April 10, 2014

HHS Data Reveals Doctors Billed Medicare For Millions

Brett Smith for - Your Universe Online

In an historic move, the Department of Health and Human Services (HHS) has released new, privacy-protected data on Medicare payments to physicians and other health care professionals for services rendered to beneficiaries.

The treasure trove of data includes bills for services and procedures by providers. It also reveals that many doctors around the country have been paid $1 million or more from the social insurance program for older Americans.

“Currently, consumers have limited information about how physicians and other health care professionals practice medicine,” said HHS Secretary Kathleen Sebelius. “This data will help fill that gap by offering insight into the Medicare portion of a physician’s practice. The data released today afford researchers, policymakers and the public a new window into health care spending and physician practice patterns.”

While some of the higher billing totals may reflect a doctor who specializes in costly procedures or an extremely efficient physician – 3 of the top 10 earners on the list previously drew scrutiny from federal investigators for fraudulent charges and one physician is currently anticipating federal trial. High billing totals may also be evidence that certain procedures are too incentivized or are more costly than they should be.

The new information set offers data for over 880,000 unique health care providers who comprehensively acquired $77 billion in Medicare payments in 2012, within the Medicare Part B Fee-For-Service program. With this information, HHS said it could execute a number of analyses that compare 6,000 distinct kinds of services and procedures delivered, and payments obtained by individual providers.

The federal agency said the data would allow side-by-side comparisons by physician, service niche, area, type of procedures provided, Medicare payment, and charge. Medical professionals determine what they may charge for services and operations provided to people and these “charges” are the quantity the physician or health care professional typically bills for the procedure.

"Data transparency is a key aspect of transformation of the health care delivery system,” said CMS Administrator Marilyn Tavenner. “While there’s more work ahead, this data release will help beneficiaries and consumers better understand how care is delivered through the Medicare program.”

The American Medical Association has intensely lobbied against the release of this data and the doctors’ organization put out a statement criticizing the move.

“The AMA is concerned that (HHS’) broad approach to releasing physician payment data will mislead the public into making inappropriate and potentially harmful treatment decisions and will result in unwarranted bias against physicians that can destroy careers,” Ardis Dee Hoven, president of the AMA, told the Washington Post. “We have witnessed these inaccuracies in the past.”

Gerald Ho, a Los Angeles rheumatologist, told the Post that he has been “dreading” the release of this previously-private billing data. Ho said of the almost $5.4 million he received from Medicare, about $5 million included the cost of specialized drugs to treat rheumatoid arthritis in patients.

“People are going to see these numbers and people aren’t going to understand,” he said. “I am not pocketing $5.3 million. To tell you the truth, I know there’s been lot of Medicare fraud, and I understand the government wants to provide a measure of transparency. But when they throw out numbers like this without any context, it’s going to be misconstrued by the public.”