Medicare data sheds new light on questionable practices, missing discipline

Heavy hitters of the  national media, including CBS News and USA Today, are using Medicare charge data to open new windows onto questionable practices by some of the nation’s doctors. In recent stories, these outlets have found evidence of thousands of unnecessary surgeries in raw or sometimes unreleased government data and have raised concerns in Congress and in statehouses about oversight to reduce unneeded procedures.

• In April, following a six-month investigation, CBS News reported that some physicians may have performed excessive numbers of high-cost spinal fusion surgery, which involves joining two or more adjacent vertebrae, often with metal rods and screws. CBS News’ data compilation showed exactly how many spinal fusions each doctor in the country performed on Medicare patients from 2011-2012, under specific billing codes. Federal agencies including the FBI, Department of Justice and INspector General of the department of Health and Human Services are reportedly following up and have opened at least one criminal investigation. In several states, the data is being cross referenced with other information to detect where surgeries might be unnecessary.

• In June, USA Today reported that tens of thousands of unnecessary surgeries are performed each year ranging from stents to angioplasty and pacemkaer implants as well as knee replacements, hysterectomoies, and cesarean sections.

• Because of multiple licenses in different states, many doctors have  revoked licenses in one state but continue to receive hundreds of thousands of dollars in Medicare payments, Bloomberg News reported April 28.

• Close scrutiny by ProPublica, an investigative journalism group, has shown a strong correlation between doctors with unusual Medicare billing patterns and those who have been disciplined by their state medical board.