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.

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5 Responses to “Medicare Bill Would Expose Docs’ Billing”

  1. Jill Gibson, CPC says:

    I think this is a good idea, as long as CMS is going to put the physician’s charges on the website and then what they paid the physician. So the patients can see how much the physician is getting paid compared to what their charge actually is for that particular service.

  2. Katrina B says:

    FINALLY! Pick up the giant rock that these abusers, and there are many, have been hiding under, and watch them all scramble like the cockroaches that they are!! I work in coding/billing, and in my hospital alone, have seen so many abuses of the system. Get these doctors in line; have them stop ordering unnecessary tests, consulting with all their buddies, and padding their documentation, for starters.. It galls me that “the AMA is especially concerned that someone checking the information could discern a physician’s income, which it feels would deprive physicians of privacy.” And yet these physicians have no problem depriving innocent, unsuspecting patients of their privacy, their money, (or Medicare’s money) or their dignity. BAH!

  3. Lin Richard says:

    I agree with Jill. Yes! Let’s publicize that Medicare and Medicaid often do not even cover the cost of the service.

  4. Trish Sutton CPC CPMA says:

    I agree with Lin. The other problem is that patients will complain that the Doctors are making to much money and we all know that Medicare patients take more time then what the reimbursement is but they don’t and won’t see that.

  5. Joy Long says:

    This is a minefield issue. I believe that it would be great for the public to see what providers get paid versus what their charges are. However, I am also concerned with the information being presented in such a way that the privacy of provider income is jeopardized. I truly believe in accountability but this has the potential to harm the many smaller providers that are truly trying to “do it right” rather than truly hitting the target – those few providers that are intentionally abusing and/or defrauding the system. And as usual with these things…the accuracy of the information is problematic as is the time spent by government employees to collate and report this information…even automated it takes people. Again…not against the what the idea is trying to accomplish but as a former regulator I am just too familiar with good ideas gone way wrong or growing way out of hand …

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