Expect to see more rules, regulations and lawsuits as healthcare data transparency increases, says Ellyn Sternfield, an attorney specializing in health law and managed care with international law firm Mintz Levin, in an article published this week in the National Law Review.
Talking about the Centers for Medicare & Medicaid Services' recent public disclosure of Medicare claims processing data online, including hospital price-comparison information, Sternfield refers to data as the "lifeblood of healthcare fraud enforcement efforts."
"It is clear that through integrated databases, government investigators are gaining enhanced access to Medicaid and Medicare data that will be mined and analyzed to develop future healthcare enforcement cases," she writes. "It is also clear that insurers, the media, class action counsel and potential qui tam whistleblowers also may soon be mining this newly available data to identify potential outliers and develop their own healthcare-based litigation efforts."
Earlier this month, Sens. Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.) introduced legislation that would open up all Medicare claims to public scrutiny, noting that additional Medicare claims transparency could curb wasteful overspending. The senators' proposed bill--the Medicare Data Access for Transparency and Accountability Act--would require the Secretary of the U.S. Department of Health & Human Services to issue regulations to make a searchable Medicare payment database available for free online. The bill also makes clear that data on Medicare payments to physicians and suppliers don't qualify as Freedom of Information Act exemptions.
Despite such measures, research published in the Journal of the American Medical Association this month found that hospital price-comparison websites are of little use to consumers.
To learn more:
- read Sternfield's article