Medicare to Release Doctor Payment Data

Medicare to Release Doctor Payment Data | Pintas & Mullins Law Firm

The Centers for Medicare and Medicaid Services (CMS) recently announced that it would release data on how and why it pays its physicians starting in spring 2014. This is a bold move for many reasons, and could greatly influence the process and outcome of medical malpractice cases throughout the country. Our team of malpractice lawyers discusses how and why this decision is such a big deal.

Starting this spring, CMS will release data regarding Medicare physician services on a case-by-case basis, to be publically available. This decision overturns a decades-long federal policy which prohibited the public release of such information. That policy, enacted in 1979, privatized how much physicians made under Medicare, noting that the public interest in such matters did not warrant its release.

How the federal court came to this decision in 1979 was based on two previous court decisions that found privacy interests for physicians to outweigh the need for transparency. Today, as healthcare costs in this country reach absurd heights, the need for transparency trumps doctor privacy interests. The need for transparency in American healthcare is a complex and extremely important issue, though beyond the scope of this post.

Consumer Advocates Speak Up

In 2006, advocacy group Consumers Checkbook requested physician payment data for those treating Medicare patients and was swiftly denied. The group filed a federal lawsuit, initially winning their case, though that decision was overturned on appeal. Four years later, The Wall Street Journal published an in-depth article series on the fraud and waste in the health care system. WSJ’s parent company subsequently filed a motion requesting the 1979 policy be overturned.

Ultimately, WSJ won its legal battle, and in 2013 CMS agreed to release the data, which many assert was long-overdue. However, the data will not be release en-masse, and requests will be reviewed by CMS on a case-by-case basis, so we will have to wait to see how it will comply with public demand. In short, CMS holds all the cards right now, and it will get to decide which, when, and how much information is disclosed.

Currently, anyone can look up medication prescribing habits by physicians for Medicare patients. This is available on the ProPublica website, and was made public in efforts to protect the American elderly and disabled from unsafe prescriptions, such as antipsychotics and other dangerous, addictive, and disorienting drugs.

How this Will Impact Malpractice Suits

The database (which is technically known as the Carrier Standard Analytic File) includes information for about 5% of Medicare beneficiaries, and all care services their physicians’ bill to CMS. Although the information focuses on a small cohort of patients, the data itself is extremely powerful.

Say a patient (regardless of Medicare status) is seriously injured while under the care of a physician listed on the Medicare database. If that patient chooses to bring a malpractice lawsuit against that physician or affiliated hospital, plaintiff lawyers could request all information related to that physician from the CMS database. This could provide invaluable information on prescribing habits, physician quality, and countless other factors that influence patient care, which could in turn impact the outcome of that case. 

Ultimately, the push for transparency is meant to benefit the country as a whole, since it is our tax dollars that pay for Medicare services. It is estimated that between $70 and $120 billion is lost every year to fraudulent or excessive Medicare billing and this release of data is a major step in the right direction toward fixing this egregious, incredibly expensive problem.

Our team of medical malpractice attorneys anxiously awaits the first release of physician payment data, which is expected to occur in about 60 days. We will continue to report on this issue as more information comes to light. If you or a loved one was seriously injured or killed by a medical mistake, contact our firm immediately. We are currently investigating cases of medical negligence resulting in serious injury for patients nationwide.