Urine drug screenings offer large profits for pain clinics

In 2010, after observing high volumes of charges for urine drug screenings, the Centers for Medicare & Medicaid Services (CMS) limited their billings. Some clinics responded by replacing simple cup testing with more specialized machine testing. While urine cup testing allows for the screening and billing of multiple drugs in one pass, the machines allow for each drug to be billed individually to Medicare. This paved the way for the opening of lucrative pain clinics, which derived most of their profits from urine drug screenings. A report from Kaiser Health News investigated Medicare billing practices related to drug testing.

The report found that, despite the efforts of CMS, the number of urine tests paid for by Medicare has continued to rise. Testing for a select number of drugs, including opiates and synthetics, cocaine, amphetamine or methamphetamine, and phencyclidine (PCP), numbered nearly 20 million in 2014. For the same drugs, this is in increase in testing volume by about ten times from 2009 and more than twenty times from 2005.

This rise continues while the medical necessity of urine screenings remains questionable, with a lack of clear guidelines for frequency of testing and insufficient data to support the usefulness of testing. Urine testing can be used as a means of monitoring pain prescriptions and preventing or catching abuse. But who exactly gets tested, how often, and for which drugs is left to the physician to decide, and individual physicians may not agree on the same standards for what is medically necessary. Some might suggest weekly drug screenings, while others would argue weekly screenings are too frequent. Additionally, urine screenings rarely detect new drugs such as the illegal hallucinogenic PCP, and data on drug abuse detected by urine testing is hard to come by. Some pain doctors make the majority of their Medicare income from drug tests, but it may not be easy to determine whether this is a symptom of a drug abuse epidemic or a symptom of unnecessary drug testing.

The line between medically necessary and unnecessary is not clearly defined, and unfortunately the high volumes of billings for urine screenings suggest that some providers have taken advantage of the system for the sake of profit. Although CMS has tried to address this, without clearer standards for drug screenings, there may still be room for abuse of the system.