The Centers for Medicare and Medicaid Services recently released Medicare billing data for the year 2012, creating quite a bit of fanfare and press attention. The data, from the Centers for Medicare & Medicaid Services, was immediately seized upon by numerous news outlets, which widely reported individual physicians who had billed Medicare in excess of $20 million. The data consists of individual billing data from the more than 880,000 Medicare providers billing for services in 2012. These providers billed in excess of $252 billion, and were paid more than $77 billion by Medicare. Notably, not long after news of the data’s release became public, Reuters reported that lawyers all over the country that specialize in representing whistle-blowers under various state, and the federal False Claims Acts had seized on the data and begun looking for new targets, and for additional facts to bolster existing cases. The release of this data is an unprecedented step towards transparency by CMS, and may represent a new age of risk for healthcare providers operating in a highly regulated, broadly enforced environment. While the full impact of the data’s release, and the release of future years’ data may not be known for some time, providers should consider at least a few important points:

Your data is out there, you should know what it says. The press, relator’s counsel, the government and your competitors will be giving new and vigorous attention to your billing practices, and every provider would do well to understand what the data says about them. By thoroughly reviewing your billing data, you can understand how your practices stack up against competitors and the industry at large. Providers billing substantially higher for certain codes and procedures, or generally for certain types of procedures should be on notice that they may be more likely targets for government and private enforcement. Providers billing disproportionately lower amounts, or for lower procedure codes in disproportionately lower instances may be missing important opportunities to build business and maximize legitimate Medicare reimbursement.

Finally, it is not uncommon for fraudsters to obtain and abuse a provider’s number without the provider’s knowledge. Sometimes the theft of a provider’s identity is discovered and resolved quickly, but sometimes it can take months or even years for the discovery to come to light. Providers would be well served by reviewing their own data to ensure that the services they are providing are in line with services being billed under their number. Any disparity, or any evidence of unauthorized billing may need to be reported to appropriate law enforcement authorities.

The release of this data represents the next step in the government’s effort to comb through its own data for patterns and other indicia of fraud. Scrutiny of providers’ billing practices is already at an all-time high, and that scrutiny will only increase as CMS makes its data available to the public, the relator’s bar and the press. Providers need to arm themselves with the information, and be prepared to defend their practices.