Journal seeks to end ban on Medicare data
National News
The publisher of The Wall Street Journal went to court Tuesday seeking to overturn a 31-year ban on the release of records about how much Medicare money individual doctors receive.
Dow Jones & Company Inc. filed papers in federal court in Orlando in an effort to end a prohibition that was implemented in 1979 following a successful lawsuit in Florida by the American Medical Association.
Dow Jones called the ban outdated and said it had limited the data reporters for The Wall Street Journal were able to obtain last year for a series of stories that examined abuses in the Medicare system.
"There is no legally supportable justification for maintaining a sweeping and obsolete injunction that for over thirty years has prevented the American public from knowing the true extent of Medicare waste, abuse and fraud," Dow Jones said in its filing.
The president of the American Medical Association said that members of the public could draw misleading conclusions from the data if it is released, given its complexity and "significant limitations."
"Physicians who provide care to Medicare patients are already subject to widespread governmental oversight," Dr. Cecil Wilson of Winter Park, Fla., said in a statement. "These federal agencies and contractors have access to the full range of Medicare data and are aggressively ferreting out improper claims."
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Workers’ Compensation Subrogation of Administrative Fees and Costs
When a worker covered by workers’ compensation makes a claim against a third party, the workers’ compensation insurance retains the right to subrogate against any recovery from that third party for all benefits paid to or on behalf of a claimant injured at work. When subrogating for more than basic medical and indemnity benefits, the Texas workers’ compensation subrogation statute provides that “the net amount recovered by a claimant in a third‑party action shall be used to reimburse the carrier for benefits, including medical benefits that have been paid for the compensable injury.” TX Labor Code § 417.002.
In fact, all 50 states provide for similar subrogation. However, none of them precisely outlines which payments or costs paid by a compensation carrier constitute “compensation” and can be recovered. The result is industry-wide confusion and an ongoing debate and argument with claimants’ attorneys over what can and can’t be included in a carrier’s lien for recovery purposes.
In addition to medical expenses, death benefits, funeral costs and/or indemnity benefits for lost wages and loss of earning capacity resulting from a compensable injury, workers’ compensation insurance carriers also expend considerable dollars for case management costs, medical bill audit fees, rehabilitation benefits, nurse case worker fees, and other similar fees. They also incur other expenses in conjunction with the handling and adjusting of workers’ compensation claims. Workers’ compensation carriers typically assert, of course, that, they are entitled to reimbursement for such expenditures when it recovers its workers’ compensation lien. Injured workers and their attorneys disagree.