Department of Health and Human Services
 
OFFICE OF 

 
INSPECTOR GENERAL 

 
 
 
 
 
 
P R  
ROVIDER  ELATIONSHIPS 

 
 
U  
AND THE  SE OF 

 
M R   
AGNETIC  ESONANCE 

 
U M
NDER THE   EDICARE 

 
P F S  
HYSICIAN  EE  CHEDULE 

 
 
 
 
 
 
Daniel R. Levinson 
  
Inspector General 

 
September 2008 
 
OEI-01-06-00261 
   
Office of Inspector General 

 
http://oig.hhs.gov 
 
The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, as  
amended, is  to protect the integrity of the Department of  Health and Human Services  
(HHS)  programs, as well as the health and welfare of beneficiaries  served by those 
programs.  This statutory mission  is  carried  out through  a nationwide network  of  audits, 
investigations, and inspections conducted by the  following operating components:  
Office of Audit Services 
The Office  of  Audit Services  (OAS) provides auditing services  for HHS, either by  conducting  
audits  with its own audit resources or by  overseeing  audit work done by others.  Audits  
examine the performance of HHS programs and/or its grantees and contractors in carrying  
out their respective responsibilities and are intended  to provide independent assessments of 
HHS programs and operations.  These assessments help reduce waste, abuse, and  
mismanagement and promote economy and efficiency  throughout  HHS. 
Office of Evaluation and Inspections  
The Office  of  Evaluation and Inspections (OEI)  conducts national evaluations to  provide 
HHS, Congress, and the public with timely, useful, and reliable information on significant 
issues.  These evaluations focus on preventing fraud,  waste, or abuse  and promoting  
economy, efficiency, and effectiveness of departmental programs.  To promote impact, OEI 
reports also present practical recommendations for improving  program operations.  
Office of Investigations 
The Office of Investigations (OI) conducts criminal, civil, and administrative investigations  
of  fraud and misconduct  related to HHS programs, operations, and beneficiaries.  With 
investigators working in all 50 States and the District of Columbia, OI  utilizes its resources 
by actively  coordinating with the Department  of Justice  and other Federal, State, and local 
law enforcement authorities.  The investigative efforts of OI often lead to  criminal 
convictions, administrative sanctions,  and/or  civil monetary  penalties.  
Office of Counsel to the Inspector General 
The Office of Counsel to the  Inspector  General (OCIG) provides general legal services to 
OIG, rendering  advice and opinions on HHS programs and operations and  providing all  
legal support for OIGs  internal operations.  OCIG represents  OIG in all civil and 
administrative fraud and abuse cases involving HHS programs,  including False Claims Act, 
program exclusion, and civil monetary penalty cases.  In  connection with these cases, OCIG 
also negotiates and monitors corporate integrity agreements.  OCIG renders advisory 
opinions, issues compliance program  guidance, publishes fraud alerts, and provides other  
guidance  to  the health care industry concerning the anti-kickback statute and other  OIG  
enforcement authorities.     E X E C U T I V E   S U M M A R Y  
OBJECTIVE 
To determine (1) how magnetic resonance (MR) services paid under 
the Medicare Physician  Fee Schedule (MPFS) are provided and   
(2) whether there is a relationship between utilization levels of 
services and how they are provided. 
BACKGROUND 
Previous Office of Inspector General work documented a more than 
fourfold increase in MR services paid under the MPFS between 1995 
and 2005. 
Medicare divides imaging services into two components:  the technical 
component and the professional component.  Medicare may pay 
separately for each or make a global payment to one provider as 
payment for both.  In certain situations, providers may purchase either 
component and reassign their Medicare payments to other entities. 
Each MR service may involve several roles, including the orderer of the 
service, providers of the technical and professional components, the  
billing provider, the payee, and equipment lessors and coowners.  Each 
role may be played by the same or multiple parties. When multiple 
parties work together to  provide MR services, they may be connected to  
one another through medical practice relationships and/or other 
business relationships. 
This study relies on analysis of 2005 Medicare Part B claims data and 
projections of data from a sample of MR services.  This study focuses on 
the provision of the technical component of MR services.  It presents 
data about all MR services and two subgroups of MR services:  (1) those 
ordered by high users of MR and (2) those in which the orderer of the  
service had  a connection to one or more of the parties involved in 
providing the service (hereafter referred to as connected services). This 
study did not analyze the appropriateness or medical necessity of MR  
services. 
FINDINGS 
Certain characteristics  were common to a majority  of magnetic 
resonance services paid under the Medicare Physician Fee 
Schedule, regardless of whether they were ordered by  high users.  
Although providers worked together to provide services in a number of 
  OEI-01-06-00261   PROVIDER  RELATIONSHIPS AND  THE USE OF  MAGNETIC RESONANCE  UNDER THE  MPFS   i  E X E C U T I V E   S U M M A R Y
   
ways, certain characteristics were common to a majority of services.  For 
example, two-thirds of services were ordered  by one of four specialties:  
internal medicine, orthopedic surgery, family practice, and neurology.  
Eighty-five percent of services were performed by the entity that was paid  
by Medicare.  Most services were performed by the independent 
diagnostic testing facility (IDTF), multispecialty group, and diagnostic 
radiology provider specialties.  Finally, MR claims were typically billed 
globally through a radiologist and had payment reassigned.  
Connected services were provided differently  than services that 
were not connected.   One-quarter of MR services paid under the MPFS 
in 2005 were connected services, which were associated with high use.  
Compared to all other services, connected services were more likely to be 
ordered by orthopedic surgeons.  Multispecialty groups performed and 
were paid for half of connected services, compared to only one-quarter of 
all other services. The IDTF and  diagnostic radiology specialties played  a 
smaller role in connected services compared to all other services.  Finally,  
connected services were more likely than other services to have been 
billed as technical component only, to have had payment reassigned, and 
to have been billed through a provider other than a radiologist.  
CONCLUSION 
The findings in this report highlight the complex nature of how 
providers deliver MR paid under the  MPFS.  The  large number of ways 
that various parties can perform and bill for services reduces the 
transparency of these transactions.  Although the analysis in this report 
was limited to MR, it is possible that such complexity extends to other 
types of high-cost imaging paid under the MPFS.  The complexity and  
limited transparency with which these services are provided warrants 
continued attention to  ensure that services are reasonable, necessary, 
and compliant with Medicare statutes and regulations. 
AGENCY COMMENTS 
The Centers for Medicare & Medicaid Services (CMS) agreed with our 
findings and our conclusion that the complexity of MR services warrants 
continued attention.  It outlined regulatory steps it has recently taken 
to address overutilization of diagnostic testing services. CMS also 
stated its commitment to examining the relationship between the 
utilization of advanced imaging services and the entities that order and 
bill for them. 
  OEI-01-06-00261   PROVIDER  RELATIONSHIPS AND  THE USE OF  MAGNETIC RESONANCE  UNDER THE  MPFS   ii   
  T A B L E   O F   C O N T E N T S  
EXECUTIVE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i
  
 
 
I N T RO DUC T IO N  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1 
  
 
 
K E Y  A N AL Y T I C  CO N C E PT S  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  7 
  
 
 
F I N D IN G S  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  9 
  
Certain characteristics were common to a majority of magnetic 

resonance services, even those ordered by high users. . . . . . . . . . .  9 
  
Connected services were provided differently than
  
services that were not connected . . . . . . . . . . . . . . . . . . . . . . . . . .  11 
  
 
 
CONC LUSION  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  14 
  
 
 
APPENDIXES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  15 
  
  A:  Methodology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  15 
  
  B:  Magnetic Resonance Service Delivery Diagrams. . . . . . . . . . .  21 
  
  C:  Statistical Tables. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  55 
  
  D:  Agency Comments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  57 
  
 
 
A C K NO WL E D G M E N T S  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  59 
   I N T R O D U C T I O N  
  I N T R O D U C T I O N  
OBJECTIVE 
To determine (1) how magnetic resonance (MR) services paid under 
the Medicare Physician  Fee Schedule (MPFS) are provided and   
(2) whether there is a relationship between utilization levels of 
services and how they are provided. 
BACKGROUND 
Previous Office of Inspector General (OIG) work documented a more 
than fourfold increase in MR services paid under the MPFS between 
1995 and 2005.1  By 2005, 43 percent of all Medicare-covered MR 
services were paid under the MPFS.2  
Overview of Magnetic Resonance  
MR enables doctors to diagnose and  treat patients by providing 
detailed images of tissues and blood  vessels deep inside the body.  MR 
is used to detect a number of conditions, including cancer, heart 
disease, damage to bones and organs, and brain disorders. Advances 
in technology continue to expand the number of clinical applications 
for MR and increase its availability in ambulatory settings covered 
under the MPFS, such as doctors  offices and imaging centers.   
Payment for Magnetic Resonance Services Under the Medicare Physician 
Fee Schedule 
Medicare covers MR as a diagnostic service under  1861(s)(3) of the 
Social Security Act.  Medicare generally covers specific imaging 
procedures if they are supported as efficacious in scientific literature  
and reasonable and necessary for the patient.3   
Medicare divides imaging services into two components:  the technical 
component,  which is the taking of the image, and the professional 
component, which is the doctor interpreting the image.  Medicare may 
pay for the components separately, to different providers, or it may 
make a global payment to one provider as payment for both 
components, even when  different providers perform the technical and  
 
1 OIG, Growth in Advanced Imaging Paid Under the Medicare Physician Fee Schedule, 

OEI-01-06-00260, October 2007.
  
2 The remaining 57 percent were covered under the Hospital Outpatient Prospective 

Payment System and the Hospital Inpatient Prospective Payment System. 

3 Centers for Medicare & Medicaid Services (CMS) Medicare National Coverage
  
Determinations Manual, Pub. No. 100-03  220.1. 

