Federal Government Released Health Care Payment Info to Get Public’s Help with Medicare Fraud
On Wednesday, April 9th, the federal government finally released information about payments from Medicare and Medicaid to doctors, and the numbers were astounding in many cases. Local reports across the country picked up on potential Medicaid and Medicare fraud in various states after parsing the numbers.
On Thursday, April 10th, representatives from various federal agencies said they decided to release the health care payment data specifically so the public, and journalists, could look through the information and help the federal government identify Medicaid and Medicare fraud.
“We know that there’s waste in the system, we know that there’s fraud in the system,” said Jonathan Blum, principal deputy administrator for the Centers for Medicare and Medicaid Services. “We want the public’s help — we want reporters’ help — with data that appear to be fraudulent.”
“For too long, this data was not public. The Medicare program is funded, by and large, with taxpayer dollars,” Blum said. There were also concerns about patient privacy, he added, which prevented the American Medical Association from releasing the data for 35 years.
“There’s some spending that just appears to be wasteful,” said Niall Brennan, acting director of CMS’ Offices of Enterprise Management. “Our goal is to sharpen the conversation. People should not jump to conclusions just by seeing spikes in spending.”
“Currently, consumers have limited information about how physicians and other health care professionals practice medicine,” said Kathleen Sebelius, secretary of Health and Human Services. “This data will help fill that gap by offering insight into the Medicare portion of a physician’s practice.”
The Medicare information details exactly how much the federal program paid individual doctors in 2012. An analysis by The Associated Press found that a tiny group, 344 out of more than 825,000 doctors, received $3 million or more apiece, and showed that about 2% of clinicians accounted for 25% of the payments. The numbers led to serious speculation about potential Medicare fraud.
The AP findings also showed that 87 of the 344 highest-paid doctors were in Florida, a state notorious for Medicare fraud.
The AMA, however, stated that high Medicare payments do not inherently indicate Medicare fraud. For example, opthamologists and cancer doctors were in the top tiers for Medicare reimbursement, but it was not an indication of Medicaid or Medicare fraud, but instead a reflection on how expensive treatments are in those specialties.
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