OIG: Feds Don't Know Who's Opted Out of Medicare

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Published 02/09/2012 - 5:46 a.m. CDT

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Medpagetoday.com REPORTS HERE that "Medicare and its contractors don't adequately track which physicians are opting out of Medicare, making it nearly impossible to determine who is cutting ties with the program and why, according to a memo from the Department of Health and Human Services' Office of the Inspector General (OIG). The data were so bad that "[w]e cannot determine the characteristics of physicians who opt out of Medicare, the trend in the number of opted-out physicians, or why physicians choose to opt out of Medicare."

"Based on the incomplete data, however, the number of physicians who opt out appears to have increased each year from 2006 to 2010 …. But, he noted, more physicians may opt out in the near future because of scheduled cuts in reimbursement."

"For instance, last summer the Texas Medical Association released survey data that showed that at least half of the doctors in the Lone Star state said they'd cut ties with Medicare if a cut went into effect."

"…It is important to keep track of which physicians no longer participate with Medicare to ensure that they aren't paid erroneously. It's also important for the government to know which doctors aren't participating in Medicare so it can keep track of geographic areas where it may be difficult for Medicare beneficiaries to find a provider. But Medicare contractors didn't keep good track of the data, and neither did CMS, OIG found."

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