  OEI-01-06-00261   PROVIDER  RELATIONSHIPS AND  THE USE OF  MAGNETIC RESONANCE  UNDER THE  MPFS   1  I N T R O D U C T I O N
   
professional components.4  In 2005, the average allowed charge for 
the professional component of the most commonly performed service,  
MR imaging of the spine without dye, was $77.  The average allowed 
charge for the technical component of the same service was $463 and 
for the global payment, $579.  
Medicare allows providers to purchase either component of MR services  
from other providers.5   Thus, a provider may pay another provider to 
perform the service and then bill Medicare as if it had performed the 
service itself.  However, specific rules apply to how and when providers 
may bill Medicare for each component.6  
In certain situations, Medicare allows a doctor to reassign his or her 
Medicare payments to another entity.7  For example, a doctor might 
reassign payment for services performed to his or her group practice. 
Roles Involved in Providing Magnetic Resonance Services Under the 
Medicare Physician Fee Schedule 
Each MR service may involve a number of persons and entities playing 
different roles, which are defined in Table 1 below. 
 
Table 1:  Roles Involved in Magnetic Resonance Services 
 
Orderer  The doctor who orders the MR service, typically  the doctor treating the 
  patient 
  Performer  The provider that performs the technical component by operating the MR  
machine that produces images for interpretation 
 
Reader  The doctor who provides the professional component by interpreting the 
images from the technical component performer 
 
Biller  The provider under whose provider number the claim for the service is  
  submitted to Medicare 
Payee  The entity that receives payment from Medicare for the service 
 
  Lessor*  An entity that  provides leased MR equipment used for the service 
 
Coowner*  An entity that  coowns MR equipment used for the service 
 
* Not necessarily involved in every MR service. 
 
4 For purposes of this document, we use the term provider to refer to Part B suppliers, 

which include doctors, group practices, imaging centers, and others. 

5 Social Security Act  1842(n), 42 U.S.C.  1395u(n)(2005). 

6 CMS Medicare Claims Processing Manual, Pub. No. 100-04, ch.1,  30.2. 

7 Social Security Act  1842(b)(6), 42 U.S.C.  1395u(b)(6). 
 
  OEI-01-06-00261   PROVIDER  RELATIONSHIPS AND  THE USE OF  MAGNETIC RESONANCE  UNDER THE  MPFS   2  I N T R O D U C T I O N
   
These roles may be played by doctors, group practices, imaging 
centers, or other entities.  In a given service episode, each role may be 
played by the same or multiple parties. 
Provider Relationships Involved in Magnetic Resonance Service Delivery  
When multiple parties are involved in a service episode, they  may be 
connected to one another through medical practice relationships and/or 
other business relationships. 
For purposes of this report, a medical practice relationship exists when 
parties share membership in a medical practice or when one party is a 
member  of the other.  An example of the former  is a relationship in 
which the ordering and billing doctors are members of the same group 
practice (two individuals who  own or are otherwise related to a third 
entity). An example of the latter is a relationship in which a group 
practice is a member of a larger health system.  An entire service 
episode could occur within a single group practice:  different practice  
members might play the roles of orderer, performer, and reader, with 
the practice serving as the biller and payee. 
For purposes of this report, a business relationship exists when two 
parties have a shared business interest, such as shared investments or 
contracts with one another.  For example, a radiology group  and an 
orthopedic group may operate an imaging center through a joint 
venture.  Alternatively, the radiologists within a multispecialty group  
practice might coown the MR equipment used by the practice and lease  
it to the medical practice.  Contracts may include lease arrangements, 
whereby a provider leases space, equipment, and/or staff from an 
imaging center.  An example is a block lease, whereby the payee leases 
a block of time from an imaging center during which the imaging center 
performs services on behalf of the payee. 
All parties must ensure that their relationships for providing MR 
services comply with Federal prohibitions on self-referral, kickbacks, 
and the markup of tests  purchased from other providers.8  These 
prohibitions are in place to protect the Medicare program and its 
beneficiaries from unnecessary and  inappropriate use of services. 
Medicare claims readily identify the orderer, biller, and payee for each 
service.  The performer of the service and underlying arrangements 
 
8 Social Security Act  1128B(b), 42 U.S.C.  1320a-7b(b); Social Security Act  1877,  
42 U.S.C.  1395nn; Social Security Act  1842(b)(6), 42 U.S.C.  1395u(b)(6). 
  OEI-01-06-00261   PROVIDER  RELATIONSHIPS AND  THE USE OF  MAGNETIC RESONANCE  UNDER THE  MPFS   3  II NN TT RR OO DD UU CC TT II OO NN    
between providers of MR services, such as leases or coownership, may 
not be evident from the claims. As a result, and because there are many 
ways that providers can work together, it is difficult to identify all of the 
  parties and relationships involved in providing each MR service. 
METHODOLOGY 
We based this study on analysis of Medicare claims data and a review  of 
a stratified random sample of claims for MR. To  review the claims in 
our sample, we conducted a survey of the providers that billed for them 
(i.e., the billers). We augmented claims and survey data with data from 
States, the unique physician identification number (UPIN) file, and the  
Internet.   We also visited three MR providers to  learn how they provide  
MR services. See Appendix A for a full discussion of our methodology. 
Scope 
This study is national in scope and focuses on the technical component 
of MR services paid under the MPFS in 2005, whether billed globally or 
for the technical component only.  We did not evaluate the legality of 
the provider relationships we identified in our review of MR services.   
We did not evaluate the  appropriateness or medical necessity of MR 
services. In studying reassignment, we focused on claims for which the 
billers UPIN differed from the payees UPIN. We did not evaluate 
whether claims were subject to a valid reassignment in accordance with 
all Medicare laws and regulations.9  
Data Collection 
We analyzed Part B data from Medicares National Claims History 
(NCH) to create a population file of  claims for MR services in 2005. 
Based on our analysis of the NCH, we assigned each service in the 
population to one of three strata:  services ordered by doctors whose  
allowed charges for the MR services they ordered placed them at or  
above the 95th percentile among all doctors who ordered MR (high 
users); services ordered  by doctors whose charges for all advanced  
imagingMR, computed tomography, and positron emission 
tomographyplaced them at or above the 95th percentile among all 
doctors who ordered these services; and services ordered by doctors who  
were in neither of the other two strata. Our population file contained 
2,624,045 MR claims representing 2,629,061 allowed services and 
 
9 Social Security Act  1842(b)(6), 42 U.S.C.  1395u(b)(6), CMS Medicare Claims  
Processing Manual, Pub. No. 100-04, ch.1,  30.2. 
OEI-01-06-00261   PROVIDER  RELATIONSHIPS AND  THE USE OF  MAGNETIC RESONANCE  UNDER THE  MPFS   4  III NNN TTT RRR OOO DDD UUU CCC TTT III OOO NNN
     
$1.8 billion in allowed charges. From this file, we drew a stratified 
simple random sample of 600 claims that were billed through 
548 unique provider numbers. Because it was under investigation by 
OIG, we dropped one provider from  our study, leaving 547 billers and 
599 claims in our sample. 
To learn about the MR services in our sample, we surveyed the biller for 
each service. We received completed surveys for 598 of the 599 claims 
in our sample, yielding a response  rate of 99.8 percent. We used  
estimates from these 598 claims to project to the population. 
We supplemented our survey data with business registration data from 
States, as well as data about providers from the UPIN file, the 
American College of Radiology Web site, provider Web sites, and Google  
Maps. We used these data sources to identify the performer of each 
service in our sample and to identify business owners, group practices, 
and practice members of the parties involved in each service.  
We then identified relationships among the parties involved in each 
service in our sample.  We identified  medical practice relationships and 
business relationships. When the orderer or the  orderers group  
practice had a relationship with a party involved in providing the 
service, we referred to the orderer as a connected  doctor and the service 
as a connected service. 
We used data from the claims, including procedure code  modifiers, 
provider numbers, and tax identification numbers, to determine 
whether services were billed to Medicare globally or for the technical 
component only. We also used these data to determine whether the 
payment was reassigned from the biller to the payee. 
Analysis 
We analyzed our data to describe MR services overall, those ordered by 
high users of MR, and those ordered by connected doctors.   We 
compared services ordered by high users to services ordered  by all other  
users, and we compared  services ordered by connected doctors to  
services ordered by all other doctors.  
Limitations 
Data from our provider  survey were self-reported. With the exception of 
questions related to where the service was performed, we did not 
independently verify these data. 
Because of the proprietary nature of business arrangements that 
providers may use to provide MR services, it is unlikely that our review  
OEI-01-06-00261   PROVIDER  RELATIONSHIPS AND  THE USE OF  MAGNETIC RESONANCE  UNDER THE  MPFS   5  I N T R O D U C T I O N
   
identified all of the business relationships among the parties involved 
with the services in our sample.  To the extent that we could not 
identify all such relationships, our estimates of the number of connected  
services might be considered  conservative. 
Standards 
We conducted this study in accordance with the Quality Standards for 
Inspections issued by the Presidents Council on Integrity and 
Efficiency and the Executive Council on Integrity and Efficiency. 
  OEI-01-06-00261   PROVIDER  RELATIONSHIPS AND  THE USE OF  MAGNETIC RESONANCE  UNDER THE  MPFS   6    K E Y   A N A L Y T I C   C O N C E P T S
In this report, we present data on all MR services and on two subsets of  
MR services:  those ordered by high users of MR  and those ordered by 
connected doctors (connected services).  Below,  we introduce key 
concepts related to the findings of this study, including our definitions of 
high users and connected services, and how we used our data sources to 
draw conclusions about MR service delivery.  
Services Ordered by High Users of Magnetic Resonance 
For the purposes of this report, we defined high users of MR  as doctors  
whose allowed charges for services that they ordered placed  them at or 
above the 95th percentile among all doctors who ordered MR services in 
2005. We identified the subset of services ordered by high users so that 
we could describe how they were provided and compare them to all 
other MR services. Table 2 below displays data about high users and all 
other users. 
 
