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Is It True What They Say About 'Medicaid Mills?'

NCJ Number
72214
Journal
Forum Volume: 4 Issue: 3 Dated: (August 1980) Pages: 12-17
Author(s)
J E Kendrick
Date Published
1980
Length
6 pages
Annotation
A recent study of physicians with large Medicaid practices revealed that fraudulent activities highlighted by Congressional investigations may be the exception rather than the rule.
Abstract
A research project funded by the Health Care Financing Administration analyzed data collected during a 1977 survey of approximately 3,500 physicians who were in private practice. The survey results were also compared with 1976 cost and income data. These findings showed that, contrary to popular opinion, Medicaid physicians were located more often in small northeastern cities, rural areas, and the South than in large urban ghettos. Most physicians with caseloads of 30 percent or more Medicaid patients averaged about the same income as those with only a small proportion of Medicaid patients. The study found that these practitioners did not order significantly more income generating ancillary services and did not charge excessive fees when compared with other physicians. However, physicians with large Medicaid practices did order injections more frequently. The typical physician with a Medicaid practice was a solo practitioner. On the negative side, visits to physicians with large Medicaid caseloads tended to be somewhat shorter, and such doctors generally had inferior backgrounds and training. An income of $80,000 a year or more was earned by one out of five physicians with a large portion of Medicaid patients. Many of these doctors were located in the south where States pay Medicaid fees which are the same or close to fees for non-Medicaid patients. Many Medicaid physicians are providing competent care as well as serving some patients who had no access to health services before the program. Formidable problems face the improvement of physician services financed through Medicaid, such as uneven distribution of physicians in relation to population and varying State reimbursement formulas. In addition to economic considerations, quality health care depends on physician acceptance of Medicaid and recognition of those doctors who are providing good Medicaid services. Charts and a table illustrate the survey's findings.