Medicare Payments Are Public?!?

For the first time in transparency history, Medicare’s payments to healthcare practitioners is now publicly available:  Medicare Provider Utilization and Payment Data

“The disclosure, covering $77 billion in payments to more than 800,000 doctors in 2012, immediately triggered a barrage of media stories.” Article.

If you are a healthcare provider, or otherwise bill Medicare Part B, payments you received are being scoured not only by the Federal Government, but lawyers and everyday citizens.
A review of the published Medicare payments are very interesting:

1.  The New York Times reported that just 100 doctors were paid $610 million;

2.  Medicare paid $21 million to one Florida ophthalmologist Salmon Melgen–who received more from Medicare than any other doctor in the country;

3.  The Wall Street Journal found that the top 1 percent of individual providers pulled in 14 percent of all 2012 payments made; and

4.  Just 2 percent accounted for a quarter of payments;

5.  Washington Post noted that Medicare paid nearly 4,000 doctors more than $1 million that year, including a cardiologist in Ocala, Fla., who took in $18.1 million, primarily for putting in stents.

“Physician groups have long resisted such a specific accounting of individual providers’ pay, and they continue to warn that the raw payment information — lacking the right context — could ruin the careers of quality docs caught in the crossfire.”

The Government stated that physicians should not be concerned about the raw data because the Government has always had information regarding payments it has made.

The difference, however, is the transparency and the connections that the public at-large can make with the new information.  Numerous news outlets are reporting that lawyers are already scouring the information to obtain information regarding potential fraudulent billings to bring whistle blower cases.  Article.

If you are a healthcare provider, you should:

1.  Know what the Medicare data says about you,

2.  Perform an audit of your documentation to make sure you are documenting correctly for the amount Medicare is paying; and

3.  Update your compliance plan to document your audits in case Medicare reviews your records.

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