Table 2:  High Users of Magnetic Resonance and All Other Users of Magnetic 
Resonance in 2005 
 
High Users  All Other Users 
 
Total number of doctors  11,434  217,262 
 
Percentage of all doctors who ordered MR  5%  95% 
 
Top three specialties  Orthopedic surgery  Internal medicine 
 
Neurology  Family practice 
 
Internal medicine  Orthopedic surgery 
 
Total MR services ordered  1,016,918  1,607,127 
 
MR services ordered, percentage of total  39%  61% 
 
Total charges for MR services ordered  $701,605,244  $1,072,238,978 
 
Charges for MR services ordered, percentage of total  40%  60% 
 
Average num ber of MR services ordered per doctor  89  7 
Average MR  charges per doctor  $61,361  $4,935 
Source:  OIG analysis of 2005 Part B data, 2008. 
 
Connected Services 
We defined  a connected  service as one in which the orderer or the 
orderers group was connectedthrough either a medical practice  or  
other business relationshipto one  or more  of the parties involved in 
providing the technical component of the service.  Thus, when a doctor  
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who ordered an MR service was connected to the performer, biller, 
payee, lessor, or coowner, we referred to the doctor as a connected doctor  
and the service as a connected service.  We identified the subset of 
connected services so that we could describe how they were provided  
and compare them to all other MR services.   
Data Analysis and Appendixes 
We analyzed two data files to draw our conclusions.  One is a file of all 
Part B claims for technical and global MR services paid under the 
MPFS in 2005. We refer to the data in this file as the population.  The 
other data source is a file with the results of our review of a  sample of 
claims we selected from the population.  We refer to these data as the 
sample. 
We based our findings on MR services overall and those ordered by high  
users on both projections from the sample and analysis of the 
population.  Specifically, our findings on the performer and whether  
payment was reassigned within the billers group rely on projections 
from the sample.  The rest of our findings on services overall and those 
ordered by high users rely on analysis of the population.   
We based our findings on connected  services entirely on projections from 
the sample.   
Appendix B contains supplementary diagrams that display aspects of 
MR service  delivery and exceed the level of detail in the body of this 
report. Each set of diagrams contains data about all services, a 
comparison  between services ordered by high users and services ordered  
by all other  users, and a comparison between services ordered by 
connected doctors and services ordered by all other doctors.  When the 
data in a box of a diagram are based on projections from the  sample, 
corresponding confidence intervals appear in that diagrams table of 
confidence intervals.    
Appendix C contains tables related to our findings that rely on 
projections from the sample.  When data in a finding are based on 
projections from the sample, corresponding confidence intervals appear 
in Table 1.  Table 2 contains the results of statistical tests of sample 
projections.  
 
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  F I N D I N G S  
 
Certain characteristics were common to a majority   In 2005, Medicare paid for about 
of magnetic resonance services paid under the  2.6 million MR services under the 
Medicare Physician Fee Schedule, regardless of  MPFS. While providers  worked  
together to  provide services in a  
whether they  were ordered by high users 
number of ways, certain 
characteristics related to how they  
were ordered, performed, and billed were common to a majority of  
services.  Services largely shared these characteristics whether or not 
they were ordered by high users of MR.   
Two-thirds of services were ordered by one of four specialties  
The doctors  who ordered MR were concentrated  among a small number 
of specialties.  See Table 3 below for the total services ordered by each of  
the top four ordering specialties.   
 
Table 3:  Top Four Ordering Specialties, Magnetic Resonance  Services  
Paid Under the Medicare Physician Fee Schedule in 2005 
 
 
Specialty  Number of Services  Percentage of all Services 
 
Internal medicine  543,727  21% 
 
Orthopedic surgery  504,102  19% 
  Family practice  348,093  13% 
  Neurology  341,737  13%
      Total Top Four  1,737,659  66% 
  Source: OIG analysis of 2005 Part B data, 2008.  
Services ordered by high users of MR were also concentrated  among 
these same  ordering specialties.  However, orthopedic surgeons and 
neurologists together ordered 51 percent of the services ordered by high 
users, compared to 20 percent of all other services.  
Finally, the distribution of payee specialties varied little by the different  
ordering specialties. In other words, no ordering specialty was notably 
associated with any one payee specialty.  The distribution of payee 
specialties was largely the same among services overall, those ordered  
by high users, and those  ordered by all other users.  
Most services  were performed by the entity that was paid by Medicare 
In 2005, the performer and the payee were the same for 85 percent of 
MR services.  The other 15 percent of services were performed by 
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another party on behalf of the payee. In these cases, the payee might 
have leased imaging capacity from an imaging center or purchased the 
service from another performer.    
Three provider specialtiesindependent diagnostic testing facility 
(IDTF), multispecialty group, and diagnostic radiologycomprised 
88 percent of performers and payees.10  See Table 1 in Appendix C for 
confidence intervals for  findings on performing  providers. 
Finally, no statistical differences existed in these percentages among 
MR services overall, those ordered by high users, and those ordered by 
all other users. 
Magnetic resonance claims were typically billed globally through 
radiologists and had payments reassigned 
Services for MR claims followed a consistent billing pattern, regardless 
of whether they were ordered by high users of MR. Claims for 
47 percent of MR services paid under the MPFS in 2005 exhibited all 
three of these characteristics: billed globally, billed through a 
radiologist, and payment reassigned. 
Seventy-eight percent of services were billed globally. Global billing 
consolidates the professional and technical components into  a single claim 
for payment to a single  provider. Globally billed services can be furnished 
in several ways. Examples include a  single provider, such as an imaging 
center, a radiology group practice, or  another group practice, furnishing 
both components; an agreement between a radiology practice, which 
provides the professional component, and an imaging center,  which 
provides the technical component; and a radiologist working under 
contract to furnish the professional component of services performed by 
imaging centers and group practices. 
Fifty-four percent of all services were billed through a radiologists 
provider number. When a radiologist was the biller for the service, the 
radiologist could have provided either or both the technical and  
professional components of the test. 
For purposes of this report, we  classified a service as having had payment 
reassigned when the billers UPIN differed from the payees UPIN. We  
determined that payment was reassigned for 68 percent of services.     
Eighty-six percent of reassignments were from a doctor to his or her group  
 
10 In Medicare claims data, IDTF and multispecialty group are considered nonphysician  
provider specialties. CMS, Medicare Claims  Processing Manual, Pub. No. 100-4, ch. 26. 
OEI-01-06-00261   PROVIDER  RELATIONSHIPS AND  THE USE OF  MAGNETIC RESONANCE  UNDER THE  MPFS   10  FF II NN DD II NN GG SS  

practice. For the remaining 14 percent of reassignments, we were unable 
to identify the connection between the payee and the biller.   Payment for 
global bills was reassigned 71 percent of the time, while payment for 
technical component-only bills was reassigned 53 percent of the time. See 
Table 1 in Appendix C for confidence intervals for percentages of services 
with payments reassigned from a doctor to his or her group practice and  
those with payments reassigned to a provider with no identified  
connection. 
Finally, billing for services largely reflected these characteristics 
whether or  not they were ordered by high users of MR. Seventy-eight 
percent of services ordered by high users were billed globally, 52 percent  
were billed through a radiologists provider number, and 68 percent had 
payment reassigned. These percentages are nearly identical to those for 
services ordered by all other users.   In addition, no statistical 
differences existed in the percentage of payments reassigned  within the 
billers group among MR services overall, those ordered by high users, 
and those ordered by all other users.   
 
In our review, we found  that one-quarter
Connected services were provided differently  
of MR services paid under the MPFS in
than services that were not connected 
2005 were connected services. In these 
services, the ordering doctor or the ordering doctors group had a 
medical practice or other business connection to one or more of the 
parties involved in providing the service. All differences between 
connected and all other  services (those that were not connected) that 
appear below were statistically significant at the 95-percent confidence 
level. See Tables 1 and 2 in Appendix C for corresponding confidence 
intervals and statistical tests. 
Connected services were associated with high use 
High users of MR ordered 55 percent of connected services, compared to  
33 percent of services that were not connected.   
Connected services were more likely to have been ordered by orthopedic 
surgeons 
Orthopedic surgeons ordered 28 percent of connected services, compared  
to 15 percent of all other services. Among the four most prevalent 
ordering specialtiesinternal medicine, orthopedic surgery, family 
practice, and neurologythis is the only difference in the percentages of  
services each ordered that was statistically significant. 
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Connected services were more likely to have been performed by  
multispecialty groups  
Multispecialty groups performed and were paid for half of connected  
services, compared to only one-quarter of services that were not  
connected.   The IDTF and diagnostic radiology specialties played a 
smaller role in connected services than in all other services. Specialties 
other than multispecialty group, IDTF, and diagnostic radiology played  
a significantly larger role in connected services than in all other 
services. See Tables 4 and 5 below for a comparison of top performer  
and payee specialties for connected  services and those that were not 
connected.    
 
Table 4: Top Specialties of Performers, Connected Services, and 
  All Other Services 
 
Percentage of  Percentage of All 
  Performer Specialty  Connected Services  Other Services 
Multispecialty clinic/group  50%  26% 
 
IDTF  13%  39% 
 
Diagnostic radiology  7%  29% 
 
All other specialties  30%  6%
 
   Total   100%  100% 
 
Source: OIG review of 2005 MR services, 2008. 
 
  Table 5: Top Specialties of Payees, Connected Services, and All 
Other Services 
 
Percentage of  Percentage of All 
 
Payee Specialty  Connected Services  Other Services 
 
Multispecialty clinic/group  51%  26% 
 
IDTF  11%  38% 
  Diagnostic radiology  7%  31% 
 
All other specialties  31%  5%
 
     Total   100%  100% 
Source: OIG review of 2005 MR services, 2008. 
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Connected services were more likely than all other services to have been 
billed as technical component only, to have had payment reassigned, and to 
have been billed through a provider other than a radiologist 
See Chart 1 below for a comparison of the billing characteristics of 
connected services and all other services. 
 
