WASHINGTON – Sens. Charles Grassley (R-Iowa) and Ron Wyden (D-Ore.) have introduced legislation to make doctors' Medicare claims data public for the first time.
"Medicare is a $500 billion program with billions of dollars going out in error each year," Grassley said. "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. More transparency about billing and payments increases public understanding of where tax dollars go. The bad actors might be dissuaded if they knew their actions were subject to the light of day."
Added Wyden: "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," he said. "Shedding light on Medicare claims will be helpful to those making medical decisions, offer insight into how Medicare dollars are being spent and prevent wasteful spending and fraud. All of which begs the question, ‘Why isn’t this information already available?’"
“Of course, Medicare already has access to its own billing data and prosecutors have plenty of ways to investigate and punish fraudsters,” wrote David Whelan on his Forbes blog. “Here’s an analogy for the Wyden-Grassley bill. It would be as if I were forced to balance my checkbook on Twitter so that the rest of you could make sure that I’m not forging checks.”
Last month, Grassley introduced legislation requiring the Department of Health and Human Services to make Medicare claims and payment data available to the public in a manner similar to other federal spending, which is disclosed online at usaspending.gov. For his part, Wyden was developing an approach to make the data public through the Federal Freedom of Information Act.
The joint bill, called the Medicare Data Access for Transparency and Accountability Act (Medicare DATA Act), contains elements from each senator's approach. The bill would require HHS to make available a searchable Medicare payment database that the public can access at no cost. It would also clarify that data on Medicare payments to physicians and suppliers do not fall under a Freedom of Information Act exemption.
Grassley and Wyden said healthcare fraud remains a pervasive problem in federal healthcare programs. It has been widely agreed that between 5 percent and 8 percent of federal healthcare expenditures is lost to fraud.
In a recent series, The Wall Street Journal used limited access to Medicare billing data to identify suspicious billing patterns and potential abuses of the Medicare system. The Wall Street Journal found cases where Medicare paid millions to a physician, sometimes for several years, before those questionable payments stopped. While volume alone doesn’t automatically mean there is fraud, waste or abuse, accountability and transparency are powerful preventive tools, Grassley and Wyden said. Grassley and Wyden serve on the Senate Finance Committee, which has jurisdiction over Medicare.
Grassley is a senior member and former chairman and ranking member. Toward the cause of transparency and good government, Grassley and Wyden earlier this year achieved success in their long-time effort to end the Senate practice of placing “secret” holds on legislation.
