Are Medically Unnecessary Tests Driving Growth of In-Office Procedures?

In a recent Wall Street Journal article titled, “In-Office Testing by Doctors Lifts Medicare Costs,” it was revealed that a sizeable chunk of the Medicare dollars are now going to physicians who utilize newly minted in-office medical devices. In fact, the WSJ’s analysis of recently released Medicare billing data showed that four of the top 10 fastest growing Medicare services from 2012 to 2014 involved new in-office devices.

So what is driving this tremendous in-office growth? Given the sizeable year-over-year jump in procedures, False Claims Act (FCA) violations might be a part of the equation. Specifically, providers could be running afoul of the FCA if the tests that are not medically reasonable and necessary for the care of Medicare patients.

Moreover, if the medical device manufacturers are deploying marketing tactics that are causing medically unnecessary in-office tests, they too could run afoul of the False Claims Act. In fact, a similar FCA causation theory was used to hold Kyphon liable for allegedly causing providers to use the manufacturer’s kyphoplasty devices in an improper setting. Subsequent to this settlement, hundreds of hospitals inked settlement checks because they allegedly followed Kyphon’s improper marketing advice.

Simply put, given the tremendous whistleblower rewards available under the FCA, healthcare providers should be on the lookout for improper marketing tactics pushing medically unnecessary in-office tests.

More information for potential whistleblowers is located at the Nolan Auerbach & White website.