Self-referrals for anatomic pathology services very costly

(HealthDay)—Health care providers who self-refer for anatomic pathology services cost Medicare about $69 million in 2010, according to a report published by the U.S. Government Accountability Office (GAO).

Researchers from the GAO examined the prevalence of anatomic self-referral (referral to an entity in which the provider or their family members have a financial interest) and its effect on Medicare spending. GAO assessed trends using Medicare Part B claims data from 2004 through 2010.

According to the report, from 2004 to 2010, self-referred anatomic pathology services increased at a faster rate than non-self-referred services. The number of self-referred anatomic pathology services more than doubled, from 1.06 million to 2.26 million, compared with a 38 percent increase in non-self-referred services. Ninety percent of referrals for self-referred anatomic pathology services in 2010 were accounted for by three provider specialties (dermatology, gastroenterology, and urology). In 2010, an estimated 918,000 more referrals for anatomic pathology services were made than would have been expected if they were not self-referring. These additional referrals are estimated to have cost Medicare about $69 million.

"GAO issued a report today with irrefutable evidence that physician self-referral is a national problem," Gene Herbek, M.D., the president-elect of the College of American Pathologists, said in a statement. "It contributes to widespread abuses, increased medical costs and over utilization, and it allows physicians to exploit a loophole that permits them to bill Medicare for certain additional services they provide to patients at the time of the office visit."

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