WSJ Sues to Gain Access to Medicare Database

A series of articles in The Wall Street Journal (links below) documented soaring Medicare costs and how confidentiality cloaks Medicare fraud by physicians.

The Journal, in conjunction with the Center for Public Integrity, fought to obtain access to 5% of Medicare’s vast database of doctors (and other healthcare providers) who receive Medicare fees for service. The database can be used to ferret out fraud.

For example, the Journal reported, " Somewhere in the New York City area there is a family-practice doctor who, government records suggest, pocketed more than $2 million in 2008 from Medicare, the federal insurance program for the elderly…. She averaged $3,239 in earnings per patient in 2008—nearly 18 times the mean for family-medicine doctors, and the 7th highest among family physicians with 10 or more patients." http://online.wsj.com/article/SB10001424052748704696304575538112856615900.html

The revelations uncovered by WSJ reporters, led the WSJ publisher to file suit to open access to Medicare’s entire database. After all, Medicare is paid for by taxpayers, so taxpayers should have access to the reimbursement data.

Wouldn’t you know it, the cloak of secrecy was the result of a 1979 suit brought by the physicians’ trade group, the American Medical Association. The AMA sought to keep Medicare reimbursement to physicians secret–thereby shielding physicians who defraud Medicare from public accountability.

THE WALL STREET JOURNAL

Journal Files Suit to Open Medicare Database

By RUSSELL ADAMS

The publisher of The Wall Street Journal filed suit Tuesday to overturn a decades-long court order barring public access to a confidential Medicare database it says is essential to rooting out fraud and abuse in the government health-care program.

The American Medical Association, the doctors’ trade group, successfully sued the government in 1979 to keep secret how much money individual doctors receive from Medicare, and the ruling still stands.

The filing by Dow Jones & Co., in the U.S. District Court for the Middle District of Florida, comes after a series of articles in the Journal about abuses of the Medicare system. The articles were based on computerized Medicare records that represent part of the broader database at the center of the 1979 case.

Secrets of the System

Soaring Medicare costs threaten to overwhelm the federal budget, yet American taxpayers are blocked from seeing exactly where their money goes. Under a three-decade-old court order, Medicare can’t publish the billings of individual physicians who participate in the program. In this series, The Wall Street Journal explores Medicare’s vast databases and shows how they can be used to expose potential fraud and waste.

Dow Jones, owned by News Corp., claims the 1979 injunction hampered the paper’s reporting since it limited its access to the data and its ability to name physicians and other providers. Dow Jones says the effort won’t violate patient confidentiality. "It’s time to overturn an injunction that, for decades, has allowed some doctors to defraud Medicare free from public scrutiny," Dow Jones general counsel Mark Jackson said in a statement.

The AMA withstood at least two attempts to reverse the injunction in 2009. In one case, the U.S. Court of Appeals for the District of Columbia ruled that under the Freedom of Information Act, physicians’ privacy interest outweighed the public interest in knowing how much doctors were collecting from Medicare.

In a statement, AMA President Cecil B. Wilson said, "Physicians, like all Americans, have the right to privacy and due process, and should not suffer the consequences of having false or misleading conclusions drawn from complex Medicare data that has significant limitations." He added that doctors who care for Medicare patients already are subject to significant oversight.

A spokeswoman for the U.S. Department of Health and Human Services, which houses the Centers for Medicare and Medicaid Services, said the department wouldn’t comment while the suit is being reviewed.

Health-care advocates, law-enforcement officials and others have argued that access to the data would have a range of benefits, such as exposing instances of fraud, easing evaluations of the quality and cost of care, and helping to ensure the government is doing everything it can to protect taxpayer funds.

"The Medicare system is funded by taxpayers, and yet taxpayers are blocked from seeing how their money is spent," said Robert Thomson, editor-in-chief of The Wall Street Journal. "It is in the interest of law-abiding practitioners that those who are gaming the system are exposed. Unless funds are used efficiently and intelligently, the health of the nation, physically and fiscally, will be undermined."

Write to Russell Adams at russell.adams@wsj.com

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