New Medicare data shines light on medical treatment and payment

Data out from Centers for Medicare and Medicaid Services reveals the costs of providing medical care in the U.S.

April 9, 2014 2:51PM ET

by Inside Story Team @AJInsideStoryAM

The Centers for Medicare and Medicaid Services (CMS) made a three-decade secret public on Wednesday: Medicare's health provider spending data.

Medicare is an expensive entitlement program that is not based on income. The new document focuses on Medicare spending in 2012. The largest portion went to routine visits.

The new data also reveals:

There are more than 880,000 Medicare providers in the U.S. today

Medicare Part-B Spending in 2012

$252.4 billion spent on medical charges, like immunizations and public health welfare agencies

Medicare Part-B Spending in 2012

Medicare Part-B Spending in 2012

Seven doctors each received more than $10 million

Medicare Part-B Spending in 2012

Three doctors in Florida each tried billing at least $22 million

Medicare Part-B Spending in 2012

Three physicians in Florida each tried billing at least $20 million to Medicare. One of those doctors was ophthalmologist Salomon Melgen, who received millions from Medicare. A year later, his offices were raided by the FBI.

Doctor billing and reimbursement claims have been kept secret for more than 35 years, but last year a federal judge ruled that they could be made public.

The American Medical Association has historically led the effort to block the budget release, citing privacy concerns and misuse of information.

In a statement released today, the AMA said:

“Medicare claims data is complex and can be confusing. The manner in which CMS is broadly releasing physician claims data, without context, can lead to inaccuracies, misinterpretations and false conclusions.”

Medicare claims data is complex and can be confusing. The manner in which CMS is broadly releasing physician claims data, without context, can lead to inaccuracies, misinterpretations and false conclusions.

American Medical Association

On Medicare spending records

The AMA added: "The key takeaway for the media: verify the data before you publish."

Doctors were not able to review the data released by CMS before it went public. The AMA says high payouts do not necessarily indicate improper billing or fraud. Doctors seeing sicker patients who need more treatment may get more money from Medicare, as could doctors with practices focused on Medicare patients.

Nevertheless, in 2013, CMS warned that providers who bill over a certain threshold would be audited.

Prosecutions of fraud have reached a record number in recent years. Since 2007, a Department of Justice task force has charged more than 1,700 doctors who have billed Medicare more than $5.5 billion. Each conviction had an average sentence of four years in prison.

What is the significance of this data released today?

What specific areas of underuse and overuse are known to be problems?

Are these huge numbers we see misleading to the untrained eye?

We consulted a panel of experts for the Inside Story.