Given the 880,000 names of physicians released by Medicare Wednesday, physicians who treat Medicare patients can expect their names to be on the list. The list, searchable here, contains the name of the provider, the specialty area, the city, county and state as well as the total payments made to the provider by Medicare for 2012. Searches can be conducted nationally or by state. Although released by the government, the list resulted from a lawsuit brought by the Wall Street Journal (WSJ) to gain access to Medicare billing data. For background, see this WSJ article. The WSJ article also contains a chart that lists the top fifteen specialties that have resulted in the highest average payments per provider.
Physician groups have been concerned that the release of data in such a raw and bulk form, without context, will lead to misinterpretations, confusion and unjust accusations of fraud. Although the full ramifications of the release are impossible to predict at this time, some things seem clear for the immediate future. Physicians, and systems that employ them, need to be prepared for the questions they are likely to receive from patients and the media. Physicians and hospitals need take these questions seriously and develop useful answers. Careless comments are likely to raise even more questions. In fact, it may be a good practice for physicians and hospitals to search this database just to know what is out there in public. It may not be just about Facebook anymore.
In the midterm future, the release is likely to cause increased scrutiny during audits. After all, a provider who receives payments above the average in a specialty area is likely to receive closer scrutiny from an auditor.
In the long term, we can expect more investigations under the False Claims Act. In fact, one of the reasons for releasing the data was to unleash a public scrutiny of providers in order to identify and root out fraud. Correct or not, more scrutiny is coming.