Chart 1:  Billing Characteristics of Connected and 

 
All Other Services
 
 
100% 
 
87% 
 
 
75% 
  64%  63% 
 
Connected 
  services 
50% 
 
38% 
All other 
  33% 
services 
 
25% 
 
14% 
 
 
0% 

 
Technical component- Payment reassigned  Billed through a provider 

 
only bill  other than a radiologist 

 
Source: OIG review of 2005 MR services, 2008. 
 
 
  OEI-01-06-00261   PROVIDER  RELATIONSHIPS AND  THE USE OF  MAGNETIC RESONANCE  UNDER THE  MPFS   13    C O N C L U S I O N
The Medicare program has seen rapid growth in MR and other types of 
advanced imaging performed in doctors offices, imaging centers, and 
other settings covered by the MPFS.  As more services are performed in 
these settings, doctors are increasingly in a position to order services 
from parties with which they have a medical practice or other business 
relationship. In these circumstances, doctors may have conflicts of 
interest, financial or otherwise.  
In this review, we sought to learn about how providers delivered MR 
covered under the MPFS and whether certain relationships among 
providers were associated with high use of services.  In particular, we  
were interested in connected services, which are services ordered by 
doctors who were connected to the parties that provided them. 
We found a relationship between connected services and services 
ordered by high users of MR, but we also found that the two  subsets of 
services differed in several ways. We found that services ordered by 
high users of MR were largely similar to all other services in how they 
were furnished and billed to Medicare.  However, this was not the case 
for connected services, which differed significantly from services that 
were not connected.   
The findings in this report highlight the complex nature of how 
providers deliver MR paid under the  MPFS.  The  large number of ways 
that various parties can perform and bill for services reduces the 
transparency of these transactions.  Although the analysis in this report 
was limited to MR, it is possible that such complexity extends to other 
types of high-cost imaging paid under the MPFS.  The complexity and  
limited transparency with which these services are provided warrants 
continued attention to  ensure that services are reasonable, necessary, 
and compliant with Medicare statutes and regulations. 
AGENCY COMMENTS 
CMS agreed with our findings and our conclusion that the complexity of 
MR services warrants continuted attention.  It outlined regulatory steps 
it has taken to curb overutilization of diagnostic testing services.  These 
include expanding the antimarkup provision to the professional 
component of services and seeking public comment on the in-office 
ancillary exception to the physician self-referral law.  CMS also stated 
its commitment to examining the relationship between the utilization of 
advanced imaging services and the entities that order and bill for them.  
The complete text of CMSs comments appears in Appendix D.  
  OEI-01-06-00261   PROVIDER  RELATIONSHIPS AND  THE USE OF  MAGNETIC RESONANCE  UNDER THE  MPFS   14    A P P E N D I X ~ A
 
Methodology  
We based this study on analysis of Medicare claims data and a review  of 
a stratified random sample of claims for magnetic resonance (MR).  To 
review the claims in our sample, we  conducted a survey of the providers  
that billed for them. We augmented our survey data with business 
registration data from States and data about providers from the unique  
physician identification number (UPIN) file, the American College of 
Radiology Web site, provider Web sites, and Google Maps.  We also  
visited three MR providers to learn how they provide MR services. 
Scope 
This study is national in scope and focuses on the technical component 
of MR services paid under the Medicare Physician Fee Schedule (MPFS) 
in 2005. We focused on the technical component because it is the most 
costly component of MR services.  We focused on MR because it has a 
wide range of clinical applications across ambulatory settings.  
We used 100-percent Part B carrier claims data from Medicares 
National Claims History (NCH) and data from a stratified simple 
random sample to describe MR services.  
We did not attempt to make any judgments about the legality of the 
provider relationships we identified in our review. 
Creation of Population File 
The data source for our sample was Medicares 2005 NCH, which 
contains all claims activity for Medicare fee-for-service beneficiaries.  
From this source, we created a population file of 2,624,045 Part B 
claims for MR services from which we drew our sample.  We  also used  
this population file in our descriptive analysis of how MR services were 
furnished and billed. Below are the steps we took to create this file and 
draw our sample. 
Create a file of claims for global and technical component services.  We  
extracted Part B carrier claims from  the 2005 NCH to create a file of 
technical component and global claims for MR, computed tomography 
(CT), and positron emission tomography (PET).  This file contained 
6,009,091 claims reflecting $3.3 billion in allowed charges. 
We then excluded 172,585 records with invalid data for the UPIN of the 
ordering doctor or allowed charges under $100.  We did so because we 
needed valid UPIN data to profile ordering doctors and because claims  
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with allowed charges under $100 were unlikely to be for the technical 
component of services. These represent 2.9 percent of the records in our 
original file and 2.9 percent of allowed charges.  
The resulting file contained 5,836,506 claim records. Each record 
contained the Healthcare Common Procedure Coding System (HCPCS) 
code and modifiers, UPIN number and specialty of the biller, UPIN 
number of the orderer, tax identification number of the payee, and  
beneficiary identifier. 
Create profiles of ordering doctors. We  summarized our claims file by 
orderers UPIN to create a profile record for each  doctor who ordered 
one or more services. The resulting file had 284,105 records. Each 
record contained allowed charges for MR, CT, and PET ordered by the  
doctor in 2005for each modality and for all three combined. Records 
also included percentile rankings based on those charges. Of the 
orderers in the file, 228,696 ordered MR. Based on analysis of the 
distributions of allowed charges in the file, we categorized each orderer 
of MR into one of three strata: doctors whose allowed charges for the 
MR services they ordered placed them at or above the 95th percentile 
among all doctors who ordered MR (high group); doctors whose  
collective charges for MR, CT, and PET services placed them at or above 
the 95th percentile among all doctors who ordered these services 
(collective high group); and doctors who were in neither the high nor the 
collective high strata (regular group). 
Append profiles to MR claims and assign claims to strata.  Our population file 
contained 2,624,045 MR claims representing 2,629,061 allowed services 
and $1.8 billion in allowed charges.   Next, we merged each orderers  
profile with the claims for MR services that he  or she ordered. This 
enabled us to assign each claim to a stratum based on whether its 
orderer was in the high, collective high, or regular group  of MR users.   
Sample Selection 
From our stratified population file, we drew a stratified simple random 
sample of claims for services ordered by high, collective high, and 
regular users. The population and sample size for each stratum are 
shown in Table 1 on the following page. 
 
 
 
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Table 1:  Population of Magnetic Resonance Claims and Sample Strata 
 
Ordering Doctor's 
Stratum   2005 Population  Allowed Charges  Sample Size 
Use of MR 
 
1  High  1,016,918  $701,605,244  200 
2    Collective High  19,695  $15,526,233  100 
3    Regular  1,587,432  $1,056,712,744  300 
Total   2,624,045  $1,773,844,221  600 
Source:  Office of Inspector General (OIG) analysis of 2005 Part B data, 2006. 
 
The 600 claims in our sample were billed under a total of 548 unique 
provider numbers.  We  used the UPIN file to locate the names and  
addresses of these billers and vetted them with our Office of 
Investigations. As a result of vetting, we dropped one provider from our  
study, leaving 547 billers and 599 claims in our sample. 
Mail Survey  
To learn about how MR services in  our sample were provided, we 
surveyed the biller for each service.  The survey contained 14 questions 
related to the billers relationship with the orderer of the service, the 
name and location of the performer, equipment ownership and leasing, 
and whether the provider had a business or medical practice 
relationship with any of the parties involved in providing the service.  
We tested the survey with four providers and vetted it within OIG. 
To conduct the survey, we used express delivery to send each biller a 
package with a cover letter, a survey, a preaddressed prepaid return 
envelope, and an instructions page with information identifying the 
specific service about which we were asking.  We instructed the biller to 
answer the  survey only with respect to the technical component of the 
specific service identified. If a biller had more than one claim in our 
sample, we sent an instruction sheet and survey for each claim. 
We received completed surveys from 546 of the 547 billers in our 
sample. We could not locate one biller that had retired from medical 
practice.  The surveys we received covered 598 of the 599 claims in our 
sample, yielding a response rate of 99.8 percent.  
Supplemental Data 
To learn more about how MR services in our sample were provided, we 
supplemented our survey data with business registration data from 
States, as well as data about providers from the UPIN file, the 
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American College of Radiology Web site, provider Web sites, and Google  
Maps. 
We used business registration data from States to identify owners of 
any business that played a role in providing a service. Such businesses  
included equipment leasing companies, imaging centers, and medical 
groups incorporated as professional corporations.  We used the UPIN 
file to identify group practices and group practice members of all 
primary parties involved with the services.  We also cross-referenced the 
payee tax identification number from each sampled claim with the 
UPIN file to identify the payee for each service in our sample.  We used 
provider Web sites to identify practice members, locations, and 
affiliations with other providers.   We used the American College of 
Radiologys Web site and Google Maps to aid in verifying performers  
locations.  Any time we identified an individual, group practice, or other 
provider associated with a claim, we  searched the UPIN file by provider 
name and location to identify and record that providers UPIN. 
Identification of Relationships and Connected Doctors 
We used both a computer program  and a manual review to identify 
medical practice relationships and business relationships among the 
primary parties involved with each service in our sample. We defined 
medical practice relationships as a doctor who was member of a group  
practice or on staff at a hospital.  Business relationships included 
shared participation as investors in a joint venture, one party having an 
ownership or managerial interest in the other, and contracts.  
When we determined that the orderer or the orderers group  practice 
had a relationship with one or more  of the parties involved in providing 
the service, we referred to the orderer as a connected doctor  and the  
service as a connected service. 
Description of Billing Attributes 
We classified all claims in our population as bills for either global 
payment or  for the technical component only and as either having had  
payment reassigned or not having had payment reassigned.  To classify 
a service as billed globally or for the technical component only, we used 
the two HCPCS modifiers that were on the claim.  To classify a service 
as having had payment reassigned, we used the UPIN numbers of the  
biller and the payee. When the billers UPIN differed from the payees 
UPIN, we classified the service as having had its payment reassigned.  
We did not determine whether other types of reassignments may have 
occurred. 
  OEI-01-06-00261   PROVIDER  RELATIONSHIPS AND  THE USE OF  MAGNETIC RESONANCE  UNDER THE  MPFS   18  A P P E N D I X ~ A  

