GAO: Imaging Self-Referrals Costing Millions

November 5, 2012

Too many physicians are self-referring patients for advanced imaging services, resulting in increased costs, according to the GAO.

Too many physicians are self-referring patients for advanced imaging services, resulting in increased costs and, as in the case of CTs, unnecessary exposure to ionizing radiation, according to the U.S. Government Accountability Office.

To understand the costs associated with the increased demand for advanced imaging exams, the GAO examined the trends of self-referrals and non-self-referrals for exams, how services differed between physicians who self-referred and those who do not, and how self-referrals had an impact on Medicare spending.

The researchers analyzed Part B claims data from 2004 through 2010, focusing on MRI and CT referrals. They also interviewed officials from CMS and other stakeholders.

Researchers found that while both the number of self-referred and non-self-referred MRIs and CTs both increased between 2004 and 2010, self-referred services increased over that time by more than 80 percent, while the non-self-referral services only increased by 12 percent.

Referrals from physicians who switched from non-self-referral to self-referral during this time period increased the year after they began self-referring. “Providers that began self-referring in 2009 - referred to as switchers - increased MRI and CT referrals on average by about 67 percent in 2010 compared to 2008,” the authors wrote.

Between 2008 and 2010, the number of referrals for MRIs and CTs from non-referrers declined, as did the number for those who did not switch (an average of 47.0 to an average of 45.4). However, the number of referrals from switchers increased from an average of 25.1 in 2008 to an average of 42.0 in 2010.

According to the report, “GAO estimates that in 2010, providers who self-referred likely made 400,000 more referrals for advanced imaging services than they would have if they were not self-referring.” These numbers resulted in an additional cost of $109 million to Medicare.

The GAO recommended that providers should be required to report when billing is for self-referred imaging studies, payments should be lower for self-referrals, and the CMS should develop a tool that would ensure supervision of self-referred tests, verifying their validity.