Effort to make Medicare data public advances
Filed under: Government, Health data, Public records
The Dow Jones Company’s efforts to make Medicare data public took a step forward yesterday with a U.S. magistrate recommending [PDF] that the 30-year-old case barring access to the data be reopened and its motion to intervene in the case be granted in U.S. district court.
Dow Jones filed a motion to intervene [PDF] in January in its attempt to have the courts overturn a 30-year-old injunction that blocks release of the data, which individually identifies medical providers. The case was placed in the court’s electronic system but its status was “closed.” The company filed an unopposed motion in February to reopen the case. Magistrate Monte C. Richardson recommended that U.S. District Judge Marcia Morales Howard grant the motions.
The injunction is the result of a 1979 lawsuit brought by the American Medical Association, which objects to the release of data that includes how much money individual doctors receive from Medicare.
Wall Street Journal reporters, who negotiated for eight years worth of data if they did not publish identities, wrote a series of stories about Medicare data, showing that the federal government isn’t taking advantage of the data it has to detect fraud.
The board of directors of the Association of Health Care Journalists released this statement when the suit was filed in January:
AHCJ strongly supports the release of Medicare payment data that can help journalists better cover both the quality of care provided to patients and the finances of this critical government program. Publicly available information should include physician names connected to these payments. We see little reason why information on payments to doctors should be subjected to greater secrecy than payments to hospitals and nursing homes. The Wall Street Journal’s coverage demonstrates that data linked to doctors would help inform the public and likely would expose fraud and abuse in the program.
Related
- WSJ exposes flaws of Medicare’s pay now, investigate later culture
- Secrets of the System: See the WSJ’s contest questionnaire about how the series was done and read the stories (AHCJ members only)
- WSJ sues for release of Medicare provider data
- Press kit about the suit
- Senators join fight to open Medicare claims data
Four states refuse to name hyper-prescribing docs
As part of his war against overprescription and fraud, Sen. Charles Grassley asked states to share data on doctors who write colossal amounts of prescriptions for drugs covered by Medicaid. At this point, at least four states are holding out, and Pharmalot’s Ed Silverman is naming names. Montana, Alabama, Wisconsin and New Jersey have declined Grassley’s request, and a commenter says Michigan, which didn’t name names, belongs on the list as well.
Silverman attempted to contact the four holdouts he listed and gleaned what other information he could from other published sources. The reasons officials gave are, for the most part, well-worn: The data’s too expensive to collect, it doesn’t have enough context and, according to Alabama, might wrongly pinpoint physicians with legitimate reasons for prescribing all those drugs.
In reply, Silverman lets the already disclosed data speak for itself:
… in Florida, the top Zyprexa provider wrote 1,356 scrips for 309 patients in 2008 and 1,238 for 236 last year, compared to the 10th-highest prescriber each year who wrote 256 for 55 patients and 192 scrips for 30 people, respectively (more here). In Texas, one doc authorized 13,596 filled scrips for Xanax in 2008, and increased that to 14,170 filled in 2009. The doc who occupied the lowest ranking in the top 10 prescribers wrote just 1,444 and 1,696, respectively. The list goes on…
Related
AHCJ members can read more about getting Medicaid prescribing data from states in this article by Christina Jewett. Jewett, now at CaliforniaWatch, requested Medicaid data from a number of states for an investigation for ProPublica.
Ex-employees tell of Texas workers’ comp troubles
The Texas Tribune’s Elise Hu has found that the Texas Department of Insurance’s Division of Workers’ Compensation has more than its share of dirty laundry, much of which is finally starting to see the light of day. The division is in charge of sanctioning physicians who are defrauding the state’s worker’s comp system by overbilling and overtreating patients. A recent spate of firings and resignations, along with a review by the Texas Sunset Advisory Commission, have helped illuminate just how dysfunctional the whole thing has become.
The crux of the matter: Staff recommended sanctions against almost 70 physicians, Hu wrote, “Yet since 2005, division records show, the state has sanctioned just five doctors with removal from the workers’ comp system — and only in cases involving paperwork violations rather than harm to patients.”
The broken enforcement system, the former employees say, stems from [Commissioner Rod Bordelon]’s insistence on putting the due process rights of accused doctors ahead of the rights of their allegedly abused patients. That misplaced focus, the employees believe, results in part from political pressure on Bordelon.
Hu discovered that the cases that were unceremoniously shuttered by Bordelon involved millions and millions of dollars in workers’ comp claims, and that the system didn’t have sufficient safeguards against abuse.
Lockhart, Watts, Nemeth and Ford (the employees who either resigned or were terminated) say they left with great disappointment at the lack of enforcement. “You can make a lot of money if you’re a doctor practicing in the workers’ comp system, if you are so inclined,” Ford says. “If you’re dishonest, or if you learn how to game a system, there’s lots of money — I mean, millions of dollars to be made.” The agency document that details investigations into the nine doctors showed that, during the one-to-two year monitoring period, seven of them billed insurers more than $1 million, two billed more than $2 million, and one billed $3.2 million.
It’s a convoluted story heavy with details and angry quotes, but if you’re just looking for a summary of how the terminated employees feel, this seems to be a pretty good one:
“[The office’s] focus since late 2005 has been to protect wealthy doctors who have learned how to game the system and take advantage of injured claimants,” Ford says. “The motives for this protection are open to speculation. Money, political pressure, and career advancement are at the top of the list.”
Calif. reluctant to boost Medi-Cal’s anti-fraud staff
California Watch’s Christina Jewett reports on the California Assembly’s lukewarm response to the assertion of Medi-Cal’s fraud busters that, with another 38 staff, they could save the $16 billion program at least $51 million annually.
Jewett says Medi-Cal’s audit and fraud staff already numbers 712 employees (at full strength) and their calculations indicate that there may be $400 million in fraud in the system, as well as another $600 million in what Jewett describes as “Erroneous billing for services, supplies and care that is not necessary or poorly documented.” Jewett also lists a few examples of what auditors say are fraudulent cases.
FDA creates tipster Web page for alleged crimes
Do you know something about the sale of counterfeit prescription drugs or off-label promotion of medical devices? What if you came across fraud committed by a clinical trial investigator or a case of product tampering? Do you know how to get in touch with the Food and Drug Administration if you knew about an alleged crime?
Well, the FDA is trying to encourage tipsters to get in touch. The agency recently created a special page on its Web site to report suspected criminal activity, and the info gets forwarded directly to the FDA’s Office of Criminal Investigation.
Here are activities the FDA’s OCI would investigate: illegal diversion of pharmaceuticals and other regulated products; Prescription Drug Marketing Act violations; schemes involving fraudulent treatments, cures or devices; New Drug Application fraud; crimes affecting the safety or integrity of the nation’s blood supply or the adulteration and/or misbranding of food; Internet facilitated criminal violations involving FDA regulated products; illegal importation of FDA regulated products, and crimes involving the manufacture, sale or distribution of unapproved FDA regulated products.
We asked an FDA spokeswoman what exactly prompted this initiative and whether any tips have actually been reported. The FDA responded that nothing prompted the move and that it “can’t comment on any of the e-mails we have received or any other communication we receive via other means.”
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