Medicare claims data on doctors to be opened a bit following fraud investigation


An open records effort by a newspaper publisher that assisted Medicare fraud crackdowns in Dallas, Houston and other major American cities has helped open the federal Medicare database to at least a segment of the public.

The Department of Health and Human Services has decided it will allow community groups, currently about 25 nationwide, made up of doctors and public and private health professionals access to its Medicare claims database, the Wall Street Journal is reporting today.

"This is a giant step forward in making our health care system more transparent," Marilyn Tavenner, acting administrator for Medicare, said. It will "ensure consumers have the access they deserve to information that will help them receive the highest quality care at the best value for their dollar.”

The database, which keeps track of the bills paid for 48 million people in the $524 billion a year Medicare program, is thought to be the single best source of information about American health care.

Medicare records have been largely confidential since 1979 when a federal judge issued an injunction in response to a lawsuit over physician privacy filed by the American Medical Association.

Dow Jones & Co., owner of the Wall Street Journal, filed a lawsuit to overturn the injunction as the paper was in the midst of an investigation into widespread Medicaid fraud. Health and Human Services relented a bit, giving the paper a small percentage of data with restrictions on publishing certain kinds of information about individual doctors.

Months of stories sparked the largest Medicare fraud sweep in U.S. history, cracking a Dallas ring that had rolled up $1 million in fraudulent billing while bribing and paying kickbacks to patients. A Houston chiropractor was also arrested for a physical therapy billing fraud.

A Texas doctor featured in one of the series has been suspended by the Texas Medical Board, the story said.

An attorney for Dow Jones said the company was reviewing the Health and Human Services decision on the database to see if it changes its position on its lawsuit.
Contact Mark Lisheron at 512-299-2318 or or on Twitter at @marktxwatchdog.

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Photo of pills by flickr user j_anet, used via a Creative Commons license.