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Dow Jones Files Lawsuit Against HHS To Overturn Ruling To Keep Medicare Physician Compensation Confidential In the False Name of

Posted Jan 25 2011 10:38pm

This is the biggest filing to create nothing more than a huge distraction and source of disruption that I have seen this year.  Again, like so many other items we see in the news today, with the general consumer having no idea how data and image mathematics works, this is yet just one more exploit.  I read the articles from the Wall Street Journal that were published and even commented on a couple of them I believe.  Dow Jones is the owner of the Wall Street Journal which I enjoy reading and they do a good job; however, this to me is going one step too far. 

In order to appreciate the bizarre nature of this lawsuit we need a little bit of history here as this should be seen as a witch hunt, which is pretty much what we have here with throwing stones.  This is not the first time the Medicare data base has come under question and for the last 30 years the AMA has blocked the attempts to make such information public.  The Journal found some good examples of a couple of situations to where fraud was found by running algorithmic formulas to find items that were in fact suspicious and with additional follow up, yes there was a lot to question with those 2 doctors.  The Journal as I remember asked for some data to analyze and HHS gave them some sample data to look at. 

image

Moving on here, you have to stop and think of how many years this data has been accumulated, many!  Of all the healthcare data in the US, this is  the grand daddy of all data bases hands down.  The AMA had been able to keep the physician compensation confidential for years and there’s some good reason behind this and that is the fact that there are lots of errors.  Now the Wall Street Journal came back and stated they could find companies that could do a better job with analyzing this data.  This is a huge an expensive process. 

Now I have done many posts on data accuracy on the Medical Quack and you should see what shows up.  I found my former MD who had been dead for 8 years listed and still taking HeatlhNet insurance, now this was not Medicare, this was a company that made millions from the public subscribing and about 6 months ago was sold to a private equity firm, so again look at this example when you use their reasoning about how easy it would be to have a company put it in a format that the public could use…very good food for thought here and this certainly is one who already has flawed data in this department floating all over the web. 

So don’t get your hopes up too high that the data will be accurate and it will even lead to more frustration, but my question arises in my head, does the Dow Jones have someone that needs to make millions doing this for profit?  You know there would be a cost as everything in the financial area is image done for profit and there’s no open free road there.  Why else might they be stirring the pot here?  Just don’t be fooled in thinking this is all just for the sake of transparency as it’s not, even though we will see some as a result but accuracy is questionable.  Here’s the post on Healthgrades that made millions and sold out to private equity.

Health Grades Hospital/Provider Rating Service Purchased by Private Equity Firm

All our law enforcement agencies for sure should have access and the ability to use the data to find fraud.  Now a little more history here about how Medicare works.  Yes there is a big massive data base for claims, but the running of the processing of medical claims is not done by Medicare, it’s administered by contractors who are nothing more than insurance companies or subsidiaries there of, and of course we know this applies to Part D too. This is yet one more profit arm for the health insurers. 

Now why does this happen?  We have have to go back a few administrations and instead of our US government investing in Health IT infrastructure, the decision was made to outsource to insurance companies who have been entrusted to handle the business based on bidding on contracts when they become available.  Now the information here with claims is flawed s Medicare just has what the contractors have delivered in the way of data.  When you think of all the years and all the data resets that have taken place, along with human data input, there are tons of errors and to have all of this publicly displayed, is perhaps not a good idea.

Most of our doctors are not killing a fat hog today within income and getting big compensations from outside sources and are honest like the rest of us, but again think back we have not had this case of business intelligence operating within the government, so we took the word of those contractors and private industry companies that everything was ok and we had little in the way to audit. 

Again based on what I have seen out there on the web with just listings and attempts to rate doctors, it’ flawed and actually CMS is doing a better job than private industry and has fewer “dead doctors” in the data base when searched.

Update on Physician Compare Sites-One MD Reader Found CMS to be More Accurate

The government is working on creating a do not pay list to help in these areas too.

The Creation of a “Do Not Pay List” Announced by Government – Will Help Keep those MDs in the Grave from Cashing In

Again, I will summarize the fact that Health IT has been outsourced and very few resources have been created at the government until the last couple of years.  To remind all of this fact, look at how the White House still had many computers running Windows 98 when the Obama Administration came in, tells you where the Bush administration priorities were <grin>.

The current administration was a bit slow with their Health IT priorities which 2 years ago concerned me as well with an HHS department not delving in immediate into Health IT and I even questioned whether or not we had the right person at the top.   I commented that this position in 2 years was going to be about 80% technology and using algorithmic formulas and I didn’t miss on that item. Now here’s what’s being done and these are posts made recently in the last few months, so CMS and HHS is on the move. 

CMS Releases Plan for a Much Needed IT Infrastructure Upgrade With Computers, Data Systems And Those Updated Algorithms

Now all of this said, what is the Dow Jones and their lawsuit with getting data out there going to do? 

Is the general public going to be able to do anything about it, no.  I’m not defending the AMA here, but I am rather talking about data and not fleecing the American Public with additional frustrations with data they can’t fix

It will only serve to frustrate and distract people from keeping on track and in essence look away from the the formulas being run on Wall Street for profits, those Algos as that’s what’s making the money.  I see this as an emotional grand staging effort to keep individuals distracted over something they cannot do much about, and thus Dow Jones, in view of how all of this has has grown over the years.

When HHS has awarded contracts, in some areas what choices have they had other than to give some to the insurance companies that have not only the data but the algorithmic systems that collect transaction fees and make millions, so there has not bee a lot of choice here. 

