News: Research shows Medicare abuse costs more than wasted tax dollars

CDI Strategies - Volume 13, Issue 51

A new study performed by researchers at Johns Hopkins found that Medicare fraud and abuse costs are much as $140 billion annually. The study, published in the Journal of the American Medical Association (JAMA) Internal Medicine, also found that this fraud and abuse is not only a financial problem, but a public health issue, reported HealthLeaders Media.

Researchers estimate that Medicare fee-for-service patients treated by clinicians who later are banned from the federal healthcare program for fraud were as much as 17% more likely to die than patients treated by non-excluded clinicians.

In 2013, that fraud and abuse contributed to 6,700 premature deaths, and study lead author Lauren Nicholas says that number is a low-ball estimate because it does not factor in other government-sponsored health insurance, commercial health insurance, or uninsured patients.

The study also found that patients treated by later-banned providers were between 11% and 30% more likely to experience an emergency hospitalization within a year.

Nicholas says the higher mortality rates of patients of later-banned clinicians are “directly related to the crimes that these perpetrators are committing in order to bill Medicare for additional revenue.”

“A lot of these perpetrators do things like illegally disseminate dangerous drugs. There are cases where they're doing medically contraindicated surgery because surgery is a lucrative thing to bill for, or they're using fraudulent make-your-own chemotherapy,” Nichols says.

According to HealthLeaders Media, the study found that even a single visit with a provider who was later excluded for fraud and abuse increased the patient’s risk of dying compared to someone who lived in the same county with the same health status but who did not see an excluded provider.

Editor’s note: To read HealthLeaders Media’s coverage of this story, click here. To read the published study, click here.

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