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Suit Filed to Open Medicare Physician Payment Database to Public

by Edward J. Kroger, MD, JD on February 18th, 2011

A Florida lawsuit filed on January 25th by Dow Jones & Co., the publishers of the Wall Street Journal, is the latest in a series of cases attempting to open the Medicare payment databases to consumers, journalists and prosecutors. In 1979, the AMA sued the federal government and obtained an injunction which keeps private the sums of money paid to individual physicians by Medicare. Attempts to reverse the injunction in 2009 failed largely on procedural grounds. The AMA has argued that the data would violate the privacy of physicians and patients. They raised a concern that Medicare payments are so complex that analysts and consumers would draw incorrect conclusions from the data.  They further argued that sufficient review of Medicare payments already prevents significant abuse.

Now, with increasing anxiety over soaring government deficits and Medicare expenses, there may be further pressure to make the Medicare payment database public.  Articles published by the Wall Street Journal (based on very limited access to a 5% sample of the database) and other news organizations seemingly highlight widespread and egregious Medicare fraud on a daily basis. This fraud and systemic abuse hurts legitimate health care providers, health care consumers and taxpayers. Advocates for disclosure point out that patient privacy concerns can be dealt with adequately in disclosing the data. The Dow Jones petition, which is interesting and well written, outlines the history of attempts to obtain the information, offers compelling public policy arguments for disclosure, and describes specific statistical examples of potential fraud.

For example, the Wall Street Journal has found that the highest national Medicare payout for physical therapy in 2008 went to an 80-year old psychiatrist – and this comprised 85% of his Medicare income.  The second highest earning Medicare doctor in 2008 was an ophthalmologist who earned 6 times the amount of the next highest earning Medicare ophthalmologist and 35 standard deviations above the average Medicare ophthalmologist.  They describe a rehabilitation specialist who has diagnosed 99% of his patients with “abnormality of gait”. And the highest paid Medicare emergency medicine specialist earns a large sum of money for home health supervision and has a website describing procedures he performs such as penile enlargement and the “Brazilian Butt Lift”.

We will provide updates on the status of the Dow Jones & Co. suit as it works its way through the courts.

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From → Health Law