According to a recently released U.S. Department of Health and Human Services Office of Inspector General (OIG) report, in 2005, physicians were associated with a higher use of magnetic resonance imaging (MRI) services when they had business or practice relationships with the parties providing those services. In circumstances where these relationships exist, the OIG concludes, "doctors may have conflicts of interest, financial or otherwise."
The report reviewed whether certain business and practice relationships among providers ("connections") were associated with higher MRI utilization rates under the Medicare Physician Fee Schedule (MPFS). The connections contemplated include medical practice relationships (for example, when parties share membership in a medical practice or when one party is member of the other) or a business relationship (for example, when two parties have a shared investment or contracts with each other).
The results of this review indicated that services ordered by physicians "connected" to the MRI service "differed significantly" from services that are were not "connected."
For example, high users of MRI services ordered 55 percent of connected services, compared to 33 percent of services that were not connected. Among the four most prevalent ordering specialties -- orthopedic surgery, internal medicine, family practice, and neurology -- orthopedic surgeons ordered 28 percent of connected services, compared to 15 percent of all other services. However, the report did not address whether the "connected" physician referrals were inappropriate or whether they ordered more MRI services in the aggregate.