Medicare

Because Florida had the only statewide information then available on doctors with a financial stake in imaging center joint ventures, GAO analyzed 1990 Medicare claims for imaging services ordered by physicians in that state. GAO found that Florida doctors with a financial interest in such centers ordered about $10 million more in Medicare-paid imaging services than other doctors in 1990. Florida physicians with imaging facilities in their offices, group practices, or other practice settings also had higher imaging rates compared with those of other physicians. The Department of Health and Human Services has not yet finalized the regulations and procedures needed to implement and enforce federal self-referral restrictions that would apply to doctors with a financial interest in joint ventures. Moreover, the Health Care Financing Administration has no system to check physician-referral patterns to identify abusive overutilization of self-referrals.

GAO found that: (1) Florida physicians with financial interests in joint-venture imaging centers had higher referral rates for a wide variety of imaging services than other Florida physicians; (2) the differences in referral rates were the greatest for costly high-technology imaging services; (3) physicians with financial interests in imaging centers offering magnetic resonance imaging (MRI) services ordered twice as many MRI scans as physicians with no financial interests in these centers; (4) Florida's Medicare costs could have been reduced by about $10 million in 1990 if physicians with financial interests in imaging centers ordered imaging services at the same rate as other Florida physicians; (5) Florida physicians that offered in-practice imaging services ordered 3 times as many MRI scans, 2 times as many computed tomography scans, 5 times as many ultrasound scans, and 4.8 times as many echocardiograms as physicians that referred their patients to outside facilities; (6) HHS has not finalized the regulations that are needed to implement and enforce federal self-referral restrictions; and (7) the Health Care Financing Administration (HCFA) and Medicare contractors have not developed procedures to systematically monitor physician referral practices or identify the overutilization of medical services provided through in-practice self-referrals.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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