Two senators – one Democrat and one Republican – have introduced legislation that would open Medicare billing records from doctors and other health providers to increased public and media scrutiny.
The Medicare Data Access for Transparency and Accountability Act, was introduced Thursday by Sens. Ron Wyden, D-Ore., and Charles Grassley, R-Iowa, who are both members of the Senate Finance Committee. The bill would require the U.S. Department of Health and Human Services (HHS) to create a free searchable Medicare payment database the public can use to track billing by health care providers.
The bill also clarifies that Medicare payments to doctors and medical suppliers would not be exempt from provisions of the Freedom of Information Act.
Grassley spokeswoman Jill Gerber said the measure is a response to reporting on Medicare fraud, waste and abuse by the Center for Public Integrity and The Wall Street Journal, which together acquired a limited portion of Medicare billing data from the Centers for Medicare and Medicaid Services, a component of HHS.
“Medicare is a $500 billion program with billions of dollars going out in error each year,” Grassley said in a statement. “The bad actors are getting bigger and bolder all the time. They’re able to stay out of law enforcement’s reach too often. It’s time to try new things. The bad actors might be dissuaded if they knew their actions were subject to the light of day.”
In 2009, the Center for Public Integrity sued the CMS for access to Medicare billing information. Partnering with The Wall Street Journal, the Center for Public Integrity subsequently acquired a sampling of eight years of the data.
Both media outlets, however, agreed in the course of negotiations with CMS to refrain from identifying medical providers based on their Medicare billing; CMS insisted on the agreement before releasing the data, since releasing the data could have put the federal agency in violation of a court order.
In 1978, the American Medical Association successfully sued the federal government to bar the predecessor of HHS from releasing the amount of money Medicare pays individual doctors. The agency, and the news organizations, could face legal ramifications if they break that agreement.
Dr. J. James Rohack, past president of the American Medical Association, said in a statement that “Releasing Medicare claims data to the public does not help combat Medicare fraud, as those tasked with this responsibility already have access to the data.” Rohack went on to say that the AMA “abhors Medicare fraud, which threatens our entire health care system, and the AMA supports vigorous efforts by the Department of Justice, HHS Office of Inspector General and others to identify perpetrators of fraud – the vast majority of whom are not physicians.”Rohack also said including a physician’s provider identification number in a public database, as the legislation suggests, could actually increase Medicare fraud and put physicians at risk for identity theft.
Thursday’s bill is the second this session to address Medicare billing data access, but the first with bipartisan sponsorship, and the first to address the Freedom of Information Act exemption. In March, Grassley introduced a bill to make public Medicare billing by doctors. That bill was referred to the Senate Finance Committee.
“Hiding information on how taxpayer dollars are being spent is not something we do in this country. Moreover, if taxpayer dollars are being spent responsibly there is no reason to hide,” Wyden said in a statement released Thursday.