Senators Grassley, Wyden push to make Medicare billing data public

Introduction

Republican Sen. Charles Grassley of Iowa introduced a bill today that would make available to the public data on Medicare billing by doctors and other health care providers, a portion of which is currently kept hidden by a decades-old U.S. District Court order in Florida.

Grassley spokeswoman Jill Gerber said the bill is a “direct outgrowth of reporting” by the Center for Public Integrity and The Wall Street Journal, which have been using limited portions of the Medicare data to expose waste, fraud, and abuse in the program.

Speaking today at a Senate Finance Committee hearing on health care fraud prevention, Grassley said Medicare payments to doctors and other providers should be just as available as standard federal contracts, which are posted on the government website USA.gov.

“A taxpayer dollar spent on Medicare isn’t any different than the public’s right to know about a taxpayer dollar spent on defense programs,” Grassley said.

Later in the hearing, Democrat Ron Wyden of Oregon said he is also preparing to introduce legislation to open the confidential Medicare billing database to cut down on fraud.

“Sunlight has always been the best disinfectant,” Wyden said. “That’s why the Center for Public Integrity wants it. That’s why The Wall Street Journal wants it.”

Up to now, however, both news organizations have been unable to gain full access to the claims data, and unable, due to the court order, to use some of the information contained in the data they have acquired.

In 1978, The American Medical Association successfully sued the federal government to bar the predecessor of the U.S. Department of Health and Human Services and others from releasing the amount of money Medicare pays individual doctors.

In 2009, the Center for Public Integrity sued the Centers for Medicare and Medicaid Services for access to Medicare billing data. Partnering with The Wall Street Journal, the Center for Public Integrity subsequently acquired eight years of the billing data.

Both media outlets, however, agreed in the course of negotiations with CMS to refrain from indentifying physicians and other providers based on their Medicare billing; CMS insisted on the agreement before releasing the data, since releasing the data could have put the federal agency in violation of the court order. The agency, and the news organizations, could face legal ramifications if they break that agreement.

In January, Dow Jones & Co., the publisher of The Wall Street Journal, filed suit to overturn the court order in the U.S. District Court for the Middle District of Florida, arguing that the order hinders the newspaper’s ability to indentify doctors who may be bilking the program by overbilling, providing unnecessary medical procedures, or fraudulently billing for procedures they did not provide.

“A transparent Medicare database is extremely important so the public, represented by the press, can provide a check on misuse of Medicare funds,” said William E. Buzenberg, executive director of the Center for Public Integrity.

During today’s hearing, both Wyden and Grassley asked Health and Human Services Inspector General Daniel Levinson and Peter Budetti, director of program integrity at the Centers for Medicare and Medicaid Services, if they would support a bill to open Medicare billing data to the public. Neither directly answered the question. “We need to be very careful and look at all of the ramifications,” Budetti said.

American Medical Association spokesman Robert Mills declined to comment on the legislation, but forwarded a comment from association president Cecil B. Wilson regarding the 1979 Florida injunction.

“The American Medical Association has zero tolerance for Medicare fraud, and studies have demonstrated that physicians are not a significant source of Medicare fraud,” Wilson wrote. “Medicare claims are subject to scrutiny by the Department of Justice, the Office of the Inspector General and others responsible for aggressively ferreting out improper claims. Physicians, like all Americans, have the right to privacy regarding their personal financial information, and courts have repeatedly upheld this right.”

Wyden said the proposed legislation would be an “information age” solution to rooting out Medicare fraud. “I think we are on the right side of history,” Wyden said. “I think the Center for Public Integrity and The Wall Street Journal are.”