Yes! Radiation oncology is #2

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

seper

Full Member
10+ Year Member
Joined
Dec 22, 2010
Messages
2,175
Reaction score
1,262
In average Medicare payout per provider.

http://online.wsj.com/news/articles...90043350808268.html?mod=WSJ_hp_LEFTTopStories
(paywal, googlable)

Among the procedures that contributed to the highest billings, excluding the drugs and supplies that drove up many ophthalmologists' and medical oncologists' billings, is intensity-modulated radiation therapy, in which doctors shoot high-powered beams of radiation at tumors.
IMRT has come under government scrutiny for its high costs and because some physicians refer patients to facilities in which they have an ownership stake. The 37 most highly paid radiation oncologists received $63 million for delivering the treatments.
The specialists' payments appear high because a large portion of the money is often tied to the staff, equipment and other expenses of offering the treatment, said David Beyer, a radiation oncologist who is former chairman of the health-policy council of the American Society for Radiation Oncology, responding to questions about the OIG report.

Members don't see this ad.
 
And Hem/Onc is #1!

Not surprising. To deliver radiation you need to buy a treatment machine that costs $4 million (which doesn't include expensive maintenance service contracts), a treatment vault that costs $750k, and you have multiple employees with annual salaries of > $80-150k/year (dosimetrists, therapists, physicists). Plus we have to pay the power bills (the electrical energy for generating 15 MV photons is not the same as a light bulb), federal/state certifications, credentialing fees for hospitals, facilities maintenance, etc. etc. Not exactly the same as a surgeon or PCP hanging up a shingle and starting a solo practice with three employees.

95% of our profits are eaten by the above. As you can see, this is a multi-factorial issue and not simply "Rad Oncs are paid too much."
 
I am interested whether these data can be used to identify and purge RadOnc outliers :)
 
Members don't see this ad :)
Not to mention that a lot of free standing centers are billing technical fees in the rad oncs name, but he/she may not have any ownership (or only a very small) stake in that machine/facility and is making nowhere near what they are appearing to bill out on this database.

I'm not 100% confident but I think this may apply to those working for 21st Century Oncology or similar entities.
 
I am interested whether these data can be used to identify and purge RadOnc outliers :)

Start typing in your favorite docs ;)

http://www.washingtonpost.com/wp-srv/special/national/medicare-doctors-database/

Not to mention that a lot of free standing centers are billing technical fees in the rad oncs name, but he/she may not have any ownership (or only a very small) stake in that machine/facility and is making nowhere near what they are appearing to bill out on this database.

I'm not 100% confident but I think this may apply to those working for 21st Century Oncology or similar entities.

Looking at the data, I too believe this is the case
 
I am interested whether these data can be used to identify and purge RadOnc outliers :)

Bold statement there, professor, especially with the use of "purge." You want to get rid of high billing radoncs? For what reason? Say you're the only radonc in Texarcana, so there's no competition. You, as a result, work incredibly hard to treat all the patients in your community, but would be considered an outlier because of your large practice. That's enough to get you on the "purge" list? Why, because "seper" thinks you shouldn't be making that much? I used Texarcana because there IS an outlier there. Feel free to move to Texarcana and compete with her, and you'll find out exactly why she doesn't have a ton of competition and is treating so many patients.
 
I agree with BobbyHeenan. I see multiple 21st century docs in Florida over 3.5 million :greedy:. Some other private docs I know with standalone centers are also in that ballpark. Meanwhile, the academic physicians I looked up have very low numbers despite having decent volumes. The hospital systems must be billing the technical fees directly and not attributing them to the physicians. That would skew the numbers to make it appear that private docs are gaming the system. I don't believe that private docs are making more per patient considering hospital systems get to charge more for providing the same services. I've seen what I consider reasonable and unreasonable practices on both sides of the PP/academic fence.
 
Last edited:
I'm talking about those engaging in outright Medicare fraud, e.g. whole brain to 45 Gy/25 fx using "scalp sparing IMRT".
These data can probably be used by to make a shortlist of contenders, and then manually audit those.

Bold statement there, professor, especially with the use of "purge." You want to get rid of high billing radoncs? For what reason? Say you're the only radonc in Texarcana, so there's no competition. You, as a result, work incredibly hard to treat all the patients in your community, but would be considered an outlier because of your large practice. That's enough to get you on the "purge" list? Why, because "seper" thinks you shouldn't be making that much? I used Texarcana because there IS an outlier there. Feel free to move to Texarcana and compete with her, and you'll find out exactly why she doesn't have a ton of competition and is treating so many patients.
 
