OPM is in the process of creating an all payer claims database for the FEHBP. A similar database has existed for the Medicare Program (and it doesn't seem to have helped too much). The Medicare database is subject to Freedom of Information Act requests. Many moons ago, the American Medical Association obtained a federal court injunction stating that CMS cannot disclose the identities of physicians who receive Medicare payments when it answers those FOIA requests. Last year, the Wall Street Journal studied the data that it could obtain from the database and it found (SHOCK!) patters of Medicare fraud. On Friday, the Wall Street Journal reports that
A New York-area family-practice doctor [Dr. Emma Poroger] who was featured in a Wall Street Journal articleabout Medicare abuses last year was indicted by a federal grand jury this week for allegedly submitting more than $13 million of false claims to the program.
* * *The Journal has gone to court in an effort to overturn the AMA injunction.
\Dr. Poroger, 56 years old, is the second health-care professional cited in a series of Journal articles about Medicare abuses who has since been indicted. A Brooklyn physical therapist, Aleksandr Kharkover, pleaded guilty in May to submitting fraudulent claims to Medicare for services that were medically unnecessary and never performed.
Another doctor featured in the series, Theresa Rice, has been suspended by the Texas medical board. And a fourth, Portland neurosurgeon Vishal James Makker, is under investigation by the Oregon medical board and is no longer allowed to operate on patients without supervision.
Modern Physician reports that Sen Charles Grassley (R Iowa) is challenging the Health and Human Services Department's decision to close public access to a separate data base known as the National Practioner Database that contains information on medical malpractice awards and sanctions against doctors.
On a related note the Privacy, Technology and the Law subcommittee of the Senate Judiciary Committee will be holding a hearing Wednesday afternoon about protecting potected health information in a digital world.
AHIP announced last week that
A new technical analysis by Oliver Wyman estimates that the new health insurance tax in the Affordable Care Act (ACA) “will increase premiums in the insured market on average by 1.9% to 2.3% in 2014,” and by 2023 “will increase premiums 2.8% to 3.7%.”Ironically this tax, which takes effect in 2014, will fall predominately on the insured plans in the health insurance exchanges that serve individuals and small business. It also adversely impacts insured FEHBP plans like the Federal Employees Plan and the HMOs participating in the Program. Self-insured plans, Medicare, and Medicaid, are exempt from the tax.