laptop and stethoscopeCMS has released data sets showing payments to hospitals and physicians for calendar year 2013: the same calendar year as the Sunshine Act data released last fall.  As a result, various sources will have contemporaneous data that could be used to suggest links between industry payments to healthcare providers and their practices, or to otherwise scrutinize perceived outliers in practice patterns.

The public can now download payment data sets that show:

  • Medicare Part B physician data: the payments and submitted charges for services and procedures provided to Medicare beneficiaries by physicians and other healthcare professionals, covering 950,000 providers who received $90 billion in Medicare payments; and
  • Inpatient and outpatient hospital charge data: the average amount that a hospital bills for services that may be provided in an inpatient stay or outpatient visit, collecting the data from over 3,000 hospitals in all 50 states and Washington, D.C.

The data will enable geographic comparisons of cost and utilization of services for physicians and hospitals.  CMS recognizes that the “detailed NPI and HCPCS data file can also be used to examine how patterns of service use vary across physicians and specialties.”

These data sets follow the recent release of Medicare Part D prescription drug data, which may be viewed as showing links between physicians’ financial relationships with drug companies and their drug-prescribing patterns.

Compliance departments should expect that these four data sets – hospital payments, provider Part B payments, provider Part D claims, and Sunshine Act payments – will likely be used by various sources to explore potential conflicts of interest and theories of liability, particularly if the government continues to refresh the data annually.