The investigation is part of a push to spotlight doctors who may be sending inflated bills to the government.
A new investigation from news outlet ProPublica analyzes Medicare billing data. The report tracks how doctors and other health care providers bill the federal healthcare program–and provides an online tool for patients who want to look up their own doctors.
Medicare spends billion of dollars each year, and ProPublica’s investigation is part of a push to spotlight doctors who may be sending inflated bills to the government. It also asks, is the government doing enough to root out fraud and abuse?
The Pulse’s Taunya English spoke with ProPublica Senior Reporter Charlie Ornstein this week. Here is a short excerpt of that conversation:
What can you tell from the way a doctor charges for office visits?
“It’s sort of interesting to see how much a doctor earns from Medicare in a given year, but for me, as a patient, and someone who’s helping relatives choose their doctors, I think it’s far more interesting to see whether or not these doctors practice medicine in a way that’s responsible and in a way that’s like their peers, or if they are choosing services and tests and procedures that others are not choosing. And if they are, I’d want to know why that is.”
What are some of the reasons that a doctor might look like an outlier compared to other physicians or health care providers?
“Some do indeed treat more complex patients, some work in impoverished communities with people who have greater health problems and some have more experience in the field and receive referrals from other doctors for complicated health conditions. That said, when you talk to most doctors, many will tell you their patients are sicker than [patients of] other doctors, but not every doctor can have sicker patients than every other doctor.”
Stepped up scrutiny from the government might send a message to providers who are engaging in aggressive billing, but I wonder if a change of policy could also hurt healthcare by discouraging doctors from taking on more complex, sicker populations of patients—out of fear that they’ll become the focus of an audit because their billing pattern is outside the norm.
“That’s certainly a fear. And the truth of the matter is that most doctors are practicing in responsible ways and in ways that compare to their peers. We tried to look at outliers in Medicare’s drug program last year, and what we found was that in some cases, they had other issues where they had been disciplined in their medical licenses, or negligence where they were facing charges at the state or federal level for fraud, and in some cases they’d been convicted. Sometimes there’s more than just being a signal in being an outlier, but there’s actual facts that warrant criminal scrutiny.”
You’ve created an online tool that lets consumers find out more about their own doctor’s billing practices. If a patient logs on, what can he or she learn?
“If you go to our Treatment Tracker, one of the things that you are going to find is information that helps put your doctor in context. We’re trying to help you understand—is your doctor providing more services than other doctors in that same specialty.”
Putting money aside, can billing patterns be an indicator that you are being over-treated—or a worry about the quality of care that you are getting?
“Overtreatment is a huge concern. Generally patients think that more health care is better but a lot of research has shown that you don’t necessarily want to get every test or every procedure, there are risks associated with those too.”