Medicare Payments Data Dump Reveals Massive Scope of Federal Health Care Billing System

Medicare is a $500 billion program that’s been
identified for years as high-risk
by the Government Accountability Office for its susceptibility to
improper payments—everything from mistaken billing to overpayments
to dubious upcoding to outright large-scale fraud. And yet since
the program’s inception, the public, including most medical policy
researchers, has never had anything like complete access to its
payment data.

That changed yesterday, when Medicare released a trove of data
on its 2012 payments to physicians for anyone, or at least anyone
with enough computing horsepower, to see. The single-year data set
is anonymized to protect patient information, and certain rare
procedures—those performed on fewer than 11 patients—don’t show up.
It’s not for everyone. The set is big enough that it’s not easy to
work with on a typical desktop computer; but for researchers,
policymakers, and journalists who can arrange for database storage
and access, it’s a pretty big deal. 

It’s going to take a while to fully process all this
information, but a couple things stand out already from the stories
that have been written so far. One is the sheer scale of the
payments involved. The data set doesn’t cover anywhere close to the
entire Medicare program, but it offers a look at $77 billion worth
of payments to 880,000 medical professionals in the year 2012. From
that group, The Washington Post
, about 4,000 physicians billed the program more than $1
million. And a handful billed in excess of $10 million.

It won’t surprise many people that
the highest billers are concentrated in the sunny state of
. The state has a heavy concentration of seniors. It’s
also a
haven for Medicare fraud
. And the data suggests a possible
correlation between unusually high billing and payment funny
to The Post, “three of the top 10 earners
already had drawn scrutiny from the federal government, and one of
them is awaiting trial on federal fraud charges.”

But bad billing, including fraud, isn’t just a matter of a few
folks at the top. The program is rife with bad payment. In fiscal
year 2012, the fee for service portion of Medicare
made $29.6 billion in improper payments
—meaning that about 8.5
percent of all payments made were problematic somehow. And that was
a pretty good year, relatively speaking, the product of a decline
from 10.8 percent in 2009. The improper payment rate shot
back up
to 10.1 percent in 2013.

The point is Medicare blows tens of billions of dollars on bad
payments every year, some of which is a result of administrative
ineptitude, and some of which is just people scamming the system.
But until now, most people have never really had an idea of what
the overall picture of that payment system looks like. This isn’t
all the information we might want—it would be great, for example,
to have more years available so we could see how payment trends
change over time. But it’s a good start. 

from Hit & Run

Florida Trying to Make Microbreweries Sell, Buy Their Own Beer Back from Distributors

Submitted for your approval
via Political
Fix Florida
: A proposed beer law so freaking stupid that
it will make you want to get really drunk.

The legislation worming its way through the Florida state Senate
forces microbreweries or other craft beer producers to sell their
beer to a distributor and then buy it back before selling it to the
thirsty public. Even if the microbrewers have restaurants or
on-site bars.

The measure (SB 1714) has so infuriated craft brewers and beer
enthusiasts that some on Twitter have christened it with the
hashtag “#growlergate.” The Community Affairs committee approved
the bill Tuesday.

Sen. Jack Latvala, R-Clearwater, was so incensed at the idea of
craft brewers having to pay someone else to sell their own product
that he likened it to a mobbed-up racket. Latvala has championed
the microbrewery cause.

The requirement is similar to paying “protection to ‘Vinnie’ in
New York,” he said.

The bill also is favored by the Big Beer lobby, which is feeling
the heat from craft beer’s competition.

Ah, there you have it! The Big Beer lobby!

The Tampa Tribune explains it
, this is all part of the
notorious and ridiculous three-tier system ushered in after

After the country’s failed experiment with Prohibition from 1920
to 1933, states wanted to make sure no one – like mobsters – had
monopoly control over booze.

They created a three-level system in which producers, including
brewers, could sell only to wholesale distributors. The
distributors then would sell to the retailers, and only retailers
could sell to consumers. The idea was that nobody in one tier could
unduly influence anyone in another, especially on pricing.

The bill is sponsored by Sen. Kelli Stargell (R-Lakeland) and,

as Political Fix notes
, doesn’t even require that the
beer actually leave a microbrewery’s property and then return. It’s
a pure payoff scheme. The bill also legalizes a 64-ounce “growler,”
or large jug of beer drawn from a tap. Currently, only 32-ounce and
128-ounce growlers are legal under state law. Because, you know,
state legislatures are filled with idiots.

Hat tip: Patrick R.

