Medicaid-Funded Therapeutic Sterilizations

In response to a request for information on Government-funded sterilizations, 193 (about 10.5 percent) of the 1,846 Medicaid sterilization claims received by Pennsylvania Blue Shield during the third calendar quarter of 1977 were selected for review. Of the 193 claims, 62 were for female sterilizations reportedly done for therapeutic reasons. A medical advisor selected 34 patients on whom hysterectomies were performed for a more detailed review based on records furnished by the hospitals where the procedures were carried out. The medical advisor questioned the medical necessity for the hysterectomies in 11 of the 34 cases. The Medical Director, Division of Utilization Review of the Pennsylvania Department of Public Welfare, which administers the State's Medicaid Program, also reviewed the medical records of these 11 patients and concurred with the medical advisor's opinion. The 11 hysterectomies were performed in 11 different hospitals. At the time the patients were admitted to the hospitals for hysterectomies, 4 of the 11 hospitals were performing reviews of Medicaid patients' records under delegations from Professional Standards Review Organizations.