[Congressional Record Volume 157, Number 50 (Thursday, April 7, 2011)]
[Senate]
[Pages S2268-S2269]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
By Mr. GRASSLEY (for himself and Mr. Wyden):
S. 756. A bill to amend title XI of the Social Security Act to
provide for the public availability of Medicare claims data; to the
Committee on Finance.
Mr. GRASSLEY. Mr. President, in March, I introduced S. 454, the
Strengthening Program Integrity and Accountability in Health Care Act,
to enhance the government's ability to combat Medicare and Medicaid
fraud.
One of the provisions in that bill would require the Secretary of
Health and Human Services to issue regulations to make Medicare claims
and payment data available to the public similar to other federal
spending disclosed on www.USAspending.gov.
That website was created by legislation sponsored by then-Senator
Obama and Senator Coburn. It lists almost all federal spending, but it
doesn't include Medicare payments made to physicians.
That means virtually every other government program, including some
defense spending, is more transparent than spending by the Medicare
program.
Medicare is funded by taxpayers, and in 2009, the federal government
spent $502 billion on Medicare.
Taxpayers should have a right to see how their hard-earned dollars
are being spent.
Also, if doctors know their billing information is public, it might
deter some wasteful practices and overbilling.
On the day that I introduced S. 454, I learned that Senator Wyden was
also working on legislation to make Medicare payments to physicians
available to the public. We decided to work together.
Today, Senator Wyden and I are introducing the Medicare Data Access
for Transparency and Accountability Act, Medicare DATA Act.
This bill would require the Secretary of Health and Human Services to
issue regulations to make available a searchable Medicare payment
database that the public can access at no cost.
Our bill also clarifies that data on Medicare payments to physicians
and suppliers do not fall under a Freedom of Information Act, FOIA,
exemption.
Under a 1979 court decision, Medicare is prohibited from releasing
physicians' billing information to the public.
But before that injunction, the Department of Health, Education, and
Welfare--now the Department of Health and Human Services--was in the
process of releasing reimbursement data for all Medicare providers.
Third parties that have tried to obtain physician specific data
through the FOIA process have failed in the past because the courts
held that physicians' privacy interests outweigh the public's interest
in disclosure.
The nonprofit, consumer organization--Consumers' Checkbook--for
example, had filed a lawsuit against the Department of Health and Human
Services to compel disclosure of that data.
The organization made its FOIA request to determine whether or not
Medicare paid physicians who had the qualifications to perform the
services for which they sought federal reimbursement, especially those
performing a high volume of difficult procedures.
In particular, the organization was looking for physicians with
insufficient board certifications or histories of disciplinary actions.
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?
And why wouldn't we want public interest watchdog groups helping to
look out for potential abuse or fraud?
In January, the Wall Street Journal reported the American Medical
Association's, AMA, concerns about making
[[Page S2269]]
Medicare claims data publicly available.
The AMA President said that physicians ``should not suffer the
consequences of having false or misleading conclusions drawn from
complex Medicare data that has significant limitations.''
But I would like to note the value of access to Medicare billing
data.
Even with limited access, the Wall Street Journal was able to
identify suspicious billing patterns and potential abuses of the
Medicare system.
The Wall Street Journal found cases where Medicare paid millions to a
physician, sometimes for several years, before those questionable
payments stopped.
Volume alone doesn't automatically mean there's fraud, waste, or
abuse.
More patients may be going to a specific physician for a particular
service because that physician is a leader in his or her field.
Nonetheless, to alleviate the concerns raised by the American Medical
Association, our bill would require a disclaimer that the data in the
public database ``does not reflect on the quality of the items of
services furnished or of the provider of services or supplier who
furnished the items or services.''
I believe transparency in the health care system leads to more
accountability and thus less waste and more efficient use of scarce
resources.
I have often quoted Justice Brandeis, who said, ``Sunlight is the
best disinfectant.''
That is what Senator Wyden and I are aiming to accomplish with the
Medicare DATA Act.
When it comes to public programs like Medicare, the Federal
Government needs all the help it can get to identify and combat fraud,
waste and abuse.
