The scan scam


Gina Kolata raises many questions in her New York Times piece today, "Good or Useless, Medical Scans Cost the Same."
Besides issues of variable scan quality, she writes:

In a recent report, the Government Accountability Office said nearly two-thirds of the money Medicare paid for imaging was for scans in doctors’ offices. And, the report added, doctors were receiving an ever larger part of their income from providing scanning services. Not only were patients more likely to have scans if a doctor did this, but the quality of some of the scans was questioned.

“No comprehensive national standards exist for services delivered in physician offices other than a requirement that imaging services are to be provided under at least general physician supervision,” the G.A.O. wrote.

Private health insurers were concerned, too. “These are alarming patterns that have also been observed in the private sector,” America’s Health Insurance Plans wrote in a response to the G.A.O.

It is clear why self-referral can be tempting, said Dr. Bruce Hillman, a radiology professor at the University of Virginia.

“It’s all profits,” Dr. Hillman said, adding that a group of doctors can make an extra $500,000 to $1 million a year simply by acquiring a scanner.


It's odd that the story doesn't mention that a federal ban against self-referral for Medicare patients in 1993. (The Stark II law.) However, there are some specific exemptions that some doctors are making use of to get around the intent of the law.

The story makes it sound like the issue is whether or not self-referral for scans is a problem. "Golly, should something be done?" the story seems to ask.

But the story misses the point that this question was answered two decades ago: self-referral for scans creates a conflict of interest that distorts medical practice. That why Congress attempted to ban self-referral.

It seems to me the story should have made it clearer that the current flavors of self-referral were set up in order to circumvent the ban... rather than just meekly raising questions about self-referral. It implies there is still something to debate on that point.

P.S. Kolata also stretches the definition of "recent."

The story fails to give readers any specific source information... other than quoting a "recent" GAO report.

The report the quote in the story is taken from is GAO-08-452... which was issued 9 months ago, in June 2008. But then readers wouldn't know that unless they searched the GAO web site trying to finding the source of the quote.

Aside from the issue of self-referral legality, this article actually very nicely brings to light the enormous corruption in health care. Even successful practices with honest doctors are forced more and more often to engage in questionable medical ethics, such as asking for scans when none are necessary. As the article points out, there's a very large monetary incentive for doctors to do that in some cases, so obviously they do. The medical field needs some serious treatment!

About this Entry

This page contains a single entry by Gary Schwitzer published on March 2, 2009 9:28 AM.

The crazy quilt of health care in the US was the previous entry in this blog.

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