Connect

Member Research and Reports

Member Research and Reports

Johns Hopkins: Patients of Medicare Providers Committing Fraud, Abuse More Likely To Be Poor, Disabled

A new study from the Johns Hopkins Bloomberg School of Public Health analyzed providers excluded from Medicare for fraud and abuse, and found that the patients they treated prior to being banned were more likely to be minorities, disabled and dually-enrolled in Medicaid to supplement financial assistance for health care.

The findings, published in the May issue of Health Affairs, highlight the risk that providers committing Medicare fraud and abuse could be taking advantage of their more vulnerable patients. Medical fraud and abuse can include patient neglect, illegally providing prescription medications, unnecessary medical procedures, deceitful billing practices and using untrained personnel for direct patient care. Fraudulent medical practice is estimated to cost the U.S. federal government between $90 to $300 billion dollars annually.

Providers excluded for fraud had the largest percentage of non-white and Medicaid dual-eligible patients, at 29.5 percent and 44.1 percent, respectively. Providers excluded for patient harm or revoked licenses were more likely to have patients under 65, disabled and dual-eligible for Medicaid. Disabled patients are 23-26 percent more likely to be treated by a provider excluded for fraud and abuse than someone treated by a non-excluded provider.

Dr. Lauren Hersch Nicholas, assistant professor in the Bloomberg School’s department of health policy and management, is the lead author. 

Read more

Tags: