Doctors across the U.S. are becoming millionaires by setting up private, on-site labs and testing urine samples for legal and illegal drugs. The simple tests are costing the U.S. government and American insurers $8.5 billion a year — more than the entire budget of the Environmental Protection Agency, a groundbreaking investigation by Kaiser Health News showed. Doctors are testing patients – even the elderly – for opioids as well as street drugs like PCP or cocaine that almost never turn up positive. And the payoff is stunning: Testing a tiny cup of urine can bring in as much as $1,845. Yet there are no national standards for who gets tested, for what, or how often. Urine testing has been particularly lucrative for doctors who operate their own labs. In 2014 and 2015, Medicare paid $1 million or more for drug-related tests billed by health professionals at more than 50 pain management practices across the U.S, the KHN investigation found.
At a dozen practices, Medicare billings were twice that high, including some doctors who received 80 percent or more of their Medicare income just from urine testing. A government official called that a “red flag” that may signal overuse and could lead to a federal investigation. The series also found that Medicare has spent tens of millions of dollars on tests to detect drugs that government lawyers have argued presented minimal abuse danger for most pain patients. Many doctors have routinely tested Medicare patients for phencyclidine, an illegal, hallucinogenic drug also known as PCP, or angel dust, for instance. Yet urine tests have rarely detected the drug. Similarly, Medicare paid more than $45 million in 2014 to test more than 200,000 people for a class of tranquilizers known as tricyclic antidepressants. Labs that also perform genetic testing also have billed Medicare for hundreds of millions of dollars in dubious tests, KHN found.
At least six labs are mired in bankruptcy court after Medicare alleged they improperly billed the government for unnecessary urine, genetic, or heart disease tests expected to cause hundreds of millions dollars in losses to taxpayers, court records show. Some doctors who order extensive urine testing through labs they own allegedly have ignored the results, raising further doubts about the validity of the tests. Court records reviewed by KHN show more than a dozen recent cases in which prosecutors have cited evidence that doctors supplied opiates to patients with repeated abnormal urine test results, putting them at risk of death or serious injury. One doctor who stood among the nation’s top Medicare urine-test billers had at least four patients die from drug-related deaths after repeated abnormal urine test results. No news organization has ever embarked on such a sophisticated analysis of drug test results.
Judges’ comments: This was reporting of exceptional depth and breadth that required locating and retrieving vast amounts of urine testing data. The meticulous analysis provides disturbing new insights about how dozens of physician-owned urine testing labs have skirted the law to turn urine into Medicare-funded “liquid gold.” The investigation by Fred Schulte and Liz Lucas was the most extensive to quantify how much is spent on urine testing or how those federal transactions are supposed to be regulated or policed.