When we  classified services in our sample as having had payment 
reassigned, we used the UPIN file and our supplemental data to 
determine whether payment was reassigned within the billers group.  
When the UPIN file or our supplemental data showed that the biller 
was a member of the payee, we classified the reassignment as within 
the billers group. 
Analysis 
Findings and conclusions are based  on analyses of data from the 
population file and from our sample. 
We analyzed these data to describe MR services overall, the  subset of 
those ordered by high users of MR, and the subset of those ordered by 
connected doctors.  We compared services ordered by high users to  
services ordered by all other users  and compared services ordered by 
connected doctors to services ordered by all other doctors. 
We based our findings on MR services overall and those ordered by high  
users on analysis of both the sample and the population.  Specifically, 
our findings on the performer and whether payment was reassigned  
within the billers group rely on analysis of the sample.  The rest of our 
findings on services overall and those ordered by high users rely on 
analysis of the population.   
We based our findings on connected services entirely on analysis of the 
sample. 
Limitations 
Data from our provider  survey were self-reported.  With the exception of 
questions related to where the service was performed, we did not 
independently verify these data. 
Because of the proprietary nature of business arrangements that 
providers may use to provide MR services, it is unlikely that our review  
identified all of the business relationships among the parties involved 
with the services in our sample.  To the extent that we could not 
identify all such relationships, our estimates might be considered  
conservative. 
We considered each claim in our population file to represent one MR  
service.  However, our population file contained 3,219 claims for more 
than one service.  We found that claims with more than one service had 
average allowed charges per service of $566 and that those with more 
than two services had allowed charges per service of $248.  This 
compares to $675 for claims with one service only.  Instead of  reviewing 
  OEI-01-06-00261   PROVIDER  RELATIONSHIPS AND  THE USE OF  MAGNETIC RESONANCE  UNDER THE  MPFS   19  A P P E N D I X ~ A  

each of the claims with more than one service to judge whether their 
service counts were valid, we decided to count them as claims for one 
service only.  The additional services that we did not count on these  
claims totaled 5,016 services, or 0.2 percent of our sample population. 
 
  OEI-01-06-00261   PROVIDER  RELATIONSHIPS AND  THE USE OF  MAGNETIC RESONANCE  UNDER THE  MPFS   20    A P P E N D I X ~ B
 
Magnetic Resonance Service Delivery Diagrams 
 
 
DIAGRAM 1:  SERVICE DELIVERY  . . . . . . . . . . . . . . . . . . . . . .  22 
  
1a:  All services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  22 
  
1b:  Services ordered by high users . . . . . . . . . . . . . . . . . . . . . . . .  23 
  
1c:  Services ordered by all other users . . . . . . . . . . . . . . . . . . . . .  24 
  
1d:  Services ordered by connected doctors  . . . . . . . . . . . . . . . . . .  25 
  
1e:  Services ordered by all other doctors. . . . . . . . . . . . . . . . . . . .  26 
  
D I A G R A M 2:   R E AS S I G N M EN T  O F  PA Y M E N T   . . . . . . . . . . .  27 
  
2a:  All services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  27 
  
2b:  Services ordered by high users . . . . . . . . . . . . . . . . . . . . . . . .  28 
  
2c:  Services ordered by all other users . . . . . . . . . . . . . . . . . . . . .  29 
  
2d:  Services ordered by connected doctors  . . . . . . . . . . . . . . . . . .  30 
  
2e:  Services ordered by all other doctors. . . . . . . . . . . . . . . . . . . .  31 
  
DIAGRAM 3:  BILLING METHOD . . . . . . . . . . . . . . . . . . . . . . . . .  32 
  
3a:  All services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  32 
  
3b:  Services ordered by high users . . . . . . . . . . . . . . . . . . . . . . . .  33 
  
3c:  Services ordered by all other users . . . . . . . . . . . . . . . . . . . . .  34 
  
3d:  Services ordered by connected doctors  . . . . . . . . . . . . . . . . . .  35 
  
3e:  Services ordered by all other doctors. . . . . . . . . . . . . . . . . . . .  36 
  
DIAGRAM 4:  PROVIDER RELATIONSHIPS . . . . . . . . . . . . . .  37 
  
4a:  All services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  37 
  
4b:  Services ordered by high users . . . . . . . . . . . . . . . . . . . . . . . .  38 
  
4c:  Services ordered by all other users . . . . . . . . . . . . . . . . . . . . .  39 
  
4d:  Services ordered by connected doctors  . . . . . . . . . . . . . . . . . .  40 
  
4e:  Services ordered by all other doctors. . . . . . . . . . . . . . . . . . . .  41 
  
CONF IDENCE INTERVAL TABLES . . . . . . . . . . . . . . . . . . . . . . .  42 
  
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  Diagram 1a:  Service Delivery, All Services 
 
 
Percentages in one column may not add to those in the preceding column because of rounding. 

 
Source: Office of Inspector General (OIG) analysis of 2005 Part B data and OIG review of 2005 

magnetic resonance (MR) services, 2008. 

See Table 1a on  p. 42 for confidence intervals. 

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Diagram 1b:  Service Delivery, Services Ordered by High Users 
Percentages in one column may not add to those in the preceding column because of rounding. 
 
Source: OIG analysis of 2005 Part B data and OIG review of 2005 MR services, 2008. 
See Table 1b on  p. 43 for confidence intervals. 
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 A P P E N D I X ~ B  

Diagram 1c:  Service Delivery, Services Ordered by All Other Users  
Percentages in one column may not add to those in the preceding column because of rounding. 
 
Source: OIG analysis of 2005 Part B data and OIG review of 2005 MR services, 2008. 
See Table 1c on p. 44 for confidence intervals. 
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Diagram 1d:  Service Delivery, Services Ordered by Connected Doctors 
Percentages in one column may not add to those in the preceding column because of rounding. 
 
Source: OIG review of 2005 MR services, 2008. 
See Table 1d on  p. 45 for confidence intervals. 
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Diagram 1e:  Service Delivery, Services Ordered by All Other Doctors 
Percentages in one column may not add to those in the preceding column because of rounding. 
 
Source: OIG review of 2005 MR services, 2008. 
See Table 1e on  p. 46 for confidence intervals. 
  OEI-01-06-00261   PROVIDER  RELATIONSHIPS AND  THE USE OF  MAGNETIC RESONANCE  UNDER THE  MPFS   26  A P P E N D I X ~ B  

 
 
 
  Diagram 2a:  Reassignment of Payment, All Services 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  Percentages in one column may not add to those in the preceding column because of rounding. 
   
Source: OIG analysis of 2005 Part B data and OIG review of 2005 MR services, 2008. 
  See Table 2a on  p. 47 for confidence intervals. 
 
 
 
 
 
 
 
 
 
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 A P P E N D I X ~ B  

 
Diagram 2b:  Reassignment of Payment, Services Ordered by High Users  
Percentages in one column may not add to those in the preceding column because of rounding. 
 
Source: OIG analysis of 2005 Part B data and OIG review of 2005 MR services, 2008. 
See Table 2b on  p. 47 for confidence intervals. 
  OEI-01-06-00261   PROVIDER  RELATIONSHIPS AND  THE USE OF  MAGNETIC RESONANCE  UNDER THE  MPFS   28 
 A P P E N D I X ~ B  

 
 
 
 Diagram 2c:  Reassignment of Payment, Services Ordered by All Other Users 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  Percentages in one column may not add to those in the preceding column because of rounding. 
 
 
Source: OIG analysis of 2005 Part B data and OIG review of 2005 MR services, 2008. 
  See Table 2c on p. 47 for confidence intervals. 
 
 
 
 
 
 
 
  OEI-01-06-00261   PROVIDER  RELATIONSHIPS AND  THE USE OF  MAGNETIC RESONANCE  UNDER THE  MPFS   29 
 A P P E N D I X ~ B  

 
 
 
Diagram 2d:  Reassignment of Payment, Services Ordered by Connected Doctors 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  Percentages in one column may not add to those in the preceding column because of rounding. 
 
  Source: OIG analysis of 2005 Part B data and OIG review of 2005 MR services, 2008. 
  See Table 2d on  p. 47 for confidence intervals. 
 
 
 
 
 
 
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Diagram 2e:  Reassignment of Payment, Services Ordered by All Other Doctors 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  Percentages in one column may not add to those in the preceding column because of rounding. 
   
Source: OIG analysis of 2005 Part B data and OIG review of 2005 MR services, 2008. 
  See Table 2e on  p. 47 for confidence intervals. 
 
 
 
 
 
 
 
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 A P P E N D I X ~ B  

 
  Diagram 3a:  Billing Method, All Services 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  Percentages in one column may not add to those in the preceding column because of rounding. 
   
Source: OIG analysis of 2005 Part B data and OIG review of 2005 MR services, 2008. 
  See Table 3a on  p. 48 for confidence intervals. 
 
 
 
 
 
 
 
  OEI-01-06-00261   PROVIDER  RELATIONSHIPS AND  THE USE OF  MAGNETIC RESONANCE  UNDER THE  MPFS   32  A P P E N D I X ~ B  

 
 
Diagram 3b:  Billing Method, Services Ordered by High Users 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
P ercentages in one column may not add to those in the preceding column because of rounding. 
 
S ource: OIG analysis of 2005 Part B data and OIG review of 2005 MR services, 2008. 
S ee Table 3b on  p. 48 for confidence intervals. 
 
 
 
 
 
 
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 A P P E N D I X ~ B  

 
  Diagram 3c:  Billing Method, Services Ordered by All Other Users 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Percentages in one column may not add to those in the preceding column because of rounding. 
 
 
Sou rce: OIG analysis of 2005 Part B data and OIG review of 2005 MR services, 2008. 
See Table 3c on p. 48 for confidence intervals. 
 
