Medicare Bill Would Expose Docs' Billing
A Medicare fraud bill Sen. Charles Grassley (R-Iowa) presented to the Senate Finance committee hearing on Medicare and Medicaid in early April would have the U.S. Department of Health and Human Services (HHS) publish Medicare claims and payment data on USAspending.gov. Under the plan, all physicians receiving Medicare would have their reimbursement easily accessible, allowing citizens to identify physicians who may be abusing the system.
“More transparency about billing and payments increases public understanding of where tax dollars go,” Grassley said. “The bad actors might be dissuaded if they knew their actions were subject to the light of day.”
The American Medical Association (AMA) opposes this move, arguing targeted efforts by the HHS Office of Inspector General (OIG) and others are more effective. The physician organization has successfully deflected similar efforts in the courts since 1979. AMA is especially concerned that someone checking the information could discern a physician’s income, which it feels would deprive physicians of privacy.
“I think it’s time to revisit this decision and make some transparency of payment physicians receive from Medicare,” said Grassley, a long-time farmer. “Pretty much like you will see Chuck Grassley’s name in the newspaper sometimes that I’ve gotten a farm subsidy through the U.S. Dept. of Agriculture.”
Grassley said the government is not the only entity trying to smoke out Medicare fraud. During the Finance hearing, he cited a recent series of Wall Street Journal articles that examined Medicare claims from 1999, 2001, and 2003-08. Under a special arrangement, the Journal, working with the Center for Public Integrity in Washington, D.C., paid the Centers for Medicare & Medicaid Services (CMS) $12,000 for a 5 percent sample of the Medicare carrier payment file for those years. The newspaper reported that it was able to identify tens of thousands of physicians and other health professionals who could be considered outliers based on the relatively large amounts they billed Medicare in those years.
The Journal, however, could not name the physicians based on its data usage agreement with CMS. That policy stems from the federal court decision that protects the privacy of physician data.
American Medical News has more on this story.