Our bill will add to the reforms Congress passed last year.
Mr. President, I ask unanimous consent that the text of the bill be
printed in the Record.
There being no objection, the text of the bill was ordered to be
printed in the Record, as follows:
S. 756
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Medicare Data Access for
Transparency and Accountability Act''.
SEC. 2. PUBLIC AVAILABILITY OF MEDICARE CLAIMS DATA.
(a) In General.--Section 1128J of the Social Security Act
(42 U.S.C. 1320a-7k) is amended by adding at the end the
following new subsection:
``(f) Public Availability of Medicare Claims Data.--
``(1) In general.--The Secretary shall, to the extent
consistent with applicable information, privacy, security,
and disclosure laws, including the regulations promulgated
under the Health Insurance Portability and Accountability Act
of 1996 and section 552a of title 5, United States Code, make
available to the public claims and payment data of the
Department of Health and Human Services related to title
XVIII, including data on payments made to any provider of
services or supplier under such title.
``(2) Implementation.--
``(A) In general.--Not later than December 31, 2012, the
Secretary shall promulgate regulations to carry out this
subsection.
``(B) Requirements.--The regulations promulgated under
subparagraph (A) shall ensure that--
``(i) the data described in paragraph (1) is made available
to the public through a searchable database that the public
can access at no cost;
``(ii) such database--
``(I) includes the amount paid to each provider of services
or supplier under title XVIII, the items or services for
which such payment was made, and the location of the provider
of services or supplier;
``(II) is organized based on the specialty or the type of
provider of services or supplier involved;
``(III) is searchable based on the type of items or
services furnished; and
``(IV) includes a disclaimer that the aggregate data in the
database does not reflect on the quality of the items or
services furnished or of the provider of services or supplier
who furnished the items or services; and
``(iii) each provider of services or supplier in the
database is identified by a unique identifier that is
available to the public (such as the National Provider
Identifier of the provider of services or supplier).
``(C) Scope of data.--The database shall include data for
fiscal year 2012, and each year fiscal year thereafter.''.
(b) Information Not Exempt Under the Freedom of Information
Act.--The term ``personnel and medical files and similar
files the disclosure of which would constitute a clearly
unwarranted invasion of personal privacy'', as used in
section 552(b)(6) of title 5, United States Code, does not
include the information required to be made available to the
public under section 1128J(f) of the Social Security Act, as
added by subsection (a).
Mr. WYDEN. Mr. President, I rise today with Senator Grassley to
introduce the Medicare Data Access for Transparency and Accountability
Act. I would like to begin by thanking my friend and esteemed colleague
for his unwavering commitment to greater transparency and
accountability in government. This Medicare DATA Act advances that
goal.
Sunshine continues to be the greatest disinfectant. In that light,
the Medicare DATA Act ensures all taxpayers have access to the Medicare
Claims Database, both to aid them in making medical decisions, and in
understanding what their money is paying for in this vital, yet
enormous, health program. Making this information public will also help
prevent wasteful spending and outright fraud in Medicare claims. The
Medicare Claims Database is an important resource for public and
private stakeholders as it captures healthcare provider payment and
claims information for roughly 1/3 of the United States healthcare
system. But why isn't this information already available?
In 1978, the Department of Health Education and Welfare attempted to
release this information, upon request, under the premise that
accessibility to the source data was in the public interest and
therefore should be made available for public consumption. An
injunction by a Florida court, however, successfully blocked that
public disclosure of this information. As a result, this data has
been--with limited exceptions made for government employees,
contractors, and researchers willing to pay for partial access--off
limits for the last three decades. Passage of the Medicare DATA Act
puts an end to that practice.
I consider hiding information affecting the American taxpayer that
clearly should be in the public domain, to be indefensible in a free
society. With this principle in mind, I join with Senator Grassley in
changing ``business as usual.''
I urge my colleagues to support this legislation so that Medicare
data is finally fully transparent and available to Medicare
beneficiaries and taxpayers alike. I look forward to working with my
colleagues in this effort.
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