Medical Fraud: Is Your Doctor Scamming Retirees?

Source: Thinkstock
Source: Thinkstock

One of the biggest costs seniors face in retirement is health care. Between the recurring costs and unexpected medical procedures, aging Americans struggle more with health care costs than seniors in other countries. It’s difficult to predict exactly how much money should be saved in anticipation of these costs, but according to a 2015 HealthView Services report, a healthy couple retiring this year at age 65 will need roughly $266,000 to cover Medicare Parts B and D and supplemental insurance for their lifetimes.

For retirees who winter in southern states like Florida, some of that money is likely going to be wasted on unnecessary medical tests, according to a New York Times analysis.

Researchers from The Dartmouth Institute for Health Policy and Clinical Practice uncovered a trend of unusually high rates of medical testing in warmer regions where retirees are easily targeted. It cannot be explained by sicker patients, according to Dartmouth’s director, Dr. Elliott Fisher. “It’s mostly based on how much doctors do in a system where you make more by doing more,” he explained. “Financial incentives and more entrepreneurial doctors are very important to what we’re seeing.”

The trend is prompting many northern doctors to caution their patients to check in with them before agreeing to any exams or procedures. High rates of testing have been observed in Arizona, California, southern Nevada, and southern Texas as well, but The New York Times noted Florida has emerged as the “epicenter of Medicare abuse.”

From 1999 to 2008, Medicare reduced reimbursement for many cardiology services, so some physicians started using high-volume testing to supplement income. Claims for echocardiograms increased by 90% during this period, peripheral vascular ultrasound tests almost tripled, and nuclear stress testing, which costs thousands of dollars, more than tripled.

Mike Miller, a 74-year-old retiree who migrates from Maryland to Florida each year, told The New York Times, “You don’t visit doctors in Florida unless you have really good references from other doctors or people who are really trustworthy.”

Source: Thinkstock
Source: Thinkstock

Unnecessary medical testing isn’t just an issue for seniors. A 2014 study commissioned for Choosing Wisely found that three out of four doctors believe fellow physicians prescribe an unnecessary test or procedure at least once per week. Choosing Wisely is a campaign working with medical societies to identify overused procedures and tests to decrease unnecessary medical care, which has been estimated to waste one-third of the $2.8 trillion America spends on health care every year.

The doctors surveyed, of course, were not quick to cite financial gain as the major reason for ordering unnecessary tests. Most claimed it was to avoid being sued or to fulfill the wishes of the patient. These are certainly part of the problem too, but doctors’ self-reported explanations should be taken with a grain of salt. The Choosing Wisely campaign has also faced criticism because, when making their lists of frequently unnecessary treatments, many medical societies omitted their most lucrative procedures.

Tests such as CT scans and X-rays are known to come with health risks from radiation exposure, but a 2015 Consumer Reports investigation found that these tests are also grossly overused. One factor in the overuse of these tests is financial incentives, as many doctors invest in radiology equipment, and these physicians tend to order far more CT scans and other imaging tests. In a 2013 study, people who had a CT scan as a child had a 24% increased risk of cancer. Children who were scanned at a very young age developed an even greater risk.

Perhaps the most disturbing aspect of America’s problem with unnecessary medical testing is not that it is financially motivated, which is hardly surprising, but that it largely targets and endangers our most vulnerable populations: children and the elderly.
Want more great content like this? Sign up here to receive the best of Cheat Sheet delivered daily. No spam; just tailored content straight to your inbox.