When Congress talks about “fraud and abuse” in health care, they inappropriately lump together two quite different categories. One are criminals who bill for services never provided, including Medicare scam billing operations run out of warehouses. The other category are real providers, especially major hospitals, who run afoul of exceedingly complex billing rules. Mistakes, perhaps, but not worthy of the label “fraud.”
The government tries to catch both types, but could use some help against the first category. If the amounts billed by each Medicare physician were publicly available, we’d crowd source some of the fraud detection function. But physician names aren’t released to the public, due in large part to court challenges by the AMA.
But the WSJ is fighting to get this data, and early results of their datamining has been very positive. After their outstanding reporting work a year ago, the WSJ now reports on another indictment by federal prosecutors of a provider highlighted in that article.
Transparency is a powerful anti-fraud rule; the AMA should stop opposing the release of this data.
I also find it ironic that the Supreme Court thinks doctors have no privacy interest for their prescription records, but the names of physicians who bill Medicare somehow requires secrecy.