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  • Self-Referral of Anatomic Pathology Cost Medicare $69 Million, Says GAO

    A new report from the Government Accountability Office (GAO) concludes that when physicians performed biopsies in their own facilities instead of referring the service to an outside lab, the number of procedures increased, and costs went up. GAO released "Action Needed to Address Higher Use of Anatomic Pathology Services by Providers Who Self-Refer" yesterday.

    This second of 4 reports in GAO's self-referral investigation covered anatomic pathology services between 2004 and 2010. Among the findings are that self-referred services more than doubled, while services referred externally increased far less (116% vs 38%); and spending was higher for self-referrals than for non-self-referral services (164% vs 57%). GAO estimated that the higher rate of procedures and higher number of services per biopsy by self-referrers cost Medicare $69 million. Additional findings and conclusions are in the report.

    "There is more than enough evidence that self-referral leads to over-utilization," stated the Alliance for Integrity in Medicare (AIM) today in response to the report. GAO recommended that the Centers for Medicare and Medicaid Services (CMS) track self-referred anatomic pathology services, create policies to ensure appropriateness of biopsy procedures, and develop new payment approaches. AIM said that while it applauds GAO's findings, it disagrees with these recommendations. "It's time to get at the root of the problem and close the self-referral loop." APTA is an AIM member.

    In its first report, GAO investigated self-referral in advanced imaging services, also concluding that financial incentives were a likely factor driving the increases in referrals and spending.

    APTA anticipates the last 2 reports in the series, on radiation oncology and physical therapy, later this year.


    • I look forward to seeing GAO's self-referral findings for POPT's.

      Posted by Rachel Rosenstein on 7/19/2013 3:22 PM

    • This is intriguing given the current battle for AB1000 in California. CPTA is pushing POPTS along with direct access.

      Posted by Tianna Meriage Reiter on 7/19/2013 5:18 PM

    • With all the mounting negative evidence against POPTS and self-referral for profit. Why is CPTA voluntarily supporting a bill to legalize and legitimize these practices? It makes no sense to me.

      Posted by Brian Stone on 7/19/2013 7:30 PM

    • In light of this report, why is the California Chapter supporting a AB100 - a bill that supports POPTs??? AB1000 will significantly hurt private practice clinics in California even if direct access is available.

      Posted by Debbie Struiksma on 7/19/2013 8:47 PM

    • Isn't the most important information the number of pathologies found ?

      Posted by Jana on 7/20/2013 8:41 AM

    • This is just the tip of the iceberg. The local scam is for several MDs to form fake corp and open a DME, Hospice, and Rehab services, load them with fake claimes then split the profit. Several years later sell these business that are built on a house of cards for big bucks. The buyer now has a million dollar company with few referrals because these MDs have moved on.

      Posted by Mike Stewart on 7/20/2013 11:29 PM

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