 
 
 
 
  OEI-01-06-00261   PROVIDER  RELATIONSHIPS AND  THE USE OF  MAGNETIC RESONANCE  UNDER THE  MPFS   34  A P P E N D I X ~ B  

 
 
Diagram 3d:  Billing Method, Services Ordered by Connected Doctors  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Percentages in one column may not add to those in the preceding column because of rounding. 
 
 
S ource: OIG review of 2005 MR services, 2008. 
See Table 3d on  p. 49 for confidence intervals. 
 
 
 
 
 
  OEI-01-06-00261   PROVIDER  RELATIONSHIPS AND  THE USE OF  MAGNETIC RESONANCE  UNDER THE  MPFS   35  A P P E N D I X ~ B  

 
 
Diagram 3e:  Billing Method, Services Ordered by All Other Doctors 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Percentages in one column may not add to those in the preceding column because of rounding. 
  
Source: OIG review of 2005 MR services, 2008. 
 
See Table 3e on  p. 49 for confidence intervals. 
 
 
 
 
  OEI-01-06-00261   PROVIDER  RELATIONSHIPS AND  THE USE OF  MAGNETIC RESONANCE  UNDER THE  MPFS   36  A P P E N D I X ~ B  

 
  Diagram 4a:  Provider Relationships, All Services 
 
 
* 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CX = Connection:  Parties are the same or one is a member of the other. 

   
Percentages in one column may not add to those in the preceding column because of rounding. 

 
 
* Proje ctions in the right-most column are based on 589 sample units and those in the column that 
precedes it are based on 590.  This causes some percentages in the right-most column to vary  
 
from the values in the preceding column.  
   
Source: OIG review of 2005 MR services, 2008. 
 
See Table 4a on  p. 50 for confidence intervals. 
 
 
  OEI-01-06-00261   PROVIDER  RELATIONSHIPS AND  THE USE OF  MAGNETIC RESONANCE  UNDER THE  MPFS   37  A P P E N D I X ~ B  

 
  Diagram 4b:  Provider Relationships, Services Ordered by High Users 
 
 
  * 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CX = Connection:  Parties are the same or one is a member of the other. 

   
Percentages in one column may not add to those in the preceding column because of rounding. 

 
 
* P rojections in the right-most column are based on 195 sample units and those in the column 
that precedes it are based on 196.  This causes some percentages in the right-most column to 
 
vary from the values in the preceding column.  
   
Source: OIG review of 2005 MR services, 2008. 
 
See Table 4b on  p. 51 for confidence intervals. 
 
  OEI-01-06-00261   PROVIDER  RELATIONSHIPS AND  THE USE OF  MAGNETIC RESONANCE  UNDER THE  MPFS   38  A P P E N D I X ~ B  

 
 
Diagram 4c:  Provider Relationships, Services Ordered by All Other Users 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 CX = Connection:  Parties are the same or one is a member of the other. 

  
Percentages in one column may not add to those in the preceding column because of rounding. 

  
 Source: OIG review of 2005 MR services, 2008. 

See Table 4c on p. 52 for confidence intervals. 

 
 
 
  OEI-01-06-00261   PROVIDER  RELATIONSHIPS AND  THE USE OF  MAGNETIC RESONANCE  UNDER THE  MPFS   39  A P P E N D I X ~ B  

 
 
Diagram 4d:  Provider Relationships, Services Ordered by Connected Doctors 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  CX = Connection:  Parties are the same or one is a member of the other. 

 
 
Percentages in one column may not add to those in the preceding column because of rounding. 

   
Source: OIG review of 2005 MR services, 2008. 

 
See Table 4d on  p. 53 for confidence intervals. 

 
 
  OEI-01-06-00261   PROVIDER  RELATIONSHIPS AND  THE USE OF  MAGNETIC RESONANCE  UNDER THE  MPFS   40  A P P E N D I X ~ B  

 
 
Diagram 4e:  Provider Relationships, Services Ordered by All Other Doctors 
 
 
 
  * 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CX = Connection:  Parties are the same or one is a member of the other. 

   
Percentages in one column may not add to those in the preceding column because of rounding. 

 
 
* Pr ojections in the right-most column are based on 449 sample units and those in the column 
that precedes it are based on 450.  This causes some percentages in the right-most column to 
 
vary from the values in the preceding column.  
   
Source: OIG review of 2005 MR services, 2008. 
 
See Table 4e on  p. 54 for confidence intervals. 
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Table 1a: Confidence Intervals for Diagram 1a: Service Delivery, All Services 
 
 
   
  95-Percent Confidence  
Service Characteristic  Point  Estimate  Sample Size  Interval 
         
  Payee connected to Performer  85.3%  590  82.1%88.4% 
 
     Reassigned  58.5%  589  54.2%62.9%
 
        Within group  50.4%  589  46.0%54.8%
 
      Outside group  8.2%  589  5.7%10.6% 
 
       Biller UPIN  same as Payee UPIN  26.7%  589  22.8%30.6% 
 
 
  Payee not connected to Performer  14.7%  590  11.6%17.9% 
 
     Reassigned  11.5%  589  8.7%14.3%
 
      Within group  9.5%  589  6.9%12.1%
 
 
      Outside group  2.0%  589  1.1%3.7%* 
 
     Biller UPIN  same as Payee UPIN  3.2%  589  1.7%4.8% 
 
  * Confidence interval calculated using the logit transformation because of poor coverage properties of the standard approximation method  
when a small number of sample  elements possess the characteristic of interest. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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  Table 1b:  Confidence Intervals for Diagram 1b:  Service Delivery, Services Ordered by  
  High Users 
 
 
  95-Percent Confidence  
Service Characteristic  Point  Estimate  Sample Size  Interval 
 
  Payee connected to Performer  82.7%  196  77.3%88.0% 
 
     Reassigned  60.0%  195  53.1%66.9%
 
            Within group  53.3%  195  46.3%60.4%
 
          Outside group  6.7%  195  3.1%10.2% 
 
       Biller UPIN  same as Payee UPIN  22.6%  195  16.7%28.5% 
 
 
  Payee not connected to Performer  17.3%  196  12.0%22.7% 
 
     Reassigned  13.8%  195  9.0%18.7%
 
          Within group  10.3%  195  6.0%14.5%
 
 
          Outside group  3.6%  195  1.0%6.2% 
 
     Biller UPIN  same as Payee UPIN  3.6%  195  1.0%6.2% 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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  Table 1c:  Confidence Intervals for Diagram 1c:  Service Delivery, Services Ordered by All 
  Other Users 
 
 
  95-Percent Confidence  
Service Characteristic  Point  Estimate  Sample Size  Interval 
 
  Payee connected to Performer  86.9%  394  83.1%90.7% 
 
     Reassigned  57.6%  394  52.0%63.2%
 
            Within group  48.5%  394  42.9%54.2%
 
          Outside group  9.1%  394  5.8%12.3% 
 
       Biller UPIN  same as Payee UPIN  29.3%  394  24.2%34.4% 
 
 
  Payee not connected to Performer  13.1%  394  9.3%16.9% 
 
     Reassigned  10.1%  394  6.7%13.5%
 
          Within group  9.1%  394  5.8%12.3%
 
 
          Outside group  1.0%  394  0.3%3.1%* 
 
     Biller UPIN  same as Payee UPIN  3.0%  394  1.1%5.0% 
 
  * Confidence interval calculated using the logit transformation because of poor coverage properties of the standard approximation method  
when a small number of sample  elements possess the characteristic of interest. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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  Table 1d:  Confidence Intervals for Diagram 1d:  Service Delivery, Services Ordered by  
  Connected Doctors 
 
 
  95-Percent Confidence  
Service Characteristic  Point  Estimate  Sample Size  Interval 
 
  Payee connected to Performer  79.2%  140  72.1%86.3% 
 
     Reassigned  69.6%  140  61.6%77.7%
 
            Within group  60.7%  140  52.1%69.2%
 
          Outside group  9.0%  140  3.9%14.0% 
 
       Biller UPIN  same as Payee UPIN  9.6%  140  4.4%14.7% 
 
 
  Payee not connected to Performer  20.8%  140  13.7%27.9% 
 
     Reassigned  17.6%  140  10.9%24.3%
 
          Within group  16.0%  140  9.6%22.5%
 
 
          Outside group  1.6%  140  0.4%6.1%* 
 
     Biller UPIN  same as Payee UPIN  3.2%  140  1.2%8.2%* 
 
  * Confidence interval calculated using the logit transformation because of poor coverage properties of the standard approximation method  
when a small number of sample  elements possess the characteristic of interest. 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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  Table 1e: Confidence Intervals for Diagram 1e: Service Delivery, Services Ordered by All 
  Other Doctors 
 
 
  95-Percent Confidence  
Service Characteristic  Point  Estimate  Sample Size  Interval 
 
  Payee connected to Performer  87.3%  450  83.9%90.7% 
 
     Reassigned  54.8%  449  49.8%59.9%
 
        Within group  46.9%  449  41.9%52.0%
 
      Outside group  7.9%  449  5.1%10.6% 
 
       Biller UPIN  same as Payee UPIN  32.4%  449  27.7%37.2% 
 
 
  Payee not connected to Performer  12.7%  450  9.3%16.1% 
 
     Reassigned  9.5%  449  6.5%12.5%
 
      Within group  7.4%  449  4.7%10.0%
 
 
      Outside group  2.1%  449  1.1%4.2%* 
 
     Biller UPIN  same as Payee UPIN  3.3%  449  1.4%5.1% 
 
  * Confidence interval calculated using the logit transformation because of poor coverage properties of the standard approximation method  
when a small number of sample  elements possess the characteristic of interest. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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Table 2a:  Confidence Intervals for Diagram 2a:   Reassignment of Payment,  All  Services 
 
 
95-Percent Confidence 
  Service Characteristic  Point Estimate  Sample Size  Interval 
 
Reassigned within  group  59.2%  417  56.7%61.7% 
 
Reassigned outside group  9.9%  417  7.4%12.4% 
 
 
 