One other thought here, how do the doctors feel about this?  They already know they are marketed and sold all over the place, even with their own AMA selling their data for profit, but how is erroneous information on good doctors that is flawed going to make them feel?  Again, the ones we are looking for in the fraud area are the exceptions and not the rule, unlike what we kind of see on Wall Street at times it seems. 

Doctors are people too and the ones we want to have confidence in to take care of us and do you know what this type of activity does for them, not much and with additional pressures we lose more of them as they get tired and don’t want to put up with it, sad to say. 

Many of these MDs are working hard to get electronic medical records going in their practices to keep up to date and give better patient care, but their thanks is going to be an accessible data base that perhaps shows a flawed side of compensation that may not be accurate?  They are also working on accountable care organizations structures, and oh yes….they are seeing patients too.  They have a lot on their plates today. 

Again if you look back and see who’s catching the fraudulent activity, it’s the government with little help from the contractors as they do not want to give up the transaction fees as they all pay, legit ones and the fraudulent claims.  Here’s a link that will explain that connection and how we need to look at how subsidiaries of companies work today. 

It’s not the same as it was 2 years ago as everyone is working an angle for profit with their algorithms.  An insurance company is also doing the IT work to monitor the stimulus incentive payments, again contracted as the IT infrastructure was not built over the years.  With the new algorithmic business intelligence being formed, federal investigators are going to have access.

In summary the Dow Jones has gone too far for a dog and pony show and should give the government a chance to begin working their new system without out this exploitation to upset and distract consumers with an OMG story they can do nothing about. 

The current campaign of awareness and advertisements for consumers for awareness and education will work if allowed to carry through without additional and undo disruptions and disruptive lawsuits such as this one, and again, nobody’s talking about how it makes the doctors feel as mentioned above there will be flaws and errors that will have unintended consequences.  I want those committing fraud caught just as much as the next person but this exploitation is no the answer and the name “Secrets of the System” seems to imply that this is something that has been done with a purpose of some type of sinister secrecy pact. 

The Dow Jones should rethink their actions quickly and stop the unnecessary law suit that will stand to benefit nobody.

I work with data and know what I’m talking about here so “first hand” experience trumps all when it comes to trying to give honest credible information to readers.  BD

Press Release:

NEW YORK (January 25, 2011) - The publisher of The Wall Street Journal filed court papers today to overturn a 31-year-old court injunction that blocks public access to records containing evidence of Medicare fraud and the doctors behind it.

The filing by Dow Jones & Company, in the U.S. District Court for the Middle District of Florida, seeks to overturn an injunction obtained by the American Medical Association in 1979. The injunction prevents the public from knowing how much taxpayer money individual doctors receive from the Medicare program. As a result, The Wall Street Journal and other news organizations are barred from fully investigating and exposing abuses in the $500 billion system. 

The legal action follows a series of articles in The Wall Street Journal last year, “Secrets of the System,” that relied on a sampling of the government’s closely guarded Medicare databases. The series highlighted suspicious billing, potential abuses of the system and the government’s role in policing Medicare payments.

However, the 1979 injunction constrained the Journal’s investigation and what it could tell its readers because it limited the Journal to only a subset of the data. In addition, the government would only release the limited subset of data if the Journal agreed not to disclose the identities of individual doctors in the databases.

“It is time to overturn an injunction that, for decades, has allowed some doctors to defraud Medicare free from public scrutiny,” said Mark H. Jackson, general counsel for Dow Jones. “The public has a significant interest in learning whether doctors are fleecing the system, the extent of the problem, and whether the government has been effective in stopping such abuse.”

This effort will not compromise patient confidentiality, Jackson added.

“The Medicare system is funded by taxpayers and yet taxpayers are blocked from seeing how their money is spent,” said Robert Thomson, editor in chief of The Wall Street Journal. “It is in the interests of law-abiding practitioners that those who are gaming the system are exposed. Unless funds are used efficiently and intelligently, the health of the nation, physically and fiscally, will be undermined.”

The Journal series revealed how Medicare reimbursement policies and doctors’ relationships with private companies in the industry could be giving doctors an incentive to bill for unnecessary and high-cost procedures. It also reported on several doctors with questionable billing practices, including one doctor who took home more than $2 million from Medicare in 2008 by billing for an improbable number of obscure medical tests and another who received more than $8.1 million from Medicare over three years while treating a suspiciously high percentage of patients with an extremely rare condition.  Because of the injunction, neither doctor could be named in the articles.

The law firm of Davis Wright Tremaine LLP is representing Dow Jones in this matter. Court papers filed by Dow Jones in this action can be found here .

About Dow Jones

Dow Jones & Company is a global provider of news and business information and a developer of technology to deliver content to consumers and organizations across multiple platforms. Dow Jones produces newspapers, newswires, Web sites, apps, newsletters, magazines, proprietary databases, conferences, radio and video.  Its premier brands include The Wall Street Journal, Dow Jones Newswires, Factiva, Barron’s, MarketWatch, SmartMoney and All Things D. Its information services combine technology with news and data to support business decision making. The company pioneered the first successful paid online news site and its industry leading innovation enables it to serve customers wherever they may be, via the Web, mobile devices and tablets. The Dow Jones Local Media Group publishes community newspapers, Web sites and other products in six U.S. states. Dow Jones & Company (www.dowjones.com) is a News Corporation company (NASDAQ: NWS, NWSA; ASX: NWS, NWSLV; www.newscorp.com).

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