Physicians' efforts keep payments on Medicare database confidential

The Wall Street Journal mined a database with extensive information about tax payments that suggests fraud and discovered a New York City doctor who most likely took more than $2 million from Medicare. But the paper could not name her because of strict confidentiality requirements on physician reimbursements. "Known as the Medicare claims database, it is a computerized record of the bills Medicare pays for medical treatment, and it is widely considered the single best source of information on the U.S. health-care system. ... But the Medicare data come with a severe limitation: While the services and earnings of hospitals and other institutional providers can be publicly identified, such information is kept strictly confidential for doctors and other individual providers. The reason is that the American Medical Association, the doctors' trade group, successfully sued the government more than three decades ago to keep secret how much money individual physicians receive from Medicare" (Schoofs and Tamman, 10/25).

Modern Healthcare: "After HHS' inspector general's office said it would provide medical schools with teaching materials about Medicare and Medicaid fraud and abuse, some experts are questioning whether that training detracts from the true purpose of medical education." Kenneth Ludmerer, a professor of medicine at Washington University in St. Louis, is one of several experts cited. "'One is that the goal of medical education is to be a true education, not vocational training,' he says. ... He contended the topic of fraud becomes an issue of character, not one of billing and coding. 'It would be a waste of precious educational time to teach people to fill out forms,' Ludmerer says. 'I think the specific instructions can wait until you get into practice,' he adds."

Ludmerer suggests that issues of fraud are better handled in residency programs, and the majority of residency and fellowship programs provided instruction on Medicare and Medicaid fraud and abuse laws (Zigmond, 10/25).