Medicare fraudsters harm patients

Patients may want to steer clear of healthcare providers that have been accused of fraud and abuse of the Medicare system, according to new research that shows a risk of beneficiary health and longevity among these providers.

Medicare has a problem with fraud and abuse causing financial strain on the federal program, but researchers from Johns Hopkins wanted to know if perpetrators of Medicare fraud and abuse are also associated with adverse health events among beneficiaries. They published their findings in JAMA Internal Medicine.

While federal authorities have placed a premium on reducing fraud to eliminate overspending in the Medicare program, little is known about the human costs of fraud and abuse when it comes to patient health. Johns Hopkins researchers looked at the mortality and emergency hospitalization rates of more than 8,200 Medicare beneficiaries treated by a fraud and abuse perpetrator (FAP) and compared them against nearly 300,000 patients treated by a randomly selected non-FAP in 2013.

Of the FAP-going patients, 5,054 were treated by fraud perpetrators, 1,157 by patient harm perpetrators and 1,193 by revoked license perpetrators. Beneficiaries treated by FAPs were more likely to be dual eligibles of both Medicare and Medicaid and be disabled younger than 65.

According to the findings, “all FAP exposures were associated with higher mortality and emergency hospitalization rates,” wrote first author Lauren Hersch Nicholas, PhD, MPP, of the Johns Hopkins Bloomberg School of Public Health, et al. In fact, patients who received healthcare services from FAPs in 2013 had a higher risk of mortality between 13% and 23% compared to the broader patient group, and saw higher rates of emergency hospitalization, between 11% and 20%.

“This study’s findings suggest that receiving medical care from a health care professional subsequently excluded from Medicare may be associated with significantly higher rates of all-cause mortality and emergency hospitalization,” Nicholas and colleagues wrote.

The study was limited in that it could not determine the observed mortality differences attributable to FAP behavior or the treatment of Medicare beneficiaries, but it does point out that removing FAPs from the Medicare program could improve beneficiary health in addition to providing savings.