Publisher Sues to Gain Access to Physician Payment Database

Dow Jones & Co., publisher of The Wall Street Journal, filed suit Tuesday to overturn a Florida court order that bars public access to a confidential Medicare database that includes the names of physicians and patients, as well as the types of healthcare services performed along with the cost. In a report, the paper said unfettered access to the database is essential to rooting out fraud and abuse in the government health-care program.

“It’s time to overturn an injunction that, for decades, has allowed some doctors to defraud Medicare free from public scrutiny,” Mark Jackson, general counsel for Dow Jones, a unit of News Corp., said in a statement. In 1979,American Medical Association successfully sued the government, arguing that it would violate physicians’ privacy to divulge how much money they received in Medicare reimbursements.

The Journal reported that the AMA has countered at least two attempts to reverse the injunction in 2009. In one case, the U.S. Court of Appeals for the District of Columbia ruled that under the Freedom of Information Act, physician privacy outweighed public interest in knowing how much doctors received from Medicare.

The court filing comes in the wake of the Journal’s series, “Secrets of the System,” which has detailed what it calls abuses and questionable practices within the Medicare system. One article in the series looked into the sharp rise in the use of intensity-modulated radiation therapy (IMRT) and the financial incentives for urologists and radiation oncologists to refer prostate cancer patients for the treatment. Another article looked at how a small group of surgeons earned millions in royalties from medical-device maker Medtronic Inc. performing spinal-fusion procedures on Medicare patients. Information in the articles was based on records that are part of the broader protected Medicare database, but it does not identify physicians by name.

The AMA has argued that the release of billing data for individual doctors would do little to improve care and prevent fraud, the Journal reported. The group has also claimed that disclosing this information would discourage doctors from accepting Medicare.

"The Medicare system is funded by taxpayers, and yet taxpayers are blocked from seeing how their money is spent," said Robert Thomson, the Journal's editor-in-chief. "It is in the interest 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."