Watch “Beer: An American Revolution—How Microbreweries
Promote Choice”

from Hit & Run

A. Barton Hinkle: Bush Lied. So Did Obama.

Back during the Vietnam War, the Pentagon’s PR
guy, Arthur Sylvester, told a group of reporters: “Look, if you
think any American official is going to tell you the truth, then
you’re stupid. Did you hear that? Stupid.” Sylvester was being too
harsh, writes A. Barton Hinkle. Americans are pretty sharp when it
comes to picking up on lies told by the other side. If they believe
the lies told by their own side, Hinkle adds, it’s not because
they’re imbeciles. It’s because they want to.

View this article.

from Hit & Run

Instapundit: Meet The New Oligarchs, Same as the Old Oligarchs

Glenn Reynolds surveys data
about declining public trust in social media and tech companies and
concludes that the cyber-chickens are coming home to roost.

It’s made worse by the increasing politicization of Silicon
Valley, and the transformation of its leaders from rebels into what
Joel Kotkin calls “the new oligarchs,” people who once talked about
technology as liberation, but who now seem more interested in using
technology as an instrument of control. It’s not just NSA spying;
it’s that the companies gather data on everyone, with comparatively
little legal oversight.

You might have been OK with that a decade or two ago, when
Silicon Valley seemed full of people who would stand up to the Man.
Now, they are The Man (or The Woman) in many ways, or in cahoots
with them. Might the information you gave to OKCupid be
used against you someday? Your only protection, really, is their
good nature. And how good is that?

Read the whole thing.

And then read Instapundit’s excellent “5
Privacy Laws I Would Put on the Books Right Now
.” Snippet:

4. Emphasize Reciprocity

Private citizens should be entitled to do anything that
government entities can do without a warrant. For example, when I’m
out in public anyone can see my license plates. But I’ll bet that
police or prosecutors or judges would object if I started tracking
their “public” movements everywhere they went. If they can fly a
drone over my backyard without a warrant, then I should be able to
do the same to them. Government officials should have no more
protection from that sort of thing than the rest of us. This will
encourage both more transparency and a more serious attention to

from Hit & Run

Did Ayaan Hirsi Ali’s Reason Interview Sink Her at Brandeis?

Hat tip: Eric Dondero of
Libertarian Republican

After announcing that it would honor author and activist Ayaan
Hirsi Ali with an honorary doctorate, Brandeis University has
its offer
, partly due to statements she made during a
2007 Reason interview

Born in Somali and raised in Kenya, Hirsi Ali fled to the
Netherlands and became an outspoken critic of the treatment of
women under Islamic law. She wrote the screenplay for the 2004
short film “Submission” (watch online). The film’s
director, Theo Van Gogh, was stabbed to death on the streets of
Amsterdam by an Islamic fanatic and Hirsi Ali ultimately fled
Holland for the United States.

Various student and faculty groups at Brandeis protested and a
petition posted at quoted from Rogier van Bakel‘s
2007 Reason interview with Hirsi Ali. The petition, which
garnered 6,802 signatures as of this morning, argued that Hirsi Ali
engages in “hate speech” and as such is not worthy of an honorary

Rogier van Bakel quotes her as follows: “Jews should be
proselytizing about a God that you can quarrel with. Catholics
should be proselytizing about a God who is love….Those are lovely
concepts of God. They can’t compare to the fire-breathing Allah who
inspires jihadism and totalitarianism.” Van Bakel notes religions’
ability to bring about change for good: “Do you think Islam could
bring about similar social and political changes?” Ms. Hirsi Ali
responds, “Only if Islam is defeated.” Van Bakel asks, “Don’t you
mean defeating radical Islam?” To that she responds, “No. Islam,
period.” (Reason, 11-07)

How can an Administration of a University that prides itself on
social justice and acceptance of all make a decision that targets
and disrespects it’s own students? This is hurtful to the Muslim
students and the Brandeis community who stand for social

Read the petition here

Brandeis officials have issued a statement
that at best shows themselves to be completely ignorant of her
work, especially her best-selling autobiography, InfidelThey

She is a compelling public figure and advocate for women’s
rights, and we respect and appreciate her work to protect and
defend the rights of women and girls throughout the world. That
said, we cannot overlook certain of her past statements that are
inconsistent with Brandeis University’s core values.  For all
concerned, we regret that we were not aware of these statements

Yeah, whatevs. Try learning about this brand-new
resource called the Interweb. You can download a “browser” for it
for free from a company called Mozilla. Obviously, a
university is fully within its rights to give awards or not to
whomever it chooses, just as Mozilla is free to promote or not
whomever it wants to CEO. And the Heritage Foundation is
to quickly accept
the resignation
of policy scholars who are attacked in
the liberal media. As I wrote about the Brendan Eich affair, this
sort of controversy is only going to become more common as
technology empowers more actors to create pressure groups and as
our economic and social interactions become
more and more symbolic
. That’s a mixed bag, for sure, but just
like Internet piracy, it ain’t going away any time soon.

