Evidence that imaging is over-reimbursed

Overly generous reimbursement for MRI and CT has fueled over-utilization of imaging and acted as a magnet for shady dealings. I knew something was up when a successful fish restaurant in my neighborhood was replaced with an MRI/CT center.

Today’s Wall Street Journal describes some of the abuses that are occurring (Medical Center is Investigated for Scan Deals). What is boils down to is imaging centers paying physicians for referrals. Imaging is so profitable that the centers are willing to pay out a large percentage of gross revenue. The Journal provides an example of a contrast CT scan that is reimbursed for $2300, of which the referring doctor keeps $1450.

It’s illegal to pay directly for referrals, so the centers use a variety of methods to get around the restrictions., e.g., paying consulting fees, setting up bogus medical director positions, and nominally leasing equipment. Government agencies, aided by whistleblowers, are going after these practices.

You don’t see these kind of arrangements in many other specialties, because there isn’t enough profit margin to be worth fighting over. Simply lowering the contrast CT scan reimbursement to $1000 would wipe out the scams by drying up the pool of money for kickbacks.

Meanwhile, where are the whistleblowers in orthopedics?

July 28, 2005

2 thoughts on “Evidence that imaging is over-reimbursed”

Leave a Reply

Your email address will not be published. Required fields are marked *