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Study finds health crime convictions increase 200% in 10 years

A study published in JAMA Network Open examined the characteristics of physicians who were excluded from Medicare and Medicaid.

Researchers examined physicians who were excluded from Medicare and Medicaid between 2007 and 2017,using a database of U.S. physicians complied by Doximity. The number of physicians excluded in each state for fraud, health crimes and substance abuse was assessed, along with physician characteristics such as age, sex, education, allopathic or osteopathic degree, practice location and specialty.

Here are the key insights to know:

1. In the 10 years examined by the researchers, 2,222 physicians were either temporarily or permanently excluded from Medicare and Medicaid.

2. Exclusions related to substance abuse, fraud and health crimes increased 20 percent per year, on average.

3. There were about 48 new conviction-related exclusions per year, increasing from 236 in 2007 to 670 in 2017. Overall, the increase was approximately 200 percent.

3. Exclusion rates were highest in the West and Southeast, with West Virginia having the highest exclusion rate.

4. Male physicians, older physicians, physicians with osteopathic training and those in specific specialties (obstetrics/gynecology, anesthesiology, surgery and others) were more likely to be excluded.

"The number of physicians excluded from participation in Medicare and state public insurance reimbursement owing to fraud, waste and abuse increased between 2007 and 2017. Several physician characteristics, including being a male, older age and osteopathic training, were significantly and positively associated with exclusion. Our results highlight the potential value of using physician characteristics in conjunction with information on medical claims filed by physicians to help identify adverse physician behavior," the researchers concluded.

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