I don’t agree with Hirsi Ali’s unqualified condemnation of
the interview
with van Bakel, she says “there is no moderate
Islam” and calls for banning free speech about the religion—and I’m
not surprised that Brandeis caved at the first sign of trouble.

There is something particularly appalling about an institution
that is predicated upon the idea of free and open discourse
throwing in the towel so quickly. Either the people running the
school there are simply total ignoramuses or they are cowards who
refuse to defend their choice. Of course, they could be both. In
any case, the reputation of the school should suffer, both as a
place where ideas can discussed and where smart people congregate.
Who wants to be the first person to turn up far more dubious
recipients of Brandeis honorary degrees?

Hirsi Ali runs a foundation dedicated to the proposition that
“women everywhere, of all cultures, merit access to education and
basic human rights.” It focuses especially on the issues of female
genital mutilation and refugee status in the West of women fleeing
the worst sort of patriarchal political and social situations.
Read more about it here.
One of the great achievements of Infidel, in my opinion,
is its description of the brutal reality of female circumcision and
the ways in which the practice is often supported by women who have
been subjected to it. Infidel is a profound contribution
to feminist and libertarian discourse precisely to the extent that
it forces all of us in the “tolerant” West to check out assumptions
about the universality of our ideas regarding pluralism and the
possibility of peaceful coexistence.

And check out Reason‘s interview with Hirsi Ali, which
is relentlessly interesting and provocative. Here’s a snippet:

Reason: George Bush, not the most conciliatory
person in the world, has said on plenty of occasions that we are
not at war with Islam.

Hirsi Ali: If the most powerful man in the West
talks like that, then, without intending to, he’s making radical
Muslims think they’ve already won. There is no moderate Islam.
There are Muslims who are passive, who don’t all
follow the rules of Islam, but there’s really only one Islam,
defined as submission to the will of God. There’s nothing moderate
about it.

Reason: So when even a hard-line critic of
Islam such as Daniel Pipes says, “Radical Islam is the problem, but
moderate Islam is the solution,” he’s wrong?

Hirsi Ali: He’s wrong. Sorry about that.

thing here.

from Hit & Run

A.M. Links: Eric Holder Says He Can Do What He Wants, Medicare Paying Millions of Dollars to Thousands of Doctors, Russia Denies Planning Invasion of Ukraine

  • whateva, i do what i wantAt a hearing of the House Judiciary Committee,
    Attorney General
    Eric Holder
    insisted he had a “vast amount of discretion” in
    deciding which federal laws to enforce and how to enforce
  • In the first such data released in more than 30 years,
    is shown to pay out at least $1 million a year to
    4,000 doctors. The average Medicare payout for a participating
    doctor is $77,000 a year.
  • Up to twenty students may be injured after reports of multiple
    stabbings at a Pittsburgh area
    high school.
  • Security researchers say they’ve found a massive breach of
    Internet security, which they have dubbed
    . Millions of passwords, credit card numbers, and
    other personal data may have been exposed for several years.
  • Brandeis University reversed its decision on awarding an
    honorary degree to the the Islam critic and women’s rights activist

    Ayaan Hirsi Ali
    after facing criticism about the commencement
  • Authorities in
    promised to use force to remove demonstrators from
    government buildings, while Russia dismissed
    claims it was planning to invade the country.

Follow Reason and Reason 24/7 on
Twitter, and like us on Facebook. You
can also get the top stories mailed to
up here

from Hit & Run

Media Hysteria Watch: Local News Show Freaks Out Over Footage of a Car Briefly Stopping

Oregon Fox affiliate gives us this
of a girl who noticed a car was slowing down behind her
as she biked, “locked eyes” with the driver, decided he was about
to try to kidnap her, and then rapidly rode up her driveway to get
away. This triggered her home’s motion-activated cameras, so we
have not-quite-dramatic footage of a car stopping at the end of her
driveway for a moment and then moving on. And that, apparently, was
enough to justify a local news report:

“It’s all speculation, of course,” the girl’s mom notes to the
reporter at one point. Then she plows ahead with her ideas about
the terrible things the driver might have been thinking as he
briefly paused his car.

