Senators Want to Release Individual Physician Medicare Revenue

Today the Wall Street Journal reports on separate pieces of legislation introduced in the Senate by Charles Grassley (R-Iowa) and Ron Wyden (D-Oregon) that would require the Medicare physician claims data base be open to the media and public.

Since a 1979, a federal court ruling in favor the American Medical Association  prohibits Medicare from publicly disclosing the amount that an individual doctor bills Medicare for services and procedures.  The legislation would overturn that court ruling in an effort its proponents claim will “help us get at the (Medicare) fraud” and advance transparency in federal health care spending.

The move comes after a series of WSJ reports documenting rampant fraud by certain physicians and allied health professionals.   The paper has editorialized in favor of making the Medicare physician claims data base open to public scrutiny so that physicians who game the system or commit fraud can be exposed.

In commenting on the legislation, officials from the Centers for Medicare and Medicaid seem to understand the adverse consequences that might arise by releasing individual physician Medicare claim records and they declined to offer their support to the proposal. Unfortunately, any specific concerns they have with the proposal weren’t noted in the article.

The AMA is talking a stand against the measures. Noting the organization’s long history of support for strong Medicare fraud prevention efforts, they said that current law enforcement and administrative mechanisms to combat fraud should be used to identify the truly bad actors because program data demonstrates that physicians are not a significant source of Medicare fraud. Just as importantly, they state that it is well-settled by courts that physicians have a certain right to privacy in their business and personal financial affairs, just like other Americans do.

My own view is that this is a bad idea.  Medicare fraud is a problem but this proposal will do little to address it.  I suspect  that CMS officials are playing this one close to the vest because they know that the information they would be forced to release might not always be accurate and would unfairly expose some physicians to baseless charges they were submitting fraudulent claims. And at a time when Medicare reimbursements for many services are being squeezed, there must surely be concern that this measure would just be one more reason for physicians to limit or perhaps not provide care for Medicare beneficiaries.

Medicare reimbursement for physicians services, like almost every other facet of federal health care regulation, is complicated and difficult to understand.   Putting claims information out there in the manner contemplated by these legislative proposals would likely not have any real effect on the amount of Medicare fraud but would have a host of adverse consequences for physicians.  Before this gets too far along, physicians and other affected parties need to speak up against it and in favor of more common sense measures that will target the real abusers of the Medicare reimbursement system.


About Bill Cadigan

WILLIAM J. CADIGAN is principal in the Law Office of William J. Cadigan, P.C. located in Chicago, Illinois. Before starting his own firm, Bill Cadigan was a member of the Health Industry Group of the law firm of Akin, Gump, Strauss, Hauer & Feld L.L.P.
This entry was posted in Fraud & Abuse, Medicare Reimbursement and tagged , . Bookmark the permalink.

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