How some physicians profit off screening patients' urine for opioids

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Spending on urine screening and related genetic tests quadrupled from 2011 to 2014 to roughly $8.5 billion annually — which is more than the entire annual budget of the U.S. Environmental Protection Agency, according to an investigation by Kaiser Health News.

Researchers from Kaiser and Rochester, Minn.-based Mayo Clinic examined private insurers' claims data, Medicare reimbursement data from 2005 to 2014, and data from OptumLabs. Their analysis also included claims from physicians and independent labs, excluding hospital or outpatient fees.

Here are six takeaways from the report.

1. Researchers discovered the federal government paid providers more in funds for urine drug screening tests in 2014 than it spent on the four most recommended cancer screening tests combined.

2. Urine testing has become particularly lucrative for physicians and healthcare practitioners who operate their own laboratories, researchers discovered. Medicare paid $1 million or more for drug testing billed by healthcare professionals at 50-plus pain management practices nationwide during 2014 and 2015.

3. San Diego-based Millennium Health, for example, received more than $166 million from Medicare in 2014 despite having been accused of fraud by eight whistle-blowers during the past decade. The company allegedly encouraged physicians to order more tests to help lower patients' risks and shield physicians from possible investigations by law enforcement, according to court filings obtained by Kaiser and Mayo Clinic researchers. Millennium Health denied the whistle-blowers' allegations and settled all eight lawsuits with the U.S. Department of Justice for a total of $256 million in 2015.

4. Basic urine testing strips to screen for drugs cost less than $10 each and can detect 10 different types of drugs within minutes. After learning some laboratories were levying significant charges for these simple tests, the CDC issued mandates in April 2010 to limit the billing amounts. However, to circumvent the CDC's rules, some physicians began to conduct urine screenings using specialized machines — machines that would also allow physicians to individually bill Medicare for each test.

5. There are virtually no national standards regarding who should be tested, for which drugs and how often. The CDC issued guidelines in March 2016 that called for testing at the beginning of a patient's opioid therapy and yearly testing for long-time users. However, despite those two mandates, the CDC recommends testing regulations be "left up to the discretion" of the healthcare professional, according to the report.

6. Medicare also issued policies in 2016 to prevent overcharging for urine tests. The policies aimed to reset laboratory fees for the first time in decades.

To read the full investigation, click here.

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