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\nWASHINGTON \u2014 The Obama administration is cracking down on doctors who repeatedly overcharge Medicare<\/a> patients, and for the first time in more than 30 years the government may disclose how much is paid to individual doctors treating Medicare patients.<\/p>\n
Marilyn B. Tavenner, the administrator of the Centers for Medicare and Medicaid Services, said that \u201crecalcitrant providers\u201d would face civil fines and could be expelled from Medicare and other federal health programs.<\/p>\n
In a directive<\/a> that took effect on Jan. 15 but received little attention, Ms. Tavenner indicated that the agency was losing patience with habitual offenders. She ordered new steps to identify and punish such doctors. <\/p>\n
A recalcitrant provider is defined as one who is \u201cabusing the program and not changing inappropriate behavior even after extensive education to address these behaviors.\u201d Cases will be referred to Daniel R. Levinson, the inspector general at the Department of Health and Human Services, who has authority to impose civil fines and exclude doctors from Medicare, Medicaid<\/a> and other programs. <\/p>\n
Federal officials estimate that 10 percent of payments in the traditional fee-for-service Medicare program are improper. That would suggest at least $6 billion a year in improper payments under Medicare\u2019s physician fee schedule. But Malcolm K. Sparrow, a Harvard professor and an expert on health care fraud, has said the losses could be greater because the official statistics \u201cfail to accurately capture fraud rates\u201d in Medicare.<\/p>\n
A new section of the Medicare manual encourages the use of fines to penalize doctors who generate a pattern of claims for goods and services that they know or \u201cshould know\u201d are not medically necessary. Providers can also be barred from Medicare if they bill the program for \u201cexcessive charges\u201d or for services substantially in excess of patients\u2019 needs.<\/p>\n
In a new report<\/a>, Mr. Levinson said Medicare officials and contractors should focus on doctors with the highest Medicare billings because they often received improper payments. He said that about 300 doctors received more than $3 million each in yearly Medicare payments and that one-third of them had been singled out for special reviews because of questionable billings.<\/p>\n<\/blockquote>\n