One might then ask, why does America experience such poor results? Part of the problem, Dr. Chagpar argues, as well as many of her colleagues, is the endless barrage of “needless tests.” As she laments toward the end of her post, “We need to stop the madness…we need to practice more rational evidence-based medicine.” Indeed, a study led by physicians at the Mount Sinai Medical Center and the Weill Cornell Medical College in New York, discovered that between unnecessary CT and MRI scans or Pap tests to screen for cervical cancer in teenagers, the U.S. spent approximately $6.8 billion in 2009 alone. And this estimate was deemed “conservative.”
In becoming aware of this problem, the federal government is now aggressively following those who use needless tests to support false claims. In fact, two cardiovascular disease testing laboratories, Health Diagnostics Laboratory (HDL) and Singulex Inc., have now agreed to pay a combined $48.5 million to settle claims the company paid doctors for unnecessary medical testing after four whistleblowers filed lawsuits against the companies on behalf of the government. Though HDL must come up with the bulk of this sum ($47 million), both companies have been accused of violating the False Claims Act, an American law that “imposes liability on persons and companies…who defraud governmental programs.”
According to Reuters, physicians were paid between $10 and $17 for each patient who was referred to the companies for blood tests prosecutors argued were unnecessary. To prevent such events from happening again, the companies must also enter specific agreements with the Department of Health and Human Services’ Office of Inspector General.
HDL and Singulex Inc. now join a list of companies that have been prosecuted for health-related fraud under the False Claims Act. In fact, according to Reuters, since January 2009, more than $23.9 billion has been recovered, of which $15.2 billion involved fraud against health care programs administered by the federal government.