Medicare billings should be public and available online … free

Guest Editorial
We applaud legislation introduced recently to shine a light on Medicare billings by doctors and other health care providers.

How much doctors receive from Medicare for services they provide to seniors should be public information — and it should be readily available online.

Sen. Chuck Grassley (R.-Iowa) and Sen Ron Wyden (D-Oregon) introduced the legislation to open the now-private data. Their bill calls for the creation of a Medicare payment database the public could search at no cost.

If that information, kept confidential by court order since 1979, was made public, it would help prevent fraud.

“Medicare is a $500 billion program with billions of dollars going out in error each year,” Grassley said in a statement. “The bad actors are getting bigger and bolder all the time. They’re able to stay out of law enforcement’s reach too often. It’s time to try new things: More transparency about billing and payments increases public understanding of where tax dollars go.

“The bad actors might be dissuaded if they knew their actions were subject to the light of day.”

Patients’ identities would not be released, the senators said.

The American Medical Association opposes the proposed legislation, claiming a public database would violate physicians’ right to privacy. In Medscape Today, the AMA asserts that the data already is available to the agencies that investigate fraud, such as the Department of Justice and the Investigator General of the Department of Health and Human Services.

The AMA also claims the database would put doctors at risk of identity theft because it would contain their national provider identifying number along with the billing data.

It’s interesting to note that The Wall Street Journal obtained limited access to Medicare records last year and published a series of articles about suspicious billing patterns and potential abuses of the system by doctors and other health care providers.

Then, in January, the newspaper’s parent company, Dow Jones, filed a legal challenge to an injunction issued in 1979. In that case, the former Department of Health, Education and Welfare sought to make Medicare billing information public. The AMA and the Florida Medical Society objected, and a federal district court issued the injunction that blocked publication of the list.

The senators proposing the reform said a high volume of Medicare billings by a health care provider alone does not indicate fraud or waste, but they believe, as we do, that transparency and accountability could prevent problems. They estimate that 5 to 8 percent of federal health care expenditures are lost to fraud. That small percentage represents a large number of taxpayer dollars.

“Hiding information on how taxpayer dollars are being spent is not something we do in this country,” Wyden said. “If taxpayer dollars are being spent responsibly, there is no reason to hide.” We agree.