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Medicare billing confidentiality allows huge fraud to persist

A recent article in The Wall Street Journal suggests that the confidentiality of doctors’ Medicare billing practices has allowed for instances of enormous fraud and abuse to go unchecked. The article highlights a number of top billers of Medicare, many of whose opulent lifestyles have been substantially funded by fraudulently misallocated taxpayer dollars.

Among those profiled is Christopher G. Wayne, known as “Rock Doc” and seen posing with celebrities Paris Hilton and Steven Tyler on his Myspace page. Dr. Wayne received more than $2.6 million from Medicare between 2007 and 2009, largely from an unusual combination of physical therapies that he provided and billed for.

The Journal article provides a number of other examples of grossly above-average Medicare billers, some of whom have received figures in the tens of millions of dollars from the Medicare program. Tellingly, all of the names generated in the article resulted from just a small sample of Medicare billing information (only 5% from 2008) that was made available to the Journal and the Center for Public Integrity.

There are many who share the opinion that the extreme confidentiality doctors currently enjoy with regards to their Medicare billing creates an environment excessively conducive to fraud. Additionally, almost all claims are paid out within 30 days, making overpayments difficult to recover. However, the Centers for Medicare and Medicaid Services (CMS) is in position to make substantially more effective use its database to identify fraud. According to Peter Budetti, the head of CMS’s new antifraud arm, “fraud prevention is our new emphasis.”

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