Various types of new lab testing scams are emerging for Medicare patients (see: Rapidly Growing Reference Lab, HDL, Tests Medicare Anti-kickback Law). Recreational drug testing for seniors has now emerged as another area of fraud (see: Doctors Cash In on Drug Tests for Seniors, and Medicare Pays the Bill). Below is an excerpt of the article describing this process:
Doctors are testing seniors for drugs such as heroin, cocaine and “angel dust” at soaring rates, and Medicare is paying the bill....Medical guidelines encourage doctors who treat pain to test their patients, to make sure they are neither abusing pills nor failing to take them, possibly to sell them. Now, some pain doctors are making more from testing than from treating. Spending on the tests took off after Medicare cracked down on what appeared to be abusive billing for simple urine tests. Some doctors moved on to high-tech testing methods, for which billing wasn’t limited. They started testing for a host of different drugs—including illegal ones that few seniors ever use—and billing the federal health program for the elderly and disabled separately for each substance. Medicare’s spending on 22 high-tech tests for drugs of abuse hit $445 million in 2012, up 1,423% in five years. The program spent $14 million that year just on tests for angel dust, or PCP. Sue Brown, a laboratory director in Brunswick, Ga., said she has never seen someone over 65 test positive for angel dust, in 25 years in the business. For dozens of pain doctors, Medicare payments for drug testing have eclipsed their income from treating patients, a Wall Street Journal analysis of 2012 billing data shows.
The billing data for 880,000 providers were released in April after a long legal effort by the Journal. In Raleigh, N.C., pain specialist Robert Wadley started doing high-tech drug tests in his office in 2010 with equipment he installed there. Drug testing accounted for 82% of his medical practice’s Medicare payments in 2012....As his case shows, even though laboratories perform most drug tests, there are ways doctors themselves can be reimbursed, including by doing the tests right in their offices. Dr. Wadley is among doctors who have purchased devices called mass-spectrometry machines that can count the precise number of particles of different substances in a urine sample. Other doctors become laboratory owners or benefit indirectly from arrangements made with labs. Dr. Wadley in 2011 helped launch a business that does tests for other physicians. The firm, AvuTox LLC, has routinely tested Medicare patients’ specimens for more than three-dozen separate drugs, billing for each. The drugs range from pain pills to MDMA, or “ecstasy,” and its chemical cousin MDEA, or “eve,” the billing data and company documents show. AvuTox was paid an average of $1,265 per Medicare patient in 2012, nearly double the average of 108 other labs where a majority of Medicare revenue related to drug tests. In its second year in business, AvuTox became the tenth-biggest recipient of Medicare drug-test payments, $7.3 million. At his medical practice, Dr. Wadley received $1.4 million for drug tests on his own patients. Many medical experts say high-tech drug tests should generally be used only to confirm results from cheaper, low-tech screenings.
CMS makes Medicare claims data available for public scrutiny through public use files (PUFs) (see: Basic Stand Alone (BSA) Medicare Claims Public Use Files (PUFs)). I posted a note three years ago suggesting that the availability of Medicare claims files could be used to root out fraud (see: Medicare Billing Rife with Fraud; Need Open Web Access to Claims Database). I even suggested at that time that those who identified cases of such fraud should be rewarded with some reward analogous to that available in whistleblower cases. By the way, the AMA opposed broad access to these medicare claims files. It is still carping about the recent April data release (see: AMA Statement on CMS’ Medicare Data Release). At any rate, some portion of the current chicanery relating to Medicare billing seems to involve scams for ordering unnecessary esoteric tests, with the ordering physician getting a cut, and now the ordering of unnecessary drug testing sometimes with testing in physician office labs (POLs).