Medicare’s $1.9 Billion Back Surgery Waste: Are You a Victim of Unnecessary Procedures?

Medicare’s $1.9 Billion Back Surgery Waste: Are You a Victim of Unnecessary Procedures?

Aches, pains, and limited mobility can significantly diminish your quality of life. If you’re a Medicare recipient experiencing back pain, you might have considered surgery as a solution. However, a recent analysis by the Lown Institute reveals a concerning trend: Medicare spent a staggering $1.9 billion on unnecessary back surgeries over a recent three-year period. This raises a critical question: Are you a victim of unnecessary procedures?

The $1.9 Billion Problem: Unnecessary Back Surgeries

The Lown Institute’s analysis of Medicare data uncovered that hospitals performed over 200,000 unnecessary back surgeries on older adults between 2021 and 2023, billing Medicare approximately $1.9 billion for these “low-value” services. That averages out to one unnecessary back surgery being performed every eight minutes. These procedures included spinal fusions, laminectomies, and vertebroplasties.

What makes a back surgery “unnecessary?” According to the Lown Institute, overuse in spinal fusion/laminectomy patients was determined when the patients had low-back pain without radicular symptoms, trauma, herniated disc, discitis, spondylosis, myelopathy, radiculopathy, radicular pain, or scoliosis. Overuse for vertebroplasty was defined in patients with spinal fractures caused by osteoporosis, excluding patients with bone cancer, myeloma, or hemangioma. In other words, the surgeries were performed on patients for whom there was little to no evidence of benefit.

Risks and Complications of Back Surgery

Undergoing an unnecessary back surgery not only wastes taxpayer money but also exposes patients to significant risks. Back surgeries carry the potential for serious complications, including:

  • Infection
  • Nerve damage
  • Blood clots
  • Pneumonia
  • Stroke
  • Heart and lung problems
  • Failed Back Surgery Syndrome (FBSS)
  • Paralysis
  • Death (in rare cases)

Up to 40% of patients experience “failed back surgery syndrome,” in which the vertebrae do not fuse back together. Moreover, some studies show that spinal fusion complications occur in up to 18% of patients.

Are You a Victim? Signs of Unnecessary Back Surgery

It can be challenging to determine if your back surgery was truly necessary. However, here are some red flags that might indicate you were a victim of an unnecessary procedure:

  1. Surgery was recommended without a clear diagnosis: If your doctor couldn’t pinpoint the exact cause of your back pain before recommending surgery, it’s a cause for concern.
  2. You had surgery for low back pain without neurological symptoms: Spinal fusions and laminectomies are generally not recommended for low back pain alone, without accompanying issues like sciatica, spinal stenosis, or nerve compression.
  3. You underwent vertebroplasty for osteoporotic spinal fractures: Current guidelines suggest vertebroplasty is often overused in these cases.
  4. Your pain persists or worsens after surgery: While some post-operative pain is expected, continued or worsening pain could indicate the surgery was not appropriate or that it failed.
  5. You experience new symptoms after surgery: New numbness, weakness, or radiating pain could signal nerve damage or other complications from the procedure.

What to Do If You Suspect Unnecessary Surgery

If you believe you may have undergone an unnecessary back surgery, here are steps you can take:

  1. Get a Second Opinion: Consult with another spine specialist to review your case and determine if the original surgery was justified. Medicare covers second opinions, and even a third if the first two differ, especially when surgery is recommended.
  2. Review Your Medical Records: Obtain copies of your medical records, including imaging studies and surgical reports, to understand the rationale behind the surgery.
  3. Seek Legal Advice: If you believe you were harmed by an unnecessary procedure, consult with a personal injury attorney experienced in medical malpractice cases. An attorney can help you investigate your claim and pursue compensation for your injuries.
  4. Report to Medicare: If you suspect fraud or abuse, report it to Medicare. This helps them identify and address problematic practices.

Alternatives to Back Surgery

Before considering surgery, explore all non-surgical treatment options for back pain. These may include:

  • Physical therapy
  • Chiropractic care
  • Pain medications
  • Injections (e.g., cortisone, nerve blocks)
  • Acupuncture
  • Lifestyle modifications (e.g., weight loss, exercise)

Medicare Coverage and Costs

Medicare Parts A and B typically cover medically necessary back surgeries. Part A covers inpatient hospital costs, while Part B covers doctor’s services and outpatient care. However, you’ll likely have out-of-pocket expenses, such as deductibles, coinsurance, and copayments.

  • Part A deductible: \$1,676 per benefit period in 2025
  • Part B deductible: \$257 per year in 2025
  • Part B coinsurance: Typically 20% of the Medicare-approved amount

Medigap policies can help cover these out-of-pocket costs.

The Importance of Informed Consent

Before agreeing to any surgery, it’s crucial to have a thorough discussion with your doctor about the risks, benefits, and alternatives. Make sure you understand:

  • The specific reasons for the surgery
  • The expected outcomes
  • Potential complications
  • Non-surgical options

Don’t hesitate to ask questions and seek clarification until you feel fully informed.

Taking Action

The $1.9 billion in Medicare waste on unnecessary back surgeries is a serious problem that puts patients at risk and drains valuable resources. If you or a loved one has undergone back surgery and suspect it may have been unnecessary, take action to protect your rights and ensure you receive appropriate care. Contact our firm today for a free consultation. We can help you evaluate your case and determine the best course of action.