwent CT scans or MRIs did so on advice from doctors practicing "self-referral"--sending patients to undergo tests conducted by doctors with a financial interest at stake--according to the Boston Globe's "White Coat Notes." 

"Our review found that unlike many states, Massachusetts does not regulate self-referral for advanced imaging services to prohibit or, at least, disclose self-referrals to patients, which could potentially result in significant negative consequences," the report said. 

Additionally, the state's Medicaid reimbursement rate for imaging is higher than the federal Medicare reimbursement rate. Due to that discrepancy, it was determined that the state lost out on roughly $8.5 million in savings from fiscal year 2007 to FY09 for dual eligible patients--Medicaid patients who also underwent the tests through Medicare. 

"The Medicare reimbursement rates for advanced imaging as set by CMS have been reduced multiple times in recent years, and more restrictive requirements for advanced imaging are proposed in the 2010 federal budget," the report stated. "[In contrast] MassHealth has had a net increase in reimbursement rates for advanced imaging services in recent years, and DHCFP sets the reimbursement rates for MassHealth using a different methodology than CMS does for Medicare." 

To learn more:
- here's the report (.pdf)
- read this Boston Globe brief
- check out this press release from DeNucci's office

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