AMA Helps Doctors Overbill Medicare by Exaggerating Time Needed for Procedures

Tuesday, July 23, 2013
Dr. Barbara Levy, chair of RUC

Thanks to the American Medical Association (AMA), some physicians in the United States can work 26 hours in a 24-hour day.


Actually, these doctors don’t work anywhere near these many hours in a day. But their billing to Medicare reflects exaggerated totals for medical procedures, like colonoscopies, that fall within AMA guidelines, according to The Washington Post.


This practice represents “one of the fundamental flaws in the pricing of U.S. health care,” wrote Peter Whoriskey and Dan Keating.


This overbilling starts with a 31-member AMA committee—the Relative Value Scale Update Committee (RUC)—that meets privately each year to establish values for most services performed by doctors. The values are then used determine what Medicare and most private insurers pay doctors for their work.


But the newspaper found that many of AMA’s estimates of the time involved in procedures are exaggerated—sometimes by as much as 100%.


For instance, the AMA says the average colonoscopy takes 75 minutes of a physician’s time, including work performed before, during and after the scoping. But really the amount of time a doctor spends with each patient is more like half an hour.


Analyzing data from Florida, the Post found that “If the AMA time estimates are correct, then 41 percent of gastroenterologists, 23 percent of ophthalmologists and 17 percent of orthopedic surgeons were typically performing 12 hours or more of procedures in a day, which is longer than the typical outpatient surgery center is open.”

-Noel Brinkerhoff


To Learn More:

How a Secretive Panel uses Data that Distort Doctors’ Pay (by Peter Whoriskey and Dan Keating, Washington Post)

The Growing Ruckus Over the RUC and Medicare Fees (by Ana Radelat, LDI Health Economist)

Worst Overcharging Hospital in U.S. (by Matt Bewig, AllGov)

Hospitals Forced to Reveal Their Most Privileged Information: The Cost of Care (by Ken Broder, AllGov California)

Overbilling by Doctors and Hospitals Costs Medicare a Billion Dollars a Year (by David Wallechinsky and Noel Brinkerhoff, AllGov)


James Dooley 10 years ago
Is anybody really surprised by this? If all the excess costs got rung out of the medical system from top to bottom health care costs would be 1/2 of what they are now." We the people " let it get there allowing lawsuits, excess billing, paper record keeping instead of computeruzing, etc.. Everyone has got a hand in the cookie jar on this and somehow we collectively have got to stop before it's too late.

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