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Groundbreaking reporting on the health-care payments system this year came from The Wall Street Journal.  The government is the largest payer of medical claims, and The Journal has made good use of what data it has to identify providers who have performed an outsize number of procedures, collected an outsize amount of money, and generally shine light on payments in a series called “Secrets of the System.”

This week, The Journal reported, “Two senators have introduced legislation to overturn a 1979 court injunction that bars the government from revealing what individual physicians earn from
Medicare. That information is stored in the Medicare-claims database, widely considered one of the best tools for finding fraud and abuse in the $500 billion federal health-insurance program for the elderly and disabled.

“The Medicare Data Access for Transparency and Accountability Act, or DATA Act, was introduced Thursday by Sens. Ron Wyden (D., Ore.) and Charles Grassley (R., Iowa). … The Wall Street Journal, together with the nonprofit Center for Public Integrity, obtained from the government limited access to the database last year. Despite severe restrictions on using the data, the Journal was able to mine it and publish a series of articles exposing how doctors and other medical practitioners appear to be gaming Medicare to increase revenue.”

If you haven’t had a chance to read the series The Journal has been publishing since October, here’s a series of links from their Web site. They charge for access; some readers may be able to read Journal stories via library databases. It’s well worth the time, if you’re interested in the topic. Here’s their explanation:

Secrets of the System Series
“Soaring Medicare costs threaten to overwhelm the federal budget, yet American taxpayers are blocked from seeing exactly where their money goes. Under a three-decade-old court order, Medicare can’t publish the billings of individual physicians who participate in the program. In this series, The Wall Street Journal explores Medicare’s vast databases and shows how they can be used to expose potential fraud and waste.

 

Jeanne Pinder

Jeanne Pinder  is the founder and CEO of ClearHealthCosts. She worked at The New York Times for almost 25 years as a reporter, editor and human resources executive, then volunteered for a buyout and founded...