It turns out that the ATTEMPTED KIDNAPPING was, in fact, a man
trying to find a boat shop. Lenore Skenazy has
the sheriff’s report
on the incident:

The vehicle and driver of the suspicious vehicle
reported to the Yamhill County Sheriff’s Office on Monday, March
31st has been located and is of no further interest. The Sheriff’s
Office would like to thank everyone for their concern and
assistance in locating the suspicious vehicle.

Family members located the vehicle at a McMinnville business on
Saturday afternoon, April 5th. The driver and owner of the vehicle
was cooperative with Sheriff’s Deputies, and stated he had driven
to the Sheridan area to look for and purchase boat parts and became
lost while looking for the business. Sheriff’s Deputies were able
to confirm the driver and his dog had been to the area on the day
of the reported incident looking for the boat shop, and ultimately
made a purchase there.

There’s no word on whether this purchase was caught ON TAPE.

Bonus statistics: In 1999, according to the most recent
Justice Department report on
the subject that I’m aware of, 797,500 children were reported
missing. But the number of “stereotypical” kidnappings—defined in
the report as crimes where a stranger or slight acquaintance
“detains the child overnight, transports the child at least 50
miles, holds the child for ransom, abducts the child with intent to
keep the child permanently, or kills the child”—was just 115.

from Hit & Run

Jacob Sullum on Stephen Breyer’s Dangerously Broad Rationale for Campaign Finance Regulations

Last week the Supreme
Court overturned federal limits on the total amounts that
one person may contribute to candidates and political committees
during a single election cycle. “The Government may no more
restrict how many candidates or causes a donor may support than it
may tell a newspaper how many candi­dates it may endorse,” the
Court declared in an opinion by Chief Justice John Roberts.

But according to Justice Stephen Breyer, who wrote a dissenting
opinion that was joined by three of his colleagues, the
restrictions challenged in McCutcheon v. FEC are
perfectly compatible with the First Amendment, which “advances not
only the individual’s right to engage in political speech, but also
the public’s interest in preserving a democratic order in which
collective speech matters.” Jacob Sullum says the
idea that individual rights must be sacrificed for the sake of a
vaguely defined collective interest reflects the dangerously broad
agenda of campaign finance “reformers,” who seek to shape the
political debate so that it comports with their own notion of the
public good.

View this article.

from Hit & Run

Brickbat: Big Baby

The Floresville
Independent School District in Texas has disciplined a
school bus
 caught on video calling an elementary school
student a “crybaby” and trying to get other students on the bus to
mock the girl. The school district did not reveal the name of the
bus driver, whom parents know as “Ms. Pat,” nor explain exactly how
she was disciplined.

from Hit & Run

Tonight on The Independents: Sen. Mike Lee, Thaddeus Russell, IJ’s Paul Sherman, Meet the Independent (Nick Troiano Edition), OK Cupid, Campaign Finance, NCAA Servitude, Plus After-Show!

Those old dudes in wigs did not like crony capitalism, at all. |||Tonight’s live episode of
(9 p.m. ET, 6 p.m. PT, on Fox Business
Network, with repeats three hours later) will once again allow you,
the beloved audience, to determine what we’ll talk about in one of
the show’s Party Panels. Go to the show’s Facebook page to
Should it be
 “LAPD officers tamper with in-car recording
equipment” or “Yale
threatens to suspend student for being too thin
“? Television
history rests in your hands.

Helping to work through these and other topics are Party
Panelists Remi
(criminal defense attorney-slash-TV commentator) and
Thaddeus Russell
(beloved Reason
). Also up for discussion: The latest
OK Cupid shenanigans
related controversies
, NCAA basketball champion Shabazz Napier
advocating for student-athletes to
get a bit more scratch
, and whether (in Sen. Kirsten
Gillibrand’s words) college campuses have become “havens
for rape
” (or in Cathy Young’s, “kangaroo

Imp! |||Sen.
Mike Lee
(R-Utah), one of the more consistently interesting
creatures on Capitol Hill, comes on to talk about his challenge to
GOP colleagues to prove their anti-crony capitalism bonafides by

croaking the Ex-Im Bank
. Institute for Justice Senior Attorney
Paul Sherman argues that

McCutcheon v. Federal Election Commission
doesn’t go far
enough in freeing political speech.
, baby-faced Millennial Nick Troiano explains why
he’s running as an
for Congress on a platform of “generational
equity,” and there’ll be some discussion about a truly disturbing
Department of Transportation anti-texting-and-driving
public service announcement

Go to
at 10 p.m. sharp for the online-only after-show, and click on
for video of past segments. Join the fun on Facebook at,
and on Twitter @ independentsFBN

from Hit & Run