4 characteristics of physicians most likely excluded from public insurance reimbursement

Anuja Vaidya (Twitter) -

The number of physicians excluded from participation in Medicare and state public insurance reimbursement due to fraud, waste and abuse increased between 2007 and 2017, according to a study published in JAMA Network Open.

Researchers conducted a cross-sectional study, for which they matched exclusion data to a database of U.S. physicians assembled by Doximity, an online networking service. They studied physicians excluded from federal and state public insurance reimbursement for fraud, health crimes and substance abuse from 2007 to 2017.

During the study period, researchers found 2,222 physicians, or 0.29 percent, were temporarily or permanently excluded from Medicare and state public insurance programs. Exclusions related to fraud, health crimes and substance abuse increased 20 percent on average per year.

Here are four characteristics of physicians most likely to be excluded:

• Male gender
• Osteopathic training
• Older age
• Being a specialist (for example, family medicine, psychiatry, internal medicine, anesthesiology, surgery and obstetrics/gynecology)

The research team also found that exclusion rates were highest in the West and Southeast. West Virginia had the highest exclusion rate, with 5.77 exclusions per 1,000 physicians.

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