On April 9, 2014, the Centers for Medicare and Medicaid Services (CMS) released data showing Medicare payments to physicians in 2012. The data covered $77 billion in payments to 880,000 physicians across the country under the Medicare Part B program, which covers outpatient services. Such payment data was not previously available because a federal court had instituted an injunction in 1979 to prevent the release of the data, but a court lifted the injunction last year.
For any physician who saw 11 or more Medicare patients in 2012, the data shows how much the physician billed to Medicare. While the data has many limitations, it will certainly lead to increased scrutiny of physicians with the highest Medicare billings and could lead to more lawsuits targeting Medicare fraud and abuse. Under the False Claims Act, private citizens may bring lawsuits, referred to as qui tam actions, against Medicare providers who they believe have defrauded the government. If a suit is successful, the individual bringing it is entitled to a cut of the damages recovered. Lawyers for individuals bringing qui tam actions may be able to use the Medicare payment data to provide additional support for their fraud claims if the data shows suspicious billing patterns.
David Dirr is an attorney in the law firm of Dressman Benzinger LaVelle, with offices in Cincinnati, Ohio, Crestview Hills, Kentucky, and Louisville, Kentucky.
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