WWL article on Dr. James Andrews

I happen to know for a fact that unnecessary MRI's, CT's, bone scans, PT, labs, etc. were being ordered so that the facilities at which he worked and bore his name could make additional money. Money (from Medicare) that I will need in 30 years and am paying for now right helped pay for these excessive exams. If he isn't satisfied with Medicare reimbursement, then DON"T accept Medicare patients. God knows he doesn't need them. It is not the sole reason Medicare is going bankrupt but it is a contributor. Having to invest millions of $$$ every year to combat fraud is also a contributor. I am paying for that too. Physicians are struggling due to the continual decline in Medicare reimbursement. The answer is in a more effecient health care system. Referring to an appropriate specialist who can treat a patient more cost effectively instead of spending government resources to improve the bottom line is a far better place to start. If a patient can get the PT, scan or labs at a facility other than HS or the AI, then stop telling your patients to go there just so it improves your bottom line. There's a law against it. Just because lots of people do it doesn't make it right. If more get caught and punished then maybe reimbursement will improve.

I agree completely with your post. However, it not that easy to say "Don't except Medicare patients." Yes, he could do that, but Medicare(CMS) sets the standard for reimbursement. So it doesn't matter if they decide not to see these patients, most insurance companies will reimburse what CMS reimburses. The only way to avoid it all together is to go self pay only. But I still think the intent was to increase the bottome line via kickbacks, not to defraud Medicare.