Physician Self-Referrals for Imaging Cost Medicare $109M in 2010

John Commins, November 7, 2012

A federal study estimates that financial incentives tied to physicians' self-referrals for advanced imaging services cost Medicare an additional $109 million in 2010.

The Government Accountability Office report, Higher Use of Advanced Imaging Services by Providers Who Self-Refer Costing Medicare Millions, examined MRI and CT services from 2004–2010. It found that the use of MRI services increased by more than 80% when physicians self-referred compared to a 12% increase for non-self-referred MRIs.

For CT services, utilization "more than doubled" with self-referrals, while non-self-referred CTs increased about 30%, the study found.

With the findings, GAO estimated that providers who self-referred ordered about 400,000 more advanced imaging services than they would have if they weren't self-referring, which cost Medicare an additional $109 million in 2010.

"To the extent that these additional referrals were unnecessary, they pose unacceptable risks for beneficiaries, particularly in the case of CT services, which involve the use of ionizing radiation that has been linked to an increased risk of developing cancer," GAO said.

John Commins

John Commins is a senior editor at HealthLeaders Media.


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