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May 11, 2015

Our newspapers and journals routinely update us on Medicare and Medicaid fraud committed throughout our country. In these fraud cases, patients’ identities and insurance information have been stolen, sham-clinics are opened where tests are billed for visits that never occurred, etc. The effects these fraud cases have on the costs of health care in the United States are well-documented.

Another area being brought to light is one we will call ‘unnecessary care.’   A recent article in The New Yorker written by Atul Gawande, a general surgeon,  goes into great detail about the amount of unnecessary care being performed today. The article references a recent study performed on 1 million Medicare patients.

From this study, researchers determined these patients had received a litany of unnecessary tests from their respective physicians. To be more specific, the article shows that the researchers reported “twenty-five to forty-two per cent of Medicare patients received at least one of the twenty-six useless tests and treatments”  – those that have been determined to either  1) have no medical benefit for the patient, and/or 2) be directly  harmful to the patient. Some examples of these tests, as presented in the article, include: “Performance of an EEG for an uncomplicated headache, doing a CT or MRI scan for low-back pain in patients without any signs of a neurological problem, or putting a coronary-artery stent in patients with stable cardiac disease.”

The author also talks about performing some research on some of his own new patients. This involved reviewing their medical records prior to being referred to him. Out of 8 new patients he saw and researched, he found that seven of them had received unnecessary care.

The results of unnecessary care can have a dramatic financial impact on both the patient’s wallet and the overall costs of health care.  Even more disturbing is the physical harm that can be done to patients who had received this unnecessary care (excessive radiation exposure, unnecessary surgeries, prescription medication, etc.) and resulting unnecessary treatments and further testing from a lack of results or findings from the original unnecessary tests. 

This is a very slippery, dangerous and expensive slope to be on and reinforces the need to continue to perform preventative medicine and treat the glaring issues, such as obesity, high blood pressure, and diabetes, which lead to numerous health complications and expensive on-going treatment for patients.

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Steven Bisciello

Steven Bisciello is a Health Care Services Group, Partner experienced in revenue enhancement programs, health care litigation, compliance and physician practice management.

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