Although hospitals and other healthcare institutions make their services and earnings publicly available through a Medicare database, similar data on physician and individual healthcare providers are kept confidential, according to a Wall Street Journal news report.
Federal investigators already use the database, the Carrier Standard Analytic File, to find fraud. Others, including academic researchers and consultants, also utilize the database to assess trends and costs in healthcare. However, the American Medical Association sued the government more than 30 years ago to keep it from disclosing physicians' identities and claims information, resulting in legislation that bars database users from identifying individual physicians and other healthcare providers and potential incidences of fraud, according to the report.
Wall Street Journal and the non-profit organization Center for Public Integrity was able to access the database after paying a fee and agreeing not to publish identities in any reports. After analyzing the database, the researchers found an unnamed New York physician administered specialized tests and profited more than $2 million in 2008 from Medicare. They also found, after running background checks on 25 other physicians, that six of the 25 physicians who administered the same specialized tests as the New York physician are linked to alleged fraud or have faced other "professional" trouble, according to the report.
The AMA continues to stand by its position that publishing individual physician claims information would accomplish little in detecting fraud and that physicians have the right to privacy, just like all other Americans, said Jeremy Lazarus, MD, an AMA member.
Read the Wall Street Journal's news report about the Carrier Standard Analytic File.
Read other coverage about Medicare fraud:
- Florida Physician and Nurse's Sentences for Medicare Fraud Upheld by Federal Appeals Court
- CHRISTUS Health in Houston to Pay $1M Settlement in Medicare Fraud Lawsuit
- CMS to Distribute $9M in Grants to Strengthen Senior Medicare Patrol Programs
Federal investigators already use the database, the Carrier Standard Analytic File, to find fraud. Others, including academic researchers and consultants, also utilize the database to assess trends and costs in healthcare. However, the American Medical Association sued the government more than 30 years ago to keep it from disclosing physicians' identities and claims information, resulting in legislation that bars database users from identifying individual physicians and other healthcare providers and potential incidences of fraud, according to the report.
Wall Street Journal and the non-profit organization Center for Public Integrity was able to access the database after paying a fee and agreeing not to publish identities in any reports. After analyzing the database, the researchers found an unnamed New York physician administered specialized tests and profited more than $2 million in 2008 from Medicare. They also found, after running background checks on 25 other physicians, that six of the 25 physicians who administered the same specialized tests as the New York physician are linked to alleged fraud or have faced other "professional" trouble, according to the report.
The AMA continues to stand by its position that publishing individual physician claims information would accomplish little in detecting fraud and that physicians have the right to privacy, just like all other Americans, said Jeremy Lazarus, MD, an AMA member.
Read the Wall Street Journal's news report about the Carrier Standard Analytic File.
Read other coverage about Medicare fraud:
- Florida Physician and Nurse's Sentences for Medicare Fraud Upheld by Federal Appeals Court
- CHRISTUS Health in Houston to Pay $1M Settlement in Medicare Fraud Lawsuit
- CMS to Distribute $9M in Grants to Strengthen Senior Medicare Patrol Programs