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Medicare Makes First-Time Release of Spending

Published on May 9, 2014 at 8:40 am in Medical Malpractice.

Kentucky Medical MalpracticeIn what The New York Times is calling the “most detailed data ever released in Medicare’s nearly 50-year history,” the federal Centers for Medicare and Medicaid Services have made public the details of the $77 billion that Medicare paid out to doctors in 2012. The monies cover services to the elderly and disabled, paid out by Medicare and Medicaid Services.

For decades, the American Medical Association and other groups have blocked the release of this data. They claimed it was for privacy concerns and the potential misuse of the information. However, a federal judge last year ruled against their objections and ordered that the information could be made public.

CNN Money listed out a table of the most highly compensated specialties:

  • Hematology/Oncology – $367,000
  • Radiation Oncology – $363,000
  • Opthamology – $327,000

Of course, it will now take some examining to determine what it all means. There is potential for confusion in looking at data without context. One source points out that those doctors don’t always keep all of the money. They may have to reimburse drug companies or other providers for part of the service. And they also have office, staff, and other expenses.

Many believe the data will be useful in rooting out the fraud in the Medicare system. This data will allow fraud investigators, health insurance companies, and others to look specifically at how many tests and procedures are being order by one provider.

One field fraught with Medicare fraud is physical therapy. Physical therapy (PT) is the 10th highest specialty in the receipt of Medicare payments, at $1.8 billion in 2012. The nature of physical therapy has allowed some providers to bill Medicare for unnecessary treatments or even for treatments they never perform; since PT providers often work alone, there may not be other labs or providers involved to provide any independent verification.

One example of the suspected fraud that might be found in the data comes from a physical therapy clinic in Brooklyn. This small physical therapy clinic alone billed Medicare $4.1 million in 2012. Its records showed 183,000 treatments to 1,950 Medicare patients that year, which comes out to 500 treatments a day, 21 in each hour – by one medical provider.

It’s possible there’s more to the story, but the release of the data will now allow investigators to get to the bottom of it. The provider claims he has not worked out of that office for years, but his billings are attributed to the address. Where he claims to have performed those procedures and why the names of the alleged other providers who performed the rest of them is yet to be shown.

The New York Times reports that of the 10 physical therapists nationwide who were paid the most by Medicare in 2012, half listed Brooklyn addresses. Two others listed addresses on Long Island, one in Queens, and one each in California and Texas.