Table 2b:   Confidence Intervals  for Diagram 2b:  Reassignment of  Payment, Services Ordered  by  
 
High Users 
 
  95-Percent Confidence 
Service Characteristic  Point Estimate  Sample Size  Interval 
 
Reassigned within  group  60.5%  147  56.6%64.4% 
 
  Reassigned outside group  9.5%  147  5.6%13.4% 
 
 
  Table 2c:  Confidence Intervals for Diagram 2c:   Reassignment of Payment,  Services  Ordered by All 
Other Users 
 
  95-Percent Confidence 
  Service Characteristic  Point Estimate  Sample Size  Interval 
  Reassigned within  group  58.4%  270  55.0%61.7% 
 
Reassigned outside group  10.2%  270  6.8%13.5% 
 
 
 
Table 2d:   Confidence Intervals  for Diagram 2d:  Reassignment of  Payment, Services Ordered  by  
  Connected Doctors 
 
95-Percent Confidence 
 
Service Characteristic  Point Estimate  Sample Size  Interval 
 
Reassigned  87.4%  141  81.6%93.2%
 
     Reassigned  within group  76.9%  141  69.5%84.3%
 
       Reassigned  outside group  10.5%  141  5.1%15.8% 
 
Biller UPIN  paid  12.6%  141  6.8%18.4% 
 
 
 
Table 2e:  Confidence Intervals for Diagram 2e:   Reassignment of Payment,  Services  Ordered by All 
  Other Doctors 
 
95-Percent Confidence 
 
Service Characteristic  Point Estimate  Sample Size  Interval 
 
Reassigned  64.3%  456  59.4%69.1%
 
     Reassigned  within group  54.4%  456  49.3%59.4%
 
       Reassigned  outside group  9.9%  456  6.9%12.9% 
Biller UPIN  paid  35.7%  456  30.9%40.6% 
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Table 3a:  Confidence Intervals for Diagram 3a:  Billing Method, All Services 
 
 
95-Percent Confidence  
 
Service Characteristic  Point Estimate  Sample Size  Interval 
 
Global  bill, reassigned within  group  49.1%  355  46.8%51.4% 
 
  Global  bill, reassigned outside group  8.2%  355  5.9%10.5% 
 
TC bill, reassigned  within group  10.1%  62  9.0%11.2% 
 
TC bill, reassigned  outside  group  1.7%  62  0.9%3.1%* 
 
 * Confidence interval calculated using the logit transformation because of poor coverage properties of the standard approximation method when a small  
number of sample elements possess the characteristic of interest. 
 
 
 
 Table 3b:  Confidence Intervals for Diagram 3b:  Billing Method, Services Ordered by High Users 
 
  95-Percent Confidence  
  Service Characteristic  Point Estimate  Sample Size  Interval 
  Global  bill, reassigned within  group  48.6%  122  45.0%52.2% 
 
Global  bill, reassigned outside group  8.4%  122  4.8%12.0% 
 
  TC bill, reassigned  within group  12.0%  25  10.6%13.0% 
 
TC bill, reassigned  outside  group  1.0%  25  0.3%3.5%* 
 
* Confidence interval calculated using the logit transformation because of poor coverage properties of the standard approximation method when a small  
 number of sample elements possess the characteristic of interest. 
 
 
 
 Table 3c:  Confidence Intervals for Diagram 3c:   Billing  Method, Services Ordered by All Other Users 
 
  95-Percent Confidence  
Service Characteristic  Point Estimate  Sample Size  Interval 
 
Global  bill, reassigned within  group  49.4%  233  46.5%52.4% 
 
  Global  bill, reassigned outside group  8.0%  233  5.1%11.0% 
 
TC bill, reassigned  within group  8.9%  37  7.3%10.5% 
 
  TC bill, reassigned  outside  group  2.2%  37  1.0%4.2%* 
 * Confidence interval calculated using the logit transformation because of poor coverage properties of the standard approximation method when a small  
number of sample elements possess the characteristic of interest. 
 
 
 
 
 
 
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 Table 3d:  Confidence Intervals for Diagram 3d:  Billing Method, Services Ordered by Connected  
 Doctors 
 
95-Percent Confidence 
 
Service Characteristic  Point Estimate  Sample Size  Interval 
 
Global bill  66.5%  141  58.3%74.8%
 
       Reassigned  60.3%  141  51.7%68.8%
 
          Within group  52.2%  141  43.4%60.9%
 
            Outside group  8.1%  141  3.3%12.8%
 
     Biller  UPIN same as  Payee  UPIN  6.3%  141  2.1%10.5% 
 
 
  TC bill  33.5%  141  25.2%41.7%
 
     Reassigned  27.1%  141  19.3%34.9%
 
            Within group  24.7%  141  17.1%32.3%
 
          Outside group  2.4%  141  0.8%7.2%*
 
     Biller  UPIN same as  Payee  UPIN  6.4%  141  2.1%10.6% 
 
 * Confidence interval calculated using the logit transformation because of poor coverage properties  of the standard approximation  method when a small  
number  of sample  elements possess the characteristic of  interest. 
 
 
 
 Table 3e:  Confidence Intervals for Diagram 3e:  Billing Method, Services Ordered by All Other 
Doctors 
 
 
95-Percent Confidence 
  Service Characteristic  Point Estimate  Sample Size  Interval 
 
Global bill  86.0%  456  82.5%89.5%
 
     Reassigned  58.6%  456  53.6%63.6%
 
            Within group  50.0%  456  45.0%55.1%
 
          Outside group  8.6%  456  5.7%11.4%
 
       Biller  UPIN same as  Payee  UPIN  27.4%  456  22.9%31.9% 
 
 
  TC bill  14.0%  456  10.5%17.5%
       Reassigned  5.7%  456  3.3%8.0%
 
          Within group  4.3%  456  2.3%6.4%
 
            Outside group  1.3%  456  0.6%3.2%*
 
     Biller  UPIN same as  Payee  UPIN  8.4%  456  5.6%11.2% 
 
* Confidence interval calculated using the logit transformation because of poor coverage properties  of the standard approximation  method when a small  
number  of sample  elements possess the characteristic of  interest. 
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Table  4a:   Confidence  Intervals  for Diagram 4a:   Provider Relationships, All  Services 
 
 
95-Percent Confidence  
 
Service Characteristic  Point Estimate  Sample Size  Interval 
 
Referring physician connected to Performer  17.9%  590  14.6%21.3%
 
       Performer connected to  Biller  15.1%  590  12.0%18.2%
 
          Biller connected to Payee  15.1%  589  12.0%18.3%
 
            Biller not connected to Payee  0.0%  589  n/a
 
     Performer not connected to Biller  2.8%  590  1.4%4.3%
 
            Biller connected to Payee  1.2%  589  0.6%2.7%*
 
          Biller not connected to Payee  1.6%  589  0.8%3.2%* 
 
 
  Referring physician not connected to Performer  82.1%  590  78.7%85.4%
 
     Performer connected to  Biller  65.4%  590  61.3%69.6%
 
            Biller connected to Payee  65.0%  589  60.8%69.2%
 
          Biller not connected to Payee  0.6%  589  0.2%1.8%*
 
       Performer not connected to Biller  16.6%  590  13.3%19.9%
 
          Biller connected to Payee  8.5%  589  6.1%11.0%
 
          Biller not connected to Payee  7.9%  589  5.6%10.3% 
 
 * Confidence interval calculated using the logit transformation because of poor coverage properties of the standard approximation method when a small  
number of sample elements possess the characteristic of interest. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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 Table 4b:  Confidence  Intervals  for  Diagram 4b:  Provider  Relationships, Services Ordered by  High 
 Users 
 
95-Percent Confidence  
 
Service Characteristic  Point Estimate  Sample Size  Interval 
 
Referring physician connected to Performer  22.4%  196  16.6%28.3%
 
       Performer connected to  Biller  19.4%  196  13.8%24.9%
 
          Biller connected to Payee  19.5%  195  13.9%25.1%
 
            Biller not connected to Payee  0.0%  195  0.0%1.9%
 
     Performer not connected to Biller  3.1%  196  1.1%6.5%*
 
            Biller connected to Payee  1.0%  195  0.1%3.7%*
 
          Biller not connected to Payee  2.1%  195  0.6%5.2%* 
 
 
  Referring physician not connected to Performer  77.6%  196  71.7%83.4%
 
     Performer connected to  Biller  61.2%  196  54.4%68.1%
 
            Biller connected to Payee  60.0%  195  53.1%66.9%
 
          Biller not connected to Payee  1.5%  195  0.3%4.4%*
 
       Performer not connected to Biller  16.3%  196  11.1%21.5%
 
          Biller connected to Payee  9.2%  195  5.1%13.3%
 
          Biller not connected to Payee  6.7%  195  3.1%10.2% 
 
 * Confidence interval calculated with an exact method based on the binomial distribution because of poor coverage properties of the standard 
approximation method when a small number of sample elements possess the characteristic of interest. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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 Table 4c:  Confidence  Intervals for Diagram 4c:   Provider Relationships, Services Ordered by All  
 Other Users 
 
95-Percent Confidence  
 
Service Characteristic  Point Estimate  Sample Size  Interval 
 
Referring physician connected to Performer  15.1%  394  11.1%19.2%
 
       Performer connected to  Biller  12.4%  394  8.7%16.2%
 
          Biller connected to Payee  12.4%  394  8.7%16.2%
 
            Biller not connected to Payee  0.0%  394  n/a
 
     Performer not connected to Biller  2.7%  394  1.4%5.3%*
 
            Biller connected to Payee  1.3%  394  0.5%3.5%*
 
          Biller not connected to Payee  1.3%  394  0.5%3.5%* 
 
 
  Referring physician not connected to Performer  84.9%  394  80.8%88.9%
 
     Performer connected to  Biller  68.1%  394  62.8%73.3%
 
            Biller connected to Payee  68.1%  394  62.8%73.3%
 
          Biller not connected to Payee  0.01%  394  0.002%0.1%*
 
       Performer not connected to Biller  16.8%  394  12.6%21.0%
 
          Biller connected to Payee  8.1%  394  5.0%11.1%
 
          Biller not connected to Payee  8.7%  394  5.6%11.9% 
 
 * Confidence interval calculated using the logit transformation because of poor coverage properties of the standard approximation method when a small  
number of sample elements possess the characteristic of interest. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  OEI-01-06-00261   PROVIDER  RELATIONSHIPS AND  THE USE OF  MAGNETIC RESONANCE  UNDER THE  MPFS   52  A P P E N D I X ~ B  

