Sens. Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.) recently introduced a bill that they say would curtail fraud, but opponents say its value is dubious.
The "Medicare Data Access for Transparency and Accountability Act," if passed, would give the public access at no cost to a database of Medicare payments made to physicians.
"Taxpayers should have a right to see how their hard-earned dollars are being spent," said Grassley in remarks introducing the bill.
"Shedding light on Medicare claims will be helpful to those making medical decisions, offer insight into how Medicare dollars are being spent and prevent wasteful spending and fraud," Wyden said in a press release. "All of which begs the question, 'Why isn't this information already available?'"
The information has been protected by a 1979 court decision that prohibits Medicare from releasing physicians' billing information to the public.
The American Medical Association has responded to the bill, saying that it, the Department of Health and Human Services and some physician organizations are opposed to the public release of doctors' Medicare billing information.
"Releasing Medicare claims data to the public does not further the goal of combating fraud, as those tasked with this responsibility already have access to the data," said Ardis Dee Hoven, MD, chairperson of the AMA's Board of Trustees.
Grassley and Wyden said they believe other organizations, such as consumer groups, should be able to access the claims data.
"My question is, 'Why wouldn't we want individuals examining this data to ensure that the government is protecting taxpayer dollars by preventing improper billing to the Medicare program?'" Grassley asked in introducing the bill.
"I think it's a good thing, basically – bottom line. I think transparency is a very good thing," said Shannon Brownlee, the acting director of New American Foundation Health Policy Program and author of "Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer."
However, she said, the bill's focus on curtailing fraud may be misguided.
"I guess I've never thought fraud was that big a deal," she said. "It's certainly part of the problem in Medicare but it's not the lion's share of why Medicare spends too much and why Medicare costs are going up faster than GDP. It's not fraud that's driving that curve."
"Fraud is a certain percentage of how much Medicare spends. Going after fraud is a perfectly valuable thing to do, but in terms of how do you constrain Medicare spending, the things we really ought to be going after is waste and in healthcare the waste piece of it is mostly unnecessary care," she added.
A byproduct of the bill may be the revelation of unnecessary care. "You would start to see who the high fliers were," she said.
This would shine a light on doctors who show higher activity – which could be the result of practice patterns, geography or advertising or due to over-treatment, over-coding or fraud, said John Maa, MD, an assistant professor of the University of California, San Francisco's Department of Surgery.
"Making the data available on a database may serve as a deterrent to physicians who might be tempted to overbill/over-treat, and now realize that the public is monitoring what they are doing," Maa said.
The American Academy of Family Physicians has long supported anti-fraud activity, particularly legislative efforts, said the organization's president, Roland Goertz, MD, but it is concerned that the data revealed will not be properly understood by those reading it.
"This bill appears to go in that direction (transparency and fraud deterrence), but the details of it are such that we're always worried by the unintended consequences," he said. "Is accomplishing those two things going to accomplish the correct outcome – having a better system – or are you simply going to complicate the world because the data is not understood well enough?"