In The Wall Street Journal, reporters Mark Schoofs and Maurice Tamman have pulled off an impressive feat, weaving a tale of freedom of information and databases so compelling that it’s already attracted hundreds of comments and attention from all over. At its heart, it’s the tale of why public Medicare payment data does not identify the doctors and individual providers who receive about an eighth of its annual disbursements. If the practitioners were identified, the authors argue, the public and press would be better equipped to expose and deter fraud.
The Medicare claims database, partially available for around $18,300 a year, is one of the most powerful health data resources in the world. It’s also hamstrung:
While the services and earnings of hospitals and other institutional providers can be publicly identified, such information is kept strictly confidential for doctors and other individual providers. The reason is that the American Medical Association, the doctors’ trade group, successfully sued the government more than three decades ago to keep secret how much money individual physicians receive from Medicare. The AMA has continued to defend this ruling, including in two cases in which federal appeals courts issued decisions last year.
This time around, The Wall Street Journal and the Center for Public Integrity took the AMA on. For health journalists, their description of what followed is really the crux of the story:
The Wall Street Journal, in conjunction with the nonprofit Center for Public Integrity, attempted for nearly a year to obtain the database. As part of the effort, the CPI filed a lawsuit against the Department of Health and Human Services, which houses the Medicare program. The Journal and CPI wanted the data at no cost; the government wanted $100,000 for eight years of data. In a settlement, The Journal and CPI obtained the requested data at a substantially reduced fee. They later obtained a decryption key to identify individual providers but signed a contract agreeing not to publish such identities in most cases.
The database, technically known as the Carrier Standard Analytic File, focuses on doctors and others paid on a fee-for-service basis. It contains 5% of all beneficiaries, and includes all doctor claims that Medicare paid directly in association with their care.
There’s far more to the story including information about the Consumers’ Checkbook lawsuit and the penultimate paragraphs on just how clear-cut fraud cases can be, once you know what to look for. An article on the Center for Public Integrity’s website promises more reporting, presumably based on the database, of “some of the questionable spending that occurs in the Medicare program.”