CMS recently announced that it would be releasing Medicare hospital utilization and payment data, as well as physician and supplier utilization and payment data. This is the third year that the hospital data has been released and the second year that the physician data has been released.
Acting CMS Administrator Andy Slavitt explained that “[t]hese data releases will give patients, researchers, and providers continued access to information to transform the health care delivery system.” Mr. Slavitt further stated that “[i]t’s important for consumers, their providers, researchers and other stakeholders to understand the delivery of care and spending under the Medicare program.”
The data at issue is wide-ranging and pertains to more than 3,000 hospitals throughout the country and to the 100 most common Medicare inpatient stays and 30 outpatient procedures that are performed at such hospitals. The recently released physician and supplier data relates to nearly 1,000,000 such providers and includes information on procedures and services that are provided to Medicare beneficiaries while allowing for comparisons between different providers.
Providers should take note of CMS’s decision to release this information because it reflects the Government’s continued efforts to increase transparency in the healthcare delivery system. This data also has potential ramifications in the context of the False Claims Act. As an initial matter, the Government is monitoring such information. Government attorneys may identify outliers that are reflected in such data and rely upon such information to identify potential targets for investigation. Moreover, with the substantial increase in the number of qui tam lawsuits that are filed annually (from 379 cases filed in 2008 to 713 cases filed in 2014), this information may serve as an additional data point that is relied upon by relators.
It is important to note that an implication of wrongdoing cannot properly be drawn simply from the data reflecting a hospital or physician’s place on these lists. However, the increased scrutiny that may be created by this release of data serves as a further reminder of the need to emphasize compliance and ensure careful, patient specific billing that is accurate and pertains to the provision of medically necessary services.