GAO Report Highlights Higher Use of Advanced Imaging Studies by Providers Who Self-Refer

by King & Spalding
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The Government Accountability Office (GAO) recently published the results of a study detailing the higher use of advanced imaging studies by providers who self-refer.  Self-referral by providers occurs when providers refer patients to entities with which they or an immediate family member have a financial relationship.  Self-referral may include situations when a physician refers a patient to his or her office for an imaging study when such physician has purchased or leased advanced imaging equipment. 

The GAO found that (i) from 2004 through 2010, the number of self-referred and non-self-referred advanced imaging services (specifically, magnetic resonance imaging (MRI) and computed tomography (CT) services) both increased, with the larger increase among self-referred services and (ii) providers’ referrals of MRI and CT services substantially increased the year after they began to self-refer.  For example, the GAO noted, among many statistics, that the number of self-referred MRI services increased from about 380,000 services in 2004 to about 700,000 services in 2010, an 80 percent increase, while the number of non-self-referred MRI services only grew about 12 percent during the same time period, from about 1.97 million services in 2004 to about 2.21 million services in 2010.   The GAO noted that the differences in advanced imaging referrals between self-referring and non-self-referring providers continued even after taking into consideration differences in practice size, specialty, geography, or patient characteristics. 

Medicare Part B expenditures, including payment for CTs and MRIs, are expected to continue to grow at what the GAO has called an “unsustainable rate,” and many see self-referral as a factor in this growth.  While the GAO made three recommendations to address the increases in self-referred imaging services, the Department of Health & Human Services only will consider one of those recommendations, specifically, the recommendation that CMS employ an approach to ensure the appropriateness of advanced imaging services referred by self-referring providers.  The GAO report may be read here.

Reporter, Christina A. Gonzalez, Houston, +1 713 276 7340, cagonzalez@kslaw.com.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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