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Attempts To Gain Insight Into Billing Practices Of Individual Doctors And Hospitals Thwarted

Within recent decades, there’s been growing concern about the rising costs of health care and the lack of transparency on the parts of physicians, hospitals and insurance providers with regard to those costs. While some states have taken steps to compel health care providers, facilities and private insurance companies to provide detailed information related to the costs of the services provided and specifics related to the coverage of these services, a recent ruling by members of the U.S. Supreme Court indicates that the American public likely won’t be privy to this type of information any time soon.

The court’s recent ruling in this matter was related to a Vermont law that required “health insurers, health providers, medical facilities and government agencies to report data on health care costs, prices, quality and use of services to the state.” Liberty Mutual Insurance Co. objected to the requirement on the basis that the Employee Retirement Income Security Act of 1974 bars states from imposing such provisions upon “self-funded plans” and that such a requirement places an undue burden on insurance companies to comply with individual state laws. Members of the court sided with Liberty Mutual, a move that is being viewed as a major setback for those fighting to provide more transparency into the inner workings of the U.S. health care system and its financial practices.

Today there are reportedly wide variances in what individual doctors and hospitals charge for services and proponents for state and national health care databases contend that understanding why these variances exist is necessary to ensure that “both health care providers and policymakers can understand the variations in the health care system, and address those that need to change.”

Based upon a sampling of Medicare-related data, such changes appear to be necessary. A 2014 ProPublica investigation reviewed the 2012 Medicare billing records of 1,800 physicians and revealed vast differences in the doctors’ billing practices which, some suggest, is indicative of rampant fraud within health care billing.

For example, through their analysis, ProPublica journalists identified some doctors who either exclusively or mostly billed Medicare for patient office visits at the highest level which points to possible cases of “cost-inflating errors and fraud.” When asked to weigh in about these findings, the Centers for Medicare and Medicaid Services released a statement noting that the agency is “working to ensure that physicians and health care providers appropriately bill.”

Source:, “Supreme Court Strikes At States’ Efforts On Health Care Transparency,” Charles Ornstein, March 2, 2016

Pro Publica, “Top Billing: Meet the Docs who Charge Medicare Top Dollar for Office Visits,” Charles Ornstein & Ryann Grochowski Jones, May 15, 2014


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