AMA: Recently Released Medicare Claims Data Inaccurate, Confusing

May 17, 2014 in News

On Thursday, the American Medical Association sent a letter to CMS arguing that critical flaws in the recently released Medicare physician payment data have produced a swath of “sensationalist” media stories and limited the data’s usefulness to the industry, Modern Healthcare reports (Carlson, Modern Healthcare, 5/15).


A federal judge in May 2013 lifted a 33-year-old injunction that barred the government from giving the public access to a confidential database of Medicare insurance claims.

The court injunction stemmed from a lawsuit that the American Medical Association and the Florida Medical Association filed to prevent former President Jimmy Carter’s administration from publishing a list of annual Medicare reimbursements.

The database, known as the Carrier Standard Analytic File, contains information on physicians and other health care providers participating in Medicare who are paid on a fee-for-service basis. It incorporates all physician claims that Medicare paid directly.

The newly released data include information on payments made under Medicare Part B in 2012 to all providers who participated (iHealthBeat, 4/9).

Letter Details

In the letter, AMA CEO James Madara wrote, “Untrained observers are using the data to make flawed regional, specialty or other comparisons that CMS should do more to discourage.”

Specifically, he noted the data have spurred “a series of sensationalist news stories, the majority of which inaccurately reported on the data, confused the public and, in some cases, may have encouraged patients to make care changes that were not in their best interest.”

Madara also highlighted several flaws with the data that he said have undermined the information’s usefulness. For example, he said the data:

  • Exclude services for which a physician met with fewer than 11 patients;
  • Lump together physician payments for expensive drugs into overall physician payments, which inflates totals for specialties that rely on high-cost drugs, such as ophthalmology and oncology; and
  • Fail to note that some physician practices or hospitals submit payments requests under a single provider (Modern Healthcare, 5/15).

In addition, he wrote that a “code-by-code comparison” of the publicly released data and a separate set of comprehensive 2012 Medicare payment claims revealed up to 40% of billing codes were absent, as well as about 179,700 physician claims.


AMA made several recommendations about how CMS should proceed, including:

  • Postponing the release of any older Medicare claims data to avoid compounding the damage of the missing information;
  • Allowing physicians to “correct and explain their data;”
  • Issuing “conspicuous” warnings about the data’s limitations; and
  • Focusing on compiling and distributing “a more selective data set that could help patients and physicians make better care choices.”

Madara wrote, “In our view, the lesson to be learned from the release of raw 2012 physician-specific Medicare claims information is twofold; it requires not only access to data, but understanding the scope, exclusions and limitations of the information.”

CMS officials said the agency had received the letter but declined to comment (Mangan, CNBC, 5/15).

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