Senate Bill to Put Physicians & Medicare Billing Data Online

April 9, 2011 — How much individual physicians receive from Medicare for treating seniors on a service-by-service basis — level-4 office visits, vaccinations, chest x-rays — would be posted online for all to see under a bill introduced April 7 by Sen. Charles Grassley (R-IA) and Sen. Ron Wyden (D-OR).

The 2 senators contend that public disclosure of billing information would help citizens and consumer watchdog groups spot Medicare fraud, waste, and abuse — and also deter clinicians from engaging in it.

"I believe transparency in the healthcare system leads to greater accountability," Sen. Grassley said on the Senate floor. "I’ve often quoted Justice Brandeis, who said, 'Sunlight is the best disinfectant.'" Accordingly, he and Wyden titled their legislation the Medicare Data Access for Transparency and Accountability Act.

The American Medical Association (AMA) counters that physicians deserve privacy when it comes to Medicare billing. Furthermore, it argues, government entities charged with combating Medicare fraud, such as the Department of Justice and the Office of Inspector General of the Department of Health and Human Services, already have access to the data. The plan to post a physician’s National Provider Identifier number along with the billing information could "put physicians at significant risk of identity theft," said J. James Rohack, MD, the AMA's immediate past president.

The proposed government Web site would contain Medicare billing data for all providers and suppliers, not just physicians. The Senate legislation requires it to be searchable, including on the basis of individual items and services. The public could access the site free of charge.

The legislation comes in the wake of a series of stories published last year by the Wall Street Journal based on an analysis of a limited amount of Medicare billing data. The stories spotlighted a number of physicians who received more than a $1 million a year from Medicare by performing an unusually high number of diagnostic tests and surgeries for seniors.

Sen. Grassley acknowledges that sheer volume for a particular service does not necessarily mean a physician is engaged in shady business. Rather, he or she may be a leader in that field, attracting more patients as a result. His legislation requires the billing-data Web site to state upfront that the information does not reflect on the quality of the service or the clinician who provides it.

The controversy over public disclosure of Medicare billing information goes back to the late 1970s, when the old Department of Health, Education, and Welfare sought to publish a list of all clinicians who treated Medicare patients and what they earned from it. The Florida Medical Association and the AMA asked a federal district court in Florida to issue an injunction blocking publication of the list, and the court obliged in 1979.

Dow Jones, the publisher of the Wall Street Journal, filed suit in that same federal court in January and asked it to lift the injunction. The case is pending.