Medicare Physician Data Analyzed For Fraud

By Katie Wike, contributing writer

Lawyers have begun investigating recently released online Medicare payment information for signs of potential fraud

As Health IT Outcomes reported earlier this month, CMS recently released the first-ever publication of Medicare Part B payments to individual physicians and physician practices. The data was released in response to transparency demands raised by the court case requiring the agency to provide public access to physician billing records.

Now, after just a matter of days, lawyers are checking for signs of potential fraud, combing the online records for misdeeds committed by drugmakers and providers and bringing cases forward on behalf of employees who think other workers might be committing Medicare fraud. According to iHealth Beat, these lawyers specialize in representing healthcare fraud whistleblowers.

By analyzing the data released in the online database, lawyers can put together the pieces of suspected fraud cases red flagged by employees. Reuters explains, “For example, if a lawyer were representing a pharmaceutical sales manager accusing his company of paying kickbacks to certain doctors, the data could point to other providers using the company's products who could serve as witnesses or be added as defendants if the billings suggest wrongdoing.”

"You'd have to be able to see that there's (improper) influence actually being exerted over healthcare decisions," said Michael Behn, a Chicago whistleblower lawyer. "But there's the possibility this data could lead to actual cases."

Although the data alone can’t prove fraud, Reuters says, “Lawyers still need a client with inside knowledge of the alleged fraud. But employees in physicians' offices or healthcare labs who suspect wrongdoing can now see whether their employers' billings are out-of-line with the rest of the industry.”