Bipartisan Senate duo wants Medicare to make payments to doctors public

Sens. Ron Wyden (D-Ore.) and Chuck Grassley (R-Iowa) are collaborating on legislation to require the federal government to make public how much it pays doctors who participate in Medicare, a Senate staffer said.

Payments to doctors and other individual providers in the Medicare claims database has been off-limits to the public since the 1970s, when the Florida Medical Association and the American Medical Association (AMA) sued to keep it secret. The issue has resurfaced in recent months after The Wall Street Journal and the Center for Public Integrity sued the Department of Health and Human Services to get the information. 

Those pushing for access to the database believe it could reveal major fraud that costs taxpayers greatly. 

“I’m very hopeful that we can have a bipartisan bill on this because I think this could create a very substantial disincentive for some of these multimillion-dollar rip-offs,” Wyden told reporters immediately after the hearing. “And I also believe that the disinfectant of getting this information out to a wider array of individuals and groups makes a lot of sense.”

Separately, Grassley introduced multi-pronged anti-fraud legislation that, among other things, would “require Medicare claims and payment data to be available to the public by provider name for the first time, similar to other federal spending disclosed on www.USAspending.gov.” Grassley referred to a federal website that tracks government spending.

“More transparency about billing and payments increases public understanding of where tax dollars go,” Grassley said in a statement. “The bad actors might be dissuaded if they knew their actions were subject to the light of day. Congress should act quickly to pass the reforms out of respect for taxpayers and on behalf of program beneficiaries.”

After their lawsuit, The Wall Street Journal and Center for Public Integrity agreed to receive a pared-down version of the database containing 5 percent of providers, which they were forbidden from identifying. Even with those restrictions, they were quickly able to identify patterns of likely fraud.

The idea of opening up the database has been gaining traction across party lines as Medicare and Medicaid fraud — estimated at $70 billion to $120 billion a year — becomes an ever bigger worry. Former House Speaker Newt Gingrich (R), a possible presidential candidate for 2012, has said he favors the idea as long as beneficiaries’ names are kept confidential.

The AMA argues that opening up the database would be a violation of doctors’ privacy and could lead to some of them leaving the program.

“The American Medical Association has zero tolerance for Medicare fraud, and studies have demonstrated that physicians are not a significant source of Medicare fraud,” AMA President Cecil Wilson said in a statement. “Medicare claims are subject to scrutiny by the Department of Justice, the Office of the Inspector General and others responsible for aggressively ferreting out improper claims. Physicians, like all Americans, have the right to privacy regarding their personal financial information, and courts have repeatedly upheld this right.”

Asked about the federal government’s support for the idea, Medicare and Medicaid Program Integrity Director Peter Budetti said simply that it would have “a lot of ramifications.”

Wyden said the time was ripe.

“Given the growing interest from a policy standpoint in healthcare toward being careful about heavy-handed regulation, and putting more of a focus on transparency and accountability and information … I think this gives us much stronger prospects than we would have years ago,” he said. “I think we’re on the right side of history … and we’re going to go forward with our bill.”