General News

Medicare "Truth Checking" Falls Short

By (about the author)     Permalink       (Page 1 of 1 pages)
Related Topic(s): ; ; ; ; ; ; , Add Tags Add to My Group(s)

View Ratings | Rate It

opednews.com Headlined to H2 7/10/14

Reprinted with permission of Columbia Journalism Review

Kudos to ProPublica for "Examining Medicare," but there's more to this story than the bad apples


Mddicare Truth Checking
(image by Columbia Journalism Review)

In April, the Department of Health and Human Services released its great Medicare data dump unlocking a treasure chest of reporting opportunities. The government revealed details about the $77 billion in payments Medicare made to 800,000 doctors who treat patients for Part B services, which include doctor visits, outpatient treatments, and lab services. News organizations and others had long pushed to make these numbers public, and once they were--thanks to a lawsuit filed by Dow Jones--the data did not disappoint. Not unexpectedly, ProPublica, expert in data slicing and dicing, pounced on the numbers. For its resulting series, called "Examining Medicare," ProPublica deserves a shout-out.

On April 16, ProPublica kicked off the series with a piece, co-published with NPR, reporting that Medicare continued to pay doctors even if they had been suspended from Medicaid, indicted or charged with fraud, or had settled civil allegations of submitting false claims to Medicare. Subsequent stories looked at ambulance companies in New Jersey billing Medicare for unusually large numbers of non-emergency ambulance rides in 2012, and docs who billed at Medicare's top level at least 90 percent of the time. A mid-June piece noted that doctors with unusual billing patterns--such as charging only for the most complicated and high-priced office visits--also had been "disciplined by their state medical boards or faced accusations against their licenses." The story nods to similar reporting done (sometimes in collaboration with ProPublica) by Bloomberg, The Wall Street Journal, theDallas Morning News, KQED in California, and the Chicago Tribune, which tailored the focus for their audiences and reached similar conclusions. The Dallas Morning News, for instance, found 10 of the 77 Texas providers who almost exclusively billed for the most expensive office visits in 2012 "have been fined or otherwise sanctioned by the Texas Medical Board."

Surely patients would want to know if their doctors were overbilling, and ProPublica's Treatment Tracker, which lets consumers compare their doctors to others, and its Patient Guide, which suggests good questions for patients to ask, are useful components of the package. Charles Ornstein, ProPublica's lead writer on the series, says the consumer features of the project "give people an opportunity to make the data personal to them."

And yet: Should consumers, a.k.a patients, have to police their doctors because the federal and state government health policemen have taken a hike, as ProPublica's reporting suggests they have? Ornstein says Medicare may have wanted reporters to help document fraud and abuse when it released its data. "CMS is giving a response it intends to put data out there that allows you to truth check," he told me. But the real question is why isn't Medicare doing its own truth checking? It's not surprising high billers often had other disciplinary problems; If a provider is willing to stretch the law in one area, why not another? What is it about Medicare's oversight of the nation's doctors that allows these outliers to continue business as usual despite a sanction now and then? The US healthcare system has evolved from a cottage industry to a profit-driven marketplace--what is it, politically, that has made this transition possible and allowed these doctors to continue flourishing? Fred Schulte, a senior reporter for the Center for Public Integrity, raised this point with me a couple weeks ago discussing his series detailing hypocrisy and regulatory neglect in the Medicare Advantage program. "Medicare managed care was a complete disaster, and then they opened the flood gates [to big money]," Schulte told me. "It's annoying that you don't see government learning from previous mistakes." Does Medicare really want to? Or are the pressures from the regulated to look the other way simply too great?

Ornstein's series does suggest that Medicare may not be doing enough policing, but doesn't really get into the whys. In the series opener he wrote: "ProPublica's analysis shows Medicare could and should be doing far more to use its own data to sniff out cost-inflating errors and fraud." In a May 29 piece, he reported the inspector general for the Department of Health and Human Services found Medicare was spending some $7 billion more than it should have for physician office visits and patient evaluations in 2010. Yet Medicare, in its reply to the IG's findings, says it has no plans to review the billings of doctors who almost always charge for the most expensive visits because it's not cost effective to do so. A regional inspector general, Dwayne Grant, who oversaw the new report told ProPublica, "We don't want to pay them too much but we don't want to pay them too little either." Last week, I highlighted six times Medicare has caved to pressure to go easy on an industry it's supposed to police; could this be a seventh?

 

Trudy Lieberman, a journalist for more than 40 years, is a contributing editor to the Columbia Journalism Review where she blogs about health care and retirement at www.cjr.org. Her blogposts are at http://www.cjr.org/author/trudy-lieberman-1/ She is also a fellow at the Center for Advancing Health where she blogs about health at (more...)
 

Share on Google Plus Submit to Twitter Add this Page to Facebook! Share on LinkedIn Pin It! Add this Page to Fark! Submit to Reddit Submit to Stumble Upon

Go To Commenting
The views expressed in this article are the sole responsibility of the author and do not necessarily reflect those of this website or its editors.

Writers Guidelines

Contact Author Contact Editor View Authors' Articles

Most Popular Articles by this Author:     (View All Most Popular Articles by this Author)

Steven Brill's "Time' Magazine Manifesto On Healthcare Costs Smashes Fences

Comparing U.S., Canadian health care systems

Steven Brill's Blockbuster Article "Bitter Pill: Why Medical Bills Are Killing Us" -- the aftereffects

Report Card on Social Security Trust Fund Coverage - An F for the headlines; a C- for the stories

How the Media Has Shaped the Social Security Debate -- The Press Plays a Dubious Role

Obamacare Exchange Watch: Low Healthcare Costs or California Dreaming?

Comments

The time limit for entering new comments on this article has expired.

This limit can be removed. Our paid membership program is designed to give you many benefits, such as removing this time limit. To learn more, please click here.

Comments: Expand   Shrink   Hide  
1 people are discussing this page, with 1 comments
To view all comments:
Expand Comments
(Or you can set your preferences to show all comments, always)

This may be more complex.When the rates are low ev... by BFalcon on Friday, Jul 11, 2014 at 1:40:15 PM