How much does Medicare pay physicians? Senate bill would make claims public

Sens. Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.) on Thursday introduced the Medicare Data Access for Transparency and Accountability Act, which would overturn a 1979 court injunction that bars the government from revealing the amount individual physicians are paid by Medicare.

The bill also would require HHS to make the data, which would hide patient identities, available at no cost.

The database, known as the Carrier Standard Analytic File, is compiled of data on physicians and other providers participating in Medicare who are paid on a fee-for-service basis. It incorporates 5% of all beneficiaries, as well as all physician claims that Medicare paid directly. Federal investigators can use the database to identify fraud, but its information on physicians and other individual providers is kept confidential from the public.

The confidentiality resulted from the American Medical Association (AMA) suing the federal government more than 30 years ago to conceal how much individual physicians receive from the program. Since then, AMA has defended the ruling in various court cases and successfully kept the funding data private. AMA said publicizing the data would have little use. However, health advocates have argued that public viewing of the data would expose physicians who abuse the system.

The Wall Street Journal and the Center for Public Integrity last year were granted limited access to the database. The Journal has since run several stories examining how physicians might be taking advantage of Medicare to increase their revenue. A number of experts have identified the database as the best tool for identifying fraud and abuse in Medicare (Schoofs/Tamman, Journal, 4/8).