Physicians React to the Release of Medicare Reimbursements

Monday, April 21, 2014
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

For years, the Centers for Medicare and Medicaid Services (CMS) kept private its records on Medicare reimbursement payments made to physicians, however, on April 9, 2014, that all changed.  The government released records revealing unprecedented details about Medicare payments made to physicians, nurse practitioners (NPs), physician assistants (PAs) and other health care providers.  

Many physicians resent being included on the list that shows some doctors billing Medicare for millions of dollars. Others believe transparency is good, but not without context to properly decipher the data.

To read why this data was not released in the past, click here to read my previous blog.


Why CMS Released Data.

This directive is a push by the Obama Administration to crack down on doctors who are making a habit out of repeatedly overcharging Medicare.  CMS stated that recalcitrant providers could face civil fines and exclusion from Medicare and other federal health care programs.   According to CMS, a recalcitrant provider is defined as one who is abusing the program and not changing inappropriate behavior even after extensive education to address these behaviors.

According to The Washington Post, federal investigators are scrutinizing the Medicare payments made to three of the top 10 earners. One is a cancer doctor in the Detroit area.  The doctor is accused of intentionally misdiagnosing illnesses and ordering unnecessary treatments.  He was arrested in August 2013, and faces federal fraud charges.

Click here to read the entire article from The Washington Post
.


Florida Doctors on the List.

Two of the nation's highest paid recipients of Medicare payments in the country are in Florida.  One West Palm Beach eye doctor received $20 million and one heart doctor in Ocala received $18 million in 2012.  According to the Orlando Sentinel, 44 Central Florida doctors were each paid at least $1 million from Medicare in 2012.  Florida recipients of the highest payments were ophthalmologists and oncologists, which is consistent with the rest of the country.

To read the article from the Orlando Sentinel, click here.


Misconceptions About the Data.


There's been a considerable amount of backlash from health care providers about the release of their Medicare payment data. According to MedPage Today, most physicians say it's none of the public's business what health care professionals are receiving for their services. Others are worried about patients confusing Medicare payments with net earnings, or the perception that a high total reported in the CMS database may reflect fraud on the doctor's behalf. Click here to read the MedPage Today article.

Releasing this data could help determine whether some procedures or treatments are overused or not cost-effective. It can also help federal investigators pinpoint physicians and health providers abusing the Medicare program. However, without the proper context, there are also a lot of misconceptions about physicians Medicare reimbursements.


Contact Health Law Attorneys 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.


Comments?

How do you feel about the government releasing details about Medicare payments to physicians and other health care providers? Do you think that data is misleading? Please leave any thoughtful comments below.


Sources:

Gever, John. "'None of Your Business': Docs React to Medicare Data Released." MedPage Today. (April 9, 2014). From: http://bit.ly/1kDOZiC

Jameson, Marni. "44 Central Florida Doctors Got at Least $1 Million in Medicare Money." Orlando Sentinel. (April 11, 2014). From: http://bit.ly/1hZ3PuC

Millman, Jason and Fallis, David S. "Doctors React to Release of Medicare Billing Records. The Washington Post. (April 9, 2014). From: http://wapo.st/RrBV5C


About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of 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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The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
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4/21/2014

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