Alex Kacik October 28, 2019
Healthcare fraudsters deliver
measurably worse care that can harm patients, according to a new study.
Patients treated by organizations
later excluded from the Medicare program for fraud and abuse were between 14%
to 17% more likely to die than those who were treated by their law-abiding
counterparts, according to a new study from researchers
at Johns Hopkins Bloomberg School of Public Health. Fraud and abuse contributed
to 6,700 premature deaths in 2013 alone, their analysis shows.
Some fraud and abuse schemes
involve organizations that bill Medicare for services that were never provided
while others harm patients, said Lauren Hersch Nicholas, assistant professor at
Johns Hopkins and lead author. She cited cases where untrained personnel read
medical images, physicians doled out opioids that patients don't need and
companies developed counterfeit chemotherapy drugs.
"That is an underappreciated
part of fraud and abuse crimes," she said.
The most vulnerable
populations—low-income, non-white, dual-eligible (in Medicare and Medicaid) and
disabled—are more frequently targeted, according to the study. Those who were
treated by a compromised organization were 11% to 30% more likely to experience
an emergency hospitalization the year they received care.
"This suggests that fraud and
abuse are one of the drivers of racial and socio-economic disparities in the
U.S.," said Nicholas, adding that the findings are likely conservative
estimates since relatively smaller cases often fall under the radar.
In 2018, more than 47,000
healthcare professionals were barred from Medicare and Medicaid, federal
programs that provide health insurance to elderly, disabled and low-income
beneficiaries, because of fraud and abuse.
Fraudulent medical practice costs
the federal government an estimated $30 billion to $140 billion annually.
Federal prosecutors have recouped more than $2 billion a year in
fraud and abuse settlements since 2010.
Researchers compared 8,204 Medicare
beneficiaries who were first treated in 2013 by a provider later banned for
fraud and abuse and 296,298 patients treated by a randomly selected provider
who had not been banned for fraud and abuse. They tracked mortality and
hospitalization for up to three years.
Nearly one-quarter—23%—of patients
seen by excluded providers were non-white, while 16.5% of patients treated by
non-excluded providers were non-white. More than 27% were disabled compared
with 18.6% in the control group and 34.7% were dual-enrolled compared with
21.9%.
More than 60% of patients in the
sample were treated by providers found to be committing fraud. The remainder
were treated by providers operating with a revoked license and those who were
barred for patient harm.
The study found that providers
excluded for fraud were associated with the highest mortality rate, at 17.3%.
Patients who were treated by providers barred for operating with revoked
licenses were 14.8% more likely to die, while those treated by providers
excluded for patient harm were 13.7% more likely to die.
A similar share of patients are
likely to die from fraudulent providers compared with those who are waiting for an organ transplant,
Nicholas said.
"We should be looking at this
as a public health problem," she said.
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