The Medicare program spends hundreds of millions dollars a year to test enrollees for their drug levels, and the liberal restrictions on tests may lead to physician abuse.
Medicare paid medical providers $457 million in 2012 to perform 16 million drug tests on enrollees, Reuters reported. The tests range anywhere from detecting blatantly illegal narcotics, such as cocaine, to prescription medicines. Drug and urine tests for patients are ripe for abuse because of fuzzy guidelines that leave the level and frequency of testing to the physician's discretion.
Abuse of prescription painkillers has been especially dramatic in recent years, prompting the U.S. Food and Drug Administration last year to issue new labeling guidelines last year for long-acting pain relievers. The U.S. Substance Abuse and Mental Health Services Administration projects that the number of adults over the age of 50 who will need substance abuse counseling will double between 2012 and the end of this decade, reaching 5.7 million.
However, some providers may engage in fraud trying to track those who might become addicted to drugs, Reuters suggested. For example, three doctors in Connecticut billed Medicare in 2012 for 24,000 drug tests that were performed on only 145 patients. They were paid a total of $1.4 million. Each of the three doctors billed $94 for each test, a comprehensive panel one of the doctors told Reuters was more accurate than a $19 test that Medicare also covers.
"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," Bill Mahon, former executive director of the National Health Care Anti-Fraud Association, told Reuters. "It's like turning on a spigot of money."
To learn more:
- read the Reuters article
- here is SAMHSA data (.pdf)
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