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Federal law reducing unnecessary tests not being enforced

MRIs, CT scans and other diagnostic imaging tests may uncover diseases and help treatment. But unnecessary tests do not help prevent a missed diagnosis, may harm patients and impose unnecessary costs. A federal law passed in 2014 to reduce unnecessary tests, however, was not implemented.

Under this law, doctor must consult clinical guidelines created by the medical industry before Medicare pays for many common medical scans. Health care providers who greatly exceed these guidelines, the five percent of providers who order the most inappropriate tests, would be required to get Medicare pre-approval for diagnostic imaging.

The law was to take effect in 2017. Because physicians claimed that it would interfere with their practices, the federal government delayed its implementation until 2020. Additionally, the Centers for Medicare & Medicaid Services has determined that next year will be a testing period where Medicare will pay for inappropriate scans even if physicians do not consult the guidelines. There is even further delay because CMS will not decide when specified penalties will begin until 2022 or 2023.

Unnecessary tests are ordered for many reasons. These include seeking a financial advantage for doctors or their health system, to address fears of malpractice suits or to mollify patients who insist on these tests.

According to critics, unnecessary CT scans may subject patients to radiation for no medical benefit. Medicare will also continue to pay for millions of examinations that are unnecessary.

There is a widespread use of imaging tests for men on Medicare who faced little risk of getting prostate cancer, according to a 2011 Harvard study. A University of Washington study claimed that 26 percent of 459 CT and MRI exams at a major academic medical center were inappropriate.

In 2011, a congressional advisory board referred to the rapid increase of these imaging tests and recommended that doctors who order more tests than other physicians obtain authorization from Medicare before having their patients undergo those examinations. Congress weakened that recommendation in its 2014 law by having doctors billing Medicare to follow procedures that confirm that imaging is appropriate for their patients.

A patient who suffers injury from medical negligence or an unnecessary procedure may be entitled to compensation. An attorney can assist them with filing a lawsuit.

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