How can physicians be ok with this? Business minded people like those in pharma would be raising hell if they had to be the face of expenditure beyond what they actually account for. Why are we ok with damaging our reputations to protect pharma and overhead thatwe have little to no control over. Why do we stand by when our status in society slips. The beaurocrats are coming to remove our agency bc they think we are pushoevers, all the while we will rationalize that it is ok
 
Well, I think we need to step back a little bit. On the one hand, I do agree with you that it is highly misleading to simply supply the public with gross Medicare reimbursements without a precise measure of where the money goes. As I stated in my previous post, the money could go towards overhead or (in the case of employed physicians) directly to a hospital or health system. Presenting data in this manner simply encourages class warfare, something this administration is well known to indulge in.

On the other hand, we are talking about federal taxpayer funds. Living in CA, I pay a *LOT* in taxes and I too would like some transparency in where my money goes. Very frequently, we see headlines like "State Department has no idea where $4 billion went" or "IRS spends $2.5 million to send employees to Vegas junket." Such headlines are common on conservative websites, yet they also don't tell the whole story and distort the truth somewhat.

I recently spoke to an individual who is highly placed in a Rad Onc PAC. This person strongly implied that all doctors should be salaried to minimize the appearance of impropriety. We have already started heading down the slippery slope.
 
Members don't see this ad :)
Well, I think we need to step back a little bit. On the one hand, I do agree with you that it is highly misleading to simply supply the public with gross Medicare reimbursements without a precise measure of where the money goes. As I stated in my previous post, the money could go towards overhead or (in the case of employed physicians) directly to a hospital or health system. Presenting data in this manner simply encourages class warfare, something this administration is well known to indulge in.

On the other hand, we are talking about federal taxpayer funds. Living in CA, I pay a *LOT* in taxes and I too would like some transparency in where my money goes. Very frequently, we see headlines like "State Department has no idea where $4 billion went" or "IRS spends $2.5 million to send employees to Vegas junket." Such headlines are common on conservative websites, yet they also don't tell the whole story and distort the truth somewhat.

I recently spoke to an individual who is highly placed in a Rad Onc PAC. This person strongly implied that all doctors should be salaried to minimize the appearance of impropriety. We have already started heading down the slippery slope.

PRECISELY why I don't donate to ASTROPAC and likely never will.
 
PRECISELY why I don't donate to ASTROPAC and likely never will.
Not All PACs for RO are like ASTRO PAC

http://www.radiationtherapyalliance.com/who-we-are

The RTA Is currently incurring the wrath of ASTRO/ASTRO PAC by supporting freestanding center reimbursement and pushing for site-neutral payments/bundled payments going forward.

It is well-known that ASTRO PAC has offered up freestanding center reimbursement to CMS as the sacrificial lamb for the entire RO community the last several years.
 
How can physicians be ok with this? Business minded people like those in pharma would be raising hell if they had to be the face of expenditure beyond what they actually account for. Why are we ok with damaging our reputations to protect pharma and overhead thatwe have little to no control over. Why do we stand by when our status in society slips. The beaurocrats are coming to remove our agency bc they think we are pushoevers, all the while we will rationalize that it is ok

If you check out the link that medgator posted above to the washington post, at the bottom of the page there is a graph of the percent of reimbursement that goes toward overhead. Radiation oncology is also #2 on that list, second only behind radiology.
 
Not All PACs for RO are like ASTRO PAC

http://www.radiationtherapyalliance.com/who-we-are

The RTA Is currently incurring the wrath of ASTRO/ASTRO PAC by supporting freestanding center reimbursement and pushing for site-neutral payments/bundled payments going forward.

It is well-known that ASTRO PAC has offered up freestanding center reimbursement to CMS as the sacrificial lamb for the entire RO community the last several years.

But they're also pushing for an immediate 7% decrease in radonc reimbursement. I fully agree that the ASTRO PAC is essentially just a PAC for the academic community only (and why they fight for their hospital overlords is beyond me), but I don't understand why the RTA would push to devalue radonc services. Seems like a classic "lesser of two evils" scenario to me.
 
But they're also pushing for an immediate 7% decrease in radonc reimbursement. I fully agree that the ASTRO PAC is essentially just a PAC for the academic community only (and why they fight for their hospital overlords is beyond me), but I don't understand why the RTA would push to devalue radonc services. Seems like a classic "lesser of two evils" scenario to me.

