Medicare Part B Publication to Shine Light on Potential Healthcare Fraud

Data released on April 9 by the Centers for Medicare & Medicaid Services (CMS) provided an unprecedented transparent look at U.S. physician Medicare billing records and the amount paid by the government for the national senior citizen healthcare program. According to the results, the U.S. government funded $77 billion in 2012, from nearly 900,000 physicians.

Prior to the release of this information, the only data available to consumers was the doctor’s name, address and phone number. Armed with these newly released numbers, prospective consumers will have a more complete depiction of the way doctors perform in the Medicare program. Potential patients will be better prepared to make informed decisions about which doctors they want to visit.

In addition to the unprecedented level of transparency, the Medicare part B publication will also allow investigators and analysts to sniff out any healthcare fraud. In the 2013 fiscal year, the United States government recovered a record $4.3 billion in health care fraud, a number which will likely rise. By examining the numbers, looking at trends and investigating anomalies, doctors who use fraudulent practices will have a much higher chance of being exposed.

With this information now available to the public and scheduled to be released each year, the system of checks and balances will make it more risky for doctors to make false claims to gain extra subsidization from the government.

Some interesting facts coming from the numbers included:

• The most common Medicare physician service was a $70 doctor visit.
• In second place was the $100 office visit.
• Copayments, secondary insurance and deductibles account for 19 percent of money earned by doctors treating Medicare patients.
• For a standard $70 visit, Medicare covers $49, while the patient or their individual insurer is responsible for the balance.

The Qui Tam attorneys at Begelman & Orlow, P. C. have over 120 years combined experience in pursuing False Claims Acts violations. If you know of a wrong that you’d like to expose, contact us today for a free consultation. Call 866–627-7052.