Medicare to Publish Physician Payment Data Annually: Will This Prevent Medicare Fraud?

Tuesday, June 30, 2015
By Ritisha K. Chhaganlal, J.D.
 
 


Billions of dollars are spent annually on Medicare payments to individuals and organizations. For over three decades, the American Medical Association (AMA), a prominent physician group in the United States, had successfully argued that a doctor’s right to privacy outweighed the public’s interest in knowing how its tax dollars were used. However, primarily due to increased Medicare fraud, the U.S. government will begin to publish Medicare Part B payments to physicians and medical groups every year.


The First Release of Physician Payment Data.

The first release of this data occurred in April 2014, which gathered physician billing data from 2012. It included 9.2 million lines of payments worth $77 billion to 880,000 physicians and other medical providers under Medicare Part B. While the Centers for Medicare and Medicaid Services (CMS) have not disclosed when it expects to release the next set of data, a spokeswoman from CMS stated that the government has decided “to update the data annually.”

This decision has sparked major controversy and criticism from doctors’ groups around the nation. However, many believe this is a step in the right direction to help control the ever-increasing costs of health care in the United States.


How This Data Can Affect You.


According to Modern Healthcare, physician groups like the AMA claim that the data distributed by CMS is flawed and lacks context. “We believe that the broad data dump by CMS has significant short-comings regarding the accuracy and value of the medical services rendered by physicians,” said AMA President Dr. Ardis Lee Hoven. “Releasing the data without context will likely lead to inaccuracies, misinterpretations, false conclusions and other unintended consequences.” This argument is based on the fact that the data does not account for physicians or medical providers who serve populations that are disproportionately sicker or require more expensive care. Total payments may also appear higher for some providers simply because the payments are based on several individuals from one office billing under a single provider number. As a result, certain physicians and medical providers may be displayed as excessive spenders, even if that is not the case. This can be problematic, as it can appear to cast a bad light on certain providers. Government officials stated that the first data set was accessed or downloaded via the Internet more than 300,000 times within weeks after the release in April 2014.


The Bottom Line.

The AMA has insisted that the Department of Health and Human Services refrain from releasing any more physician payment data until improvements have been made to the data set. To read a past blog about physicians’ reactions to the release of this data, click here.

CMS has admitted that the published data is not perfect; however, it insists that releasing it is a necessary step to create a more transparent health care system in the United States. According to the Wall Street Journal, Dr. John Libertino, CEO Emeritus of the Lahey Clinic and chairman of the Institute of Urology, stated: “The majority of physicians-- I would say 90% or 95%-- are good people and don’t take advantage of the public trust. But I do think there are some people who need to be weeded out.”



Comments?

 
What are your thoughts on this data going public? Do you believe the data is misleading? Please leave any thoughtful comments below.
 
Contact a Health Care Attorney Experienced with Medicare and Medicaid Cases.
 
 
 
Attorneys with The Health Law Firm represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program. We also handle Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S.

Our attorneys also represent health care professionals and health facilities in qui tam or whistleblower cases both in defending such claims and in bringing such claims. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistleblower cases, as well.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.


Sources:

Carlson, Joe. “CMS Reveals Medicare Physician Pay Data.” Modern Healthcare. (April 9, 2014). From:
 
http://www.modernhealthcare.com/article/20140409/NEWS/304099954

Masi, Domitilla and Patel, Kavita. “Medicare Physician Data to be Released Annually: What Does it Mean for Researchers and Consumers?” Brookings. (February 3, 2015). From:

http://www.brookings.edu/blogs/health360/posts/2015/02/03-annual-medicare-physician-payment-data-cms-patel

Stewart, Christopher S. “Medicare to Publish Physician-Payment Data Yearly.” Wall Street Journal. (February 1, 2015). From:

http://www.wsj.com/articles/medicare-to-publish-physician-payment-data-yearly-1422842176



 
 
About the Author: Ritisha K. Chhaganlal, J.D., is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone (407) 331-6620.
 
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6/30/2015

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