 Table 4d:   Confidence Intervals for Diagram 4d:   Provider Relationships, Services Ordered by  
 Connected Doctors 
 
95-Percent Confidence  
 
Service Characteristic  Point Estimate  Sample Size  Interval 
 
Referring physician connected to Performer  72.0%  140  64.1%79.8%
 
       Performer connected to  Biller  60.6%  140  52.0%69.2%
 
          Biller connected to Payee  60.6%  140  52.0%69.2%
 
            Biller not connected to Payee  0.0%  140  n/a
 
     Performer not connected to Biller  11.4%  140  5.8%16.9%
 
            Biller connected to Payee  4.9%  140  1.1%8.7%
 
          Biller not connected to Payee  6.5%  140  2.1%10.8% 
 
 
  Referring physician not connected to Performer  28.0%  140  20.2%35.9%
 
     Performer connected to  Biller  15.2%  140  8.9%21.4%
 
            Biller connected to Payee  14.4%  140  8.3%20.5%
 
          Biller not connected to Payee  0.8%  140  0.1%5.4%*
 
       Performer not connected to Biller  12.9%  140  7.0%18.7%
 
          Biller connected to Payee  9.6%  140  4.4%14.7%
 
          Biller not connected to Payee  3.3%  140  1.3%8.4%* 
 
 * Confidence interval calculated using the logit transformation because of poor coverage properties of the standard approximation method when a small  
number of sample elements possess the characteristic of interest. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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 Table 4e: Confidence  Intervals for Diagram 4e:   Provider Relationships, Services Ordered by All  
 Other Doctors 
 
95-Percent Confidence  
 
Service Characteristic  Point Estimate  Sample Size  Interval 
 
Referring physician not connected to Performer
 
      Performer connected to  Biller  82.1%  450  78.3%86.0%
 
         Biller connected to Payee  81.8%  449  77.9%85.7%
 
           Biller not connected to Payee  0.5%  449  0.1%2.1%*
 
   Performer not connected to Biller  17.9%  450  14.0%21.8%
 
           Biller connected to Payee  8.2%  449  5.4%10.9%
 
         Biller not connected to Payee  9.5%  449  6.5%12.5% 
 
* Confidence interval calculated using the logit transformation because of poor coverage properties of the standard approximation method when a small  
 number of sample elements possess the characteristic of interest. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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  A P P E N D I X ~ C
Statistical Tables 
Table 1:   Confidence Intervals 
Point   Sample   95-Percent  
Findings  Estimate  Size  Confidence Interval 
Findings on Services  Overall 
Percentage of services performed by payee  85.3%  590  82.1%  - 88.4% 
Percentage of services performed by independent  diagnostic testing facility (IDTF), 
88.0%  542  85.0% - 91.0% 
multispecialty group, or diagnostic radiology 
Percentage of services not performed by payee  14.7%  590  11.6% - 17.9% 
Percentage of reassigned services with payment reassigned  within  group  85.7%  417  82.0% - 89.3% 
Percentage of reassigned services with  payment reassigned  outside group  14.3%  417  10.7%  - 18.0% 
Findings on Connected Services 
Percentage of services that were connected services  24.8%  598  21.1% - 28.5% 
Percentage of connected services ordered by high users of  magnetic  resonance (MR)  54.7%  141  47.2% - 62.3% 
Percentage of services that were not connected ordered by  high users  of MR  33.3%  457  30.7% - 35.9% 
Percentage of connected services ordered by orthopedic surgery  27.8%  141  20.0% - 35.6% 
Percentage of services that were not connected ordered by  orthopedic  surgery  14.6%  456  11.0% - 18.2% 
Table 4 
Percentage of connected services performed by multispecialty group  49.6%  125  40.3% - 58.9% 
Percentage of services that were not connected performed  by multispecialty  group  25.7%  417  21.0% - 30.3% 
Percentage of connected services performed by IDTF  13.4%  125  7.1% - 19.7% 
Percentage of services that were not connected performed  by IDTF  39.3%  417  34.1% - 44.5% 
Percentage of connected services performed by diagnostic radiology  7.2%  125  2.4% - 12.0% 
Percentage of services that were not connected performed  by diagnostic  radiology  28.8%  417  24.0% - 33.6% 
Percentage of connected services performed by all other specialties  29.8%  125  21.3% - 38.3% 
Percentage of services that were not connected performed  by all other specialties  6.2%  417  3.7% - 8.8% 
Table 5 
Percentage of connected services paid to multispecialty group  50.8%  140  42.0% - 59.6% 
Percentage of services that were not connected paid to multispecialty group  26.4%  454  21.9% - 30.8% 
Percentage of connected services paid to IDTF  11.2%  140  5.7% - 16.7% 
Percentage of services that were not connected paid to IDTF  37.8%  454  32.9% - 42.7% 
Percentage of connected services paid to diagnostic  radiology  7.3%  140  2.8% - 11.9% 
Percentage of services that were not connected paid to diagnostic radiology  31.0%  454  26.3% - 35.6% 
Percentage of connected services paid to all  other specialties  30.7%  140  22.5% - 38.8% 
Percentage of services that were not connected paid to all other specialties  4.9%  454  2.7% - 7.1% 
Chart 1 
Percentage of connected services billed as technical  component only  33.4%  141  25.2% - 41.7% 
Percentage of services that  were  not connected billed as technical component only  14.0%  457  10.5%  - 17.5% 
Percentage of connected services with payment reassigned  87.4%  141  81.6% - 93.2% 
Percentage of services that were not connected with payment reassigned  64.3%  456  59.4% - 69.1% 
Percentage of connected services billed through a provider other  than  a radiologist  63.2%  141  54.8% - 71.6% 
Percentage of services that  were  not connected billed through a provider  other than a 
37.8%  457  32.9% - 42.7% 
radiologist 
  OEI-01-06-00261   PROVIDER  RELATIONSHIPS AND  THE USE OF  MAGNETIC RESONANCE  UNDER THE  MPFS   55  A P P E N D I X ~ C  

Table 2: Chi-Square Tests for Connected Magnetic Resonance Services 
P value    
Findings  Point Estimate  chi-square 
Findings on Connected  Services 
Percentage of connected services ordered by  high  users of MR  54.7% 
Percentage  of  all other services ordered by high  users of MR  33.3%  < .0001 
Percentage of connected services ordered by  orthopedic  surgery  27.8% 
Percentage  of  all other services ordered by orthopedic  surgery  14.6%  .0008 
Table 4 
Percentage of connected services performed by multispecialty group  49.6% 
Percentage  of  all other services performed by multispecialty group  25.7%  <.0001 
Percentage of connected services performed by IDTF  13.4% 
Percentage  of  all other services performed  by IDTF  39.3%  <.0001 
Percentage of connected services performed by diagnostic radiology  7.2% 
Percentage  of  all other services performed by diagnostic radiology  28.8%  <.0001 
Percentage  of  connected services  performed by all other specialties  29.8% 
Percentage of all  other services  performed by  all other specialties  6.2%  <.0001 
Table 5 
Percentage of connected services paid  to multispecialty group  50.8% 
Percentage  of  all other services paid to multispecialty group  26.4%  <.0001 
Percentage of connected services paid  to IDTF  11.2% 
Percentage  of  all other services paid to IDTF  37.8%  <.0001 
Percentage of connected services paid  to diagnostic radiology  7.3% 
Percentage  of  all other services paid to diagnostic radiology  31.0%  <.0001 
Percentage of connected services paid  to all  other specialties  30.7% 
Percentage  of  all other services paid to all other specialties  4.9%  <.0001 
Chart 1 
Percentage of connected services billed as technical  component  only  33.4% 
Percentage  of  all other services billed as technical component  only  14.0%  <.0001 
Percentage of connected services with  payment  reassigned  87.4% 
Percentage  of  all other services with payment reassigned  64.3%  <.0001 
Percentage of connected services billed through provider other than radiologist  63.2% 
Percentage  of  all other services billed through  provider other than radiologist  37.8%  <.0001 
  OEI-01-06-00261   PROVIDER  RELATIONSHIPS AND  THE USE OF  MAGNETIC RESONANCE  UNDER THE  MPFS   56    A P P E N D I X ~ D
Agency Comments 
 
  OEI-01-06-00261   PROVIDER  RELATIONSHIPS AND  THE USE OF  MAGNETIC RESONANCE  UNDER THE  MPFS   57  A P P E N D I X ~ D  

  OEI-01-06-00261   PROVIDER  RELATIONSHIPS AND  THE USE OF  MAGNETIC RESONANCE  UNDER THE  MPFS   58   
A B PA A PN AECN CNEK KDRN NI OX2OWN  W~LD L E  AEPD DAG GGMEME EN NT TS S   
 
 
This report was prepared under the  direction of Joyce M. Greenleaf, 
Regional Inspector General for Evaluation and Inspections in the 
Boston regional office, and Russell W. Hereford, Deputy Regional 
Inspector General.    
Kenneth R.  Price served as the team leader for this study.  Other 
principal Office of Evaluation and Inspections staff from the  Boston 
regional office who contributed include Amanda L. Pyles, Rosemary C.  
Borck, and Rose C. Lichtenstein; central office staff include Kevin 
Farber and Doris Jackson.   
 
 
  OEI-01-06-00261   PROVIDER  RELATIONSHIPS AND  THE USE OF  MAGNETIC RESONANCE  UNDER THE  MPFS   59