Monday, November 10, 2014

Why Is The Doctor Testing Your Grandma For Ecstasy?

You want proof that medical schools are full of smart people? Just follow the money. The Wall Street Journal has a report out on the exploding growth in the number of drug tests being administered on Medicare patients. In 2012, the government healthcare program for the elderly spent $445 million on drug testing, up nearly 1,500% in five years.

Why is this happening? In the past, a doctor could bill Medicare $20 for each class of drug that was tested using a simple urine dipstick exam. Then four years ago, the feds thought they would try to save money by capping the total bill to $20 for each urine specimen. This didn't sit well with some physicians.

Doctors then figured out that Medicare doesn't put a limit on urine drug exams using more high tech equipment like mass spectrometry. Medicare allowed doctors to bill for each individual drug tested using the new machines. This turned into a goldmine for some enterprising physicians.

Dr. Robert Wadley of Raleigh, NC started a urine drug testing firm called AvuTox that used a mass spectrometer. Each drug that is screened is billed over $20 to Medicare. A standard panel that AvuTox offers consists of over 40 different substances tested. The tests included range from standard narcotics to ecstasy to PCP, which are rarely positive in patients over 65 years old. His average payment from Medicare in 2012 was $1,265. AvuTox received $7.3 million from the government, the tenth highest drug testing reimbursement in the country. Dr. Wadley was paid $1.4 million from the program for his own patients. "Urine drug testing is how I pay the bills," he admits.

AvuTox then parlayed it expertise in Medicare billing into a scheme for patients with regular health insurance. It offered its services to other doctors, who pay the company a flat fee. The physicians then bill the patient's insurance company for the tests and they get to keep the balance. On AvuTox's website, they claim doctors can make as much as an extra $96,000 per year. That claim has since been taken down once the media started asking about it.

Dr. Wadley states he is innocent. He says he had no idea he was doing more urine drug testing on the elderly than other doctors. He believes all the drug screens he performs and bills the government for are medically necessary to detect any drug abuse problems that aren't being picked up.

Some doctors even go so far as to cause the problem that they will eventually bill Medicare to detect and treat. Dr. Fathalla Mashali, a Massachusetts pain physician was the single highest recipient of Medicare money for urine drug screening in 2012--$2.8 million. Ironically he was also arrested by the FBI for Medicare fraud for prescribing narcotics to known drug users and not performing physical exams to document their need for pain meds.

Some doctors just get too greedy for their own good. But the government makes it so easy to do so, especially if you're smart enough to get into medical school.

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