Thursday, November 23, 2017
Editorials

Editorial: Throwing a light on Medicare billing

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The Medicare reimbursement data released this week provides valuable insight into the opaque world of medical billing. The public now knows the government paid doctors $64 billion in reimbursements in 2012 and that several of the country's most highly reimbursed physicians practice in Florida and are under investigation for potential abuse. Receiving large Medicare reimbursements does not necessarily indicate fraud, but it does raise red flags. As the light shines more brightly on medical costs, the government should aggressively prosecute fraud and rein in attempts by doctors to buy political influence that could short-circuit investigations of their billing practices. The entire medical industry, from doctors to drug companies, should know the public is watching for signs of abuse.

The Department of Health and Human Services released the Medicare data on Wednesday after years of public pressure and a lawsuit filed by the Wall Street Journal. The most highly reimbursed specialities were concentrated in a few fields such as ophthalmology, oncology and rheumatology. Doctors say that is a result of the high cost of drugs and expensive equipment.

Florida is home to 28 of the 100 highest-billing Medicare doctors in the country, including the top two, Dr. Salomon E. Melgen, an ophthalmologist in West Palm Beach, and Dr. Asad Qamar, an Ocala cardiologist. According to the New York Times, the doctors were reimbursed $21 million and $18 million, respectively, for their work in 2012. Both doctors have been investigated for their high-billing practices. They have made six-figure donations to Democratic political causes and candidates, apparently in hopes of deflecting criticism of their business practices. Melgen and Qamar say they have done nothing wrong and cite the cost of expensive drugs, complicated medical procedures, high numbers of employees and large caseloads as reasons for their extensive Medicare billings.

Nationwide, doctors have given the Medicare data release mixed reviews. Some describe it as an invasion of privacy that may lead the public to incorrectly assume doctors are bilking the government. The raw data, the doctors say, does not explain factors such as the cost of expensive drugs, practices with multiple doctors that are reimbursed under a single physician's name, or doctors who work for clinics and receive salaries rather than money from Medicare. Those are legitimate concerns. But they don't outweigh the benefits of transparency, which provides the public with the opportunity to see how taxpayer dollars are spent.

The federal government acted responsibly last year when it released hospital billing data and has done so again in sharing Medicare reimbursements. It should continue on the path of full disclosure and make public billing information for Medicare Advantage plans, which are run by private insurers. Increased transparency could spark reform in an industry marked by confusing, exorbitant bills that consumers struggle to understand — and doctors and hospitals rarely have to justify.

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