Medicare and its patients were overbilled by $17 million in a national study of chemotherapy because the doctors doubled-billed, took payments without giving treatment and took payments for patients who didn’t have cancer, an internal review found.
The Inspector General of Health and Human Services report, released to the public Wednesday, found Medicare made payments in a chemotherapy “demonstration” for almost 44,000 patients who weren’t receiving chemotherapy.
The report reveals a pattern of waste, fraud and abuse in the $275 million study.
The purpose of the study was to chart patients’ reactions to chemotherapy. Doctors were paid up to $130 every time they reported the degree to which a patient suffered from nausea, vomiting, pain and fatigue as a result chemotherapy.
The government paid 80 percent of each of these bills, and Medicare patients paid the rest.
Thestudy was the most expensive program ever undertaken by the Centers for Medicare and Medicaid Services, the government agency responsible for the government’s largest health care program.
And the study was a waste, Wednesday’s Inspector General’s report states.
“Our analysis of a full year of demonstration data revealed numerous inconsistencies and anomalies that raise further issues concerning the integrity of the data,” the report states. “Based on these concerns, we conclude that the demonstration data are unreliable.”
About 7,500 doctors participated in the yearlong study. The median amount paid to each doctor was $23,000, but the top 10 billers were given more than $270,000 each, the report states.
The doctors include, according to the report, a Florida oncologist who received $625,603; a Kansas oncologist who received $507,563; and a California oncologist who received $443,170. Wednesday’s report is another blow to the credibility of the Centers for Medicare. The report was requested by Sen. Chuck Grassley, R-Iowa, who has called repeatedly for an overhaul of the Centers.
Steven Hahn is a spokesman for the American Association of Retired Persons. He said the lesson from Wednesday’s report is patients have to study their Medicare statements carefully.
“Because they’re paid for by the government, a lot of people just throw them away without looking at them,” Hahn said. “We actually want beneficiaries to become the front line of defense against waste, fraud and abuse by looking at those statements like they would look at their credit card statements.”
Officials at the Centers for Medicare did not respond to a request for comment.
Phony claims breakdown
According to Wednesday’s report, Medicare paid out almost 95,000 erroneous claims under the yearlong study. Among them:
» 58,891 patients who were receiving chemotherapy but didn’t have cancer.
» 43,996 patients who weren’t receiving chemotherapy.
» 37,397 duplicate bills
