Lawyers Analyze Online Physician Payment Data for Potential Fraud

April 14, 2014 in News

Immediately following CMS’ release of Medicare payment data last week, lawyers who specialize in representing health care fraud whistleblowers began mining the information for possible indications of fraud, Reuters reports.

Such lawyers focus on bringing cases against drugmakers and providers on behalf of employees who think other workers might be committing Medicare fraud (Baynes, Reuters, 4/14).


On Wednesday, CMS publicly released the data for the first time since 1979, showing the program paid out $77 billion to more than 880,000 health care providers in 2012. The data included information on payments made under Medicare Part B to all participating providers (iHealthBeat, 4/10).

New Effort To Combat Fraud

According to Reuters, settlements resulting from whistleblower cases can be substantial, with the whistleblowers receiving up to 30% of the government’s recovered funds. Typically, lawyers receive about 40% of the whistleblower’s award.

Patrick Burns, co-director of Taxpayers Against Fraud, said that he was contacted by a group of lawyers right after the release asking for his help accessing the data, which is available to the public online.

Attorney Marc Raspanti, who currently has several Medicare fraud cases pending against drugmakers for allegedly providing kickbacks to providers, said he is analyzing the data to see if physicians are prescribing a suspiciously high amount of certain drugs, which could bolster his allegations.

In addition, whistleblower lawyer Reuben Guttman said the data could help direct lawyers to other targets or possible witnesses in already filed cases.

Meanwhile, other lawyers have said that the data could point to leads for new fraud allegations. According to Reuters, lawyers would still need to find clients who have inside knowledge of alleged fraud.

Still, the data allow for employees who suspect fraud to now see whether their employers’ billing seems out of line with similar providers, according to Reuters (Reuters, 4/14).

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