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Medicare Continues Effort to Reduce Fraud and Abuse

Apr 18, 2014

A new frontier in the battle against fraud, waste and abuse was opened up with the widely reported April 9 release of Medicare payment data on 888,000 physicians and other clinicians who received $77 billion in Medicare Part B payments in 2012. The data also compares 6,000 types of services and procedures and provides the names of physicians who collect millions of dollars a year from Medicare, which may be a program-integrity red flag depending on their specialty and the degree of treatment their patients require.

The Centers for Medicare and Medicaid (CMS) is hailing the transparency because Medicare is taxpayer funded and because it opens doors for researchers to address important policy questions, such as why there are different spending trends by service codes and providers and geography.

One CMS chart shows the 10 specialties with the highest Medicare allowed payments per physician. They collectively made up 57% — $44 billion — of the total Medicare Part B payments included in the new data set. According to the website, the top specialties are:

  • Hematology/oncology: The average amount collected from Medicare in 2012 was $463,844 per physician. The number of physicians was 7,373 and the average number of unique types of items, services or procedures billed was 24.
  •  Radiation oncology: The average Medicare allowed amount per doctor was $458,222, for 4,135 physicians who billed for 17 unique types of items, services or procedures.
  •  Ophthalmology: $429,657 on average was paid to each of 17,067 physicians who billed for 14 unique types of items, services or procedures.
  •  Medical oncology: $390,992 for each of 2,612 physicians who billed for 21 unique types of items, services or procedures.
  •  Rheumatology: $333,000 on average paid to each of 4,053 physicians who billed for 17 unique types of items, services or procedures.

The data provided by CMS to the public will provide more transparency to taxpayer funds spent on health care. Health care providers should review the information as it pertains to their practice and them individually. This will assist them with any questions from their patients as they are providing needed medical services to them.

Read the CMS report: Medicare Provider Utilization and Payment Data.


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