Blog | Friday, November 2, 2012

QD: News Every Day--Self-referrals for imaging studies pose risks for patients, cost Medicare $109 million

Medicare should reduce payments and ensure medical need when physicians refer patients to scanning facilities in which they have a financial interest, the General Accountability Office suggested.

The agency reviewed Medicare Part B data from 2004 to 2010, and said in a report that providers who self-referred likely made 400,000 more referrals for advanced imaging services than they would have if they were not self-referring in 2010, costing Medicare about $109 million.

"To the extent that these additional referrals were unnecessary, they pose unacceptable risks for beneficiaries, particularly in the case of CT services, which involve the use of ionizing radiation that has been linked to an increased risk of developing cancer," the agency stated.

There was an 80% rise in self-referral MRI scans compared to a 12% rise in non-self-referred procedures, the agency stated. And, the analysis showed that providers' referrals "substantially increased the year after they began to self-refer." Meanwhile, the average number of referrals made by providers who remained self-referrers or non-self-referrers declined.