Secret Medicare Database Keeps Fraud From Public

In a blow to government transparency, a federal database that can expose fraud in the nation’s largest taxpayer-funded medical program is off limits to the public because an influential trade group wants the information to be kept secret.

As a result, the American public is banned from accessing details of how tens of billions of tax dollars are spent on Medicare, the federal insurance program for the elderly and disabled. That’s because the country’s powerful doctors’ trade group, American Medical Association, sued the government more than 30 years ago to keep private how much money physicians get from Medicare.

In 2009 that amounted to $62.5 billion, some of which was billed fraudulently by crooked practitioners, according to an in-depth probe conducted by the nation’s largest newspaper. After a year-long battle with the government agency(Department of Health and Human Services)that keeps the computerized Medicare records, the paper finally accessed the information though it came with restrictions.

Financed by U.S. taxpayers, the extensive database tracks all the money Medicare pays for medical treatment. Reporters were prohibited from naming physicians, even in cases where outright fraud had been committed by the doctor. One example featured a New York family practice doctor who billed Medicare more than $2 million in one year alone for highly questionable procedures.

If the database were fully available to public scrutiny, perhaps waste in the fraud-infested Medicare program could be exposed regularly. After all, federal investigators use the secret database to root out corruption although they aren’t very efficient at doing it.

In the last few months, several huge Medicare fraud schemes have been busted around the country and many had been operating for years without being detected. Most recently an Armenian crime syndicate got charged for billing Medicare more than $100 million for treatments that no doctor ever performed and no patient ever received in bogus clinics throughout the U.S.

Before that 94 people—including doctors—were charged with submitting more than $251 million in false Medicare claims in several states, including Florida, Texas, Michigan and New York. Among them was a veteran Miami physician charged with submitting about $103 million in fraudulent bills.