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Wednesday, July 17, 2013

Self-Referring Providers Continue to Take a Toll on Medicare

by James Swann

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Self-referring providers in 2010 referred biopsy services at a higher rate than non self-referring providers, resulting in an additional $69 million in Medicare payments, according to a GAO report. 
 
A self-referral occurs when a provider refers patients to entities with which the provider or his or her immediate family have a financial relationship, and while most self-referrals are prohibited under the Stark law, there are certain exceptions, including biopsy services.

GAO recommended CMS require that providers indicate whether biopsy services were self-referred or not, and also called on the agency to devise a new payment structure to remove the financial incentive linked to self-referral.

The report was prepared for  for Sens. Max Baucus (D-Mont.) and Chuck Grassley (R-Iowa) and Reps. Henry A. Waxman (D-Calif.) and Sander M. Levin (D-Mich.), and Baucus and Grassley each said that CMS should focus on ensuring that biopsy services are in a patient's best interest, and not being performed for financial gain. "Federal policy should drive doctors to make decisions based on quality of care, not financial relationships," Grassley said.
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