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
notes, 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
Florida. 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
business.
According 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.
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