U.S. federal investigators are hunting incidents of Medicare fraud, using sophisticated computer technology to determine unusual patterns.
In one case, investigators found a patient who had reportedly undergone a diagnostic rectal-probe procedure 118 times in a year at 21 medical facilities.
As one official told USA Today: "It's unlikely that could have occurred. This person would not have been able to sit on a plane."
The use of computer programs to find suspicious patterns is designed to help discover insurance fraud before payment.
Medicare investigators said they have also discovered cases in which improperly obtained Medicare patient identification numbers were used to bill for examinations that were likely never performed. Such discoveries have resulted in 83 diagnostic centers losing their Medicare billing privileges this year, with $163 million in payments denied.
Fraud is estimated to account for as much as 10 percent of the nation's $2 trillion healthcare spending bill.
Copyright 2006 by United Press International
Related stories:
PET confirmed as valuable cancer diagnostic and disease-staging tool
The recent release of data by the National Oncologic PET Registry (NOPR) showing that positron emission tomography (PET) produced scans revealing disease at a molecular level, which then caused physicians to change treatment plans for more than one-third of participating patients, has corroborated decades of nuclear medicine research.
Study links depression to higher death rate from all causes among Medicare beneficiaries with diabetes
(PhysOrg.com) -- In a large group of Medicare beneficiaries with diabetes, depression was associated with a higher death rate from all causes during a two-year study period. The findings are published in the October 2008
Journal of General Internal Medicine.
Increasing health care value improves health care quality
Finding better ways to deliver healthcare to patients is key to ensuring that Medicare is able to meet the needs of the nation's baby boomers according to a new paper by Geisinger Health System published in
Health Affairs.
New laboratory technique improves success in 'highly sensitized' kidney transplants
Kidney transplant specialists at Cedars-Sinai Medical Center have developed innovative laboratory techniques to improve opportunities and success rates for kidney transplant candidates who are at high risk of organ rejection because of previous exposure to donor antigens, according to an article in the Sept. 27 issue of the journal
Transplantation.
Researchers evaluate cost-effectiveness of genetic screening to guide initial HIV treatment
A major study from a team of researchers from Weill Cornell Medical College and Massachusetts General Hospital has found that a recent change to HIV-treatment guidelines recommending genetic screening is cost-effective under certain conditions. The new recommendation suggests conducting a genetic screening test prior to prescribing the drug abacavir, one of the preferred first-line drugs for the treatment for HIV-infected adults.
Hospitals could reduce unnecessary tests for cardiac diagnostic imaging
Hospitals that perform cardiac nuclear stress testing under published national practice guidelines could reduce unnecessary testing and, potentially costs, according to a Henry Ford Hospital study.
PET scans lead to treatment changes in majority of colorectal cancer patients
In the largest multi-institutional study to date examining the impact of positron emission tomography (PET) in changing disease management of individuals with suspected recurrent colorectal cancer, researchers found that treatment plans were changed for more than half of patients, according to an article in the September issue of
The Journal of Nuclear Medicine.
Struggling generations: Bankruptcies among seniors soaring
(PhysOrg.com) -- The rates of personal bankruptcies have declined among young people while soaring among older Americans, a new study shows.