Looking at Medicare Costs and Keeping an Eye on Doctors

By:  Warren Mass
Looking at Medicare Costs and Keeping an Eye on Doctors

A report released April 9 by the Office of Inspector General for the Department of Health and Human Services urged greater scrutiny of doctors who are the highest billers for Medicare payments.

The office, which serves as a federal watchdog on fraud and abuse for the department, finished compiling the report of Medicare data for the year 2012 last December. Several news organizations that scrutinized the data found that a small number of physicians listed received a disproportionately large share of Medicare payouts.

An analysis of the data by AP found that 344 physicians, out of more than 825,000 individual physicians listed in the Medicare claims database, were paid at least $3 million apiece, with combined billings of nearly $1.5 billion.

Another analysis of the report by the Wall Street Journal found that the top one percent of the 825,000 individual medical providers accounted for 14 percent of the $77 billion total billing recorded in the data. The Journal also found that the 1,000 highest-paid Medicare doctors received a combined total of $3.05 billion in payments.

Yet another look at the government data by Bloomberg News revealed that Medicare paid almost 4,000 doctors and medical providers more than one million dollars apiece, with seven receiving more than $10 million. Fewer than three percent of the doctors received about 28 percent of the $64 billion paid out to individual providers.

Prior to the recent release of the HHS report, information from the Medicare database had been withheld from the public since 1979, when a federal court in Florida granted the American Medical Association an injunction blocking release of the information based on the AMA’s claims that physicians’ privacy would be violated if the data were made public. Last May, a federal judge lifted the injunction after Dow Jones & Co. had filed a lawsuit asking for the data to be made public. Last week, the Obama administration decided to make all Medicare payment information public.

Bloomberg reported opposing views on the release of data on the physicians. Joe Antos, identified as a scholar at the American Enterprise Institute, said that the release of the information “will benefit not just consumers and the taxpayers but ultimately the healthcare sector because it will shine some light in some dark corners where, frankly, health-care providers should improve the way they practice.”

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