Medicare paid Illinois doctors, social workers, and others for more than 290,000 group psychotherapy sessions in 2012–more than twice as many as the second-place state–New York.
That’s a story all by itself. But it gets better (that is, worse). Three obstetrician-gynecologists and a chest surgeon offered 37,864 sessions that year and were reimbursed $730,000.
Paying an obstetrician to offer group psychotherapy is like paying a psychiatrist to deliver a baby. Why are U.S. taxpayers paying for this?
In an important story that ran jointly on ProPublica and in The Chicago Tribune, Charles Ornstein of ProPublica explains why we’re paying: “Medicare has no policy regarding which physicians may perform group psychotherapy.” That comes from an email Ornstein received from Aaron Albright, a spokesman for the U.S. Centers for Medicare and Medicaid Services.
But we’re still not done–the story gets even better. As Ornstein explains in his first few grafs, the Medicaid program in Illinois had exactly the same problem a few years ago until it changed its rules, and this kind of spending plummeted. If Medicaid can figure this out, why can’t Medicare?
Although his story focused on Illinois, Ornstein did poke around in other states, where he found these interesting cases:
…A Queens, N.Y., primary care doctor, Mark Burke, was paid for more sessions than anyone else in the country — 20,841. He accounted for nearly one in every six sessions delivered in the entire state of New York in Medicare, separate data show. He did not return messages left at his office.
…Makeba Gordon, a social worker in Detroit…was reimbursed for nearly 5,000 group therapy sessions for her 26 Medicare patients, an average of 190 each. She also billed for 2,820 individual psychotherapy visits for the same 26 patients, who allegedly would have received an average of 298 therapy sessions apiece in 2012. Gordon could not be reached for comment.
Ornstein includes a link to previous ProPublica stories on Medicare billing, which is worth a look. As discouraging as it is to see how badly these programs are being run, it’s reassuring to see that ProPublica is shining a light on this mess–which could be a first step toward cleaning it up.
-Paul Raeburn
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