I agree. There seem to be no great candidates here.

I think the largest motivator from RTA is stability so that they can better predict the market and forecast for shareholders/investors. They are willing to give up some reimbursement for perceived added stability.

On the other hand I have been frustrated with ASTRO's preoccupation with urorads and their heavy academic/large hospital bias. I'm no fan of urorads, but ASTRO seems obsessed with it and I fear it could have widespread consequences if they get their way (see Gfunks prior posts about this).
 
I agree. There seem to be no great candidates here.

I think the largest motivator from RTA is stability so that they can better predict the market and forecast for shareholders/investors. They are willing to give up some reimbursement for perceived added stability.

On the other hand I have been frustrated with ASTRO's preoccupation with urorads and their heavy academic/large hospital bias. I'm no fan of urorads, but ASTRO seems obsessed with it and I fear it could have widespread consequences if they get their way (see Gfunks prior posts about this).

Their obsession against urorads hurts multi and single specialty freestanding radiation practices as well. In nearly all those cases, the single/multispecialty and urorads centers are possible competition for academic centers in areas where they coexist.

Rta is trying to go for stability and eventually alternative payment models like bundled case-based reimbursement with payment parity between freestanding and hospital-based rt centers
 
Last edited:
You know, we had a great thing going in medicine. for centuries. then the baby boomers took over. And they seem intent to keep running us into the ground.
 
Please, people in this forum understand this "overhead" perfectly well. Doctors also get to pocket a portion of technical component either through productivity bonus (if employed) or direct payments during the year (if co-owning equipment).

If you check out the link that medgator posted above to the washington post, at the bottom of the page there is a graph of the percent of reimbursement that goes toward overhead. Radiation oncology is also #2 on that list, second only behind radiology.
 
Please, people in this forum understand this "overhead" perfectly well. Doctors also get to pocket a portion of technical component either through productivity bonus (if employed) or direct payments during the year (if co-owning equipment).

Or the "co-owners" potentially get nothing for a time while they upgrade their equipment to provide better care for their patients. Hopefully people on this forum understand the implications of that "overhead" as well.
 
Or the "co-owners" potentially get nothing for a time while they upgrade their equipment to provide better care for their patients. Hopefully people on this forum understand the implications of that "overhead" as well.

I wouldn't count on it, most people make it all the way to residency without ever having owned a business...a ton of attendings retire having never owned a business. Until they have paid the overhead checks for a business, it's hard for most people to not think like an employee
 
Sure, that can happen. Still, "overhead" term adopted in media for coverage of this topic is a misnomer.


Or the "co-owners" potentially get nothing for a time while they upgrade their equipment to provide better care for their patients. Hopefully people on this forum understand the implications of that "overhead" as well.
 
Please, people in this forum understand this "overhead" perfectly well. Doctors also get to pocket a portion of technical component either through productivity bonus (if employed) or direct payments during the year (if co-owning equipment).

I put that up because someone was concerned about them only posting how much docs got without consideration for overhead, so I was just pointing out that they did attempt to put that information out there as well.

I know a few rad oncs in solo private practice and have heard about their struggles with overhead (especially during the first few years) first hand, and even with them saying 75% still agree it doesn't tell the whole picture.
 
Guys please don't be naive and fall for the trap that they're doing this for transparency. There is a systematic campaign against doctors salaries to set the stage for drastic cuts to reimbursement. As the public outcry increases with increasing media coverage, government will get what they want and legislation will be passed to make doctors salary similar to what they earn in other developed nations (ignoring that their education is much cheaper and less rigorous than ours). Transparency is a good thing but only when done right. By now I hope people have learned never to believe anything political leaders say because they're constantly playing political games even with the most serious issues (regardless of whether they are Democrat or Republicans) and what they're doing with this data is exactly that--they're deliberately manipulating people's perceptions to push an agenda in the name of transparency.

This database has nothing to do with transparency or showing fraud as the government and media are touting it to be. It's extremely misleading because it includes raw numbers and just because those numbers are assigned to one physician does not mean that money is going to him/her. The average person will not realize that it does NOT represent the take home salary/profit. Many clinics may use a single Medicare ID to streamline billing process, so in a multi-physician clinic those numbers that get attributed to a single physician may actually represent the reimbursement of several doctors. Also drug costs get included in those numbers when in reality that money is going to the drug company, not the physician.

see an excellent quote by an optho that provides some context to the numbers which the government refuses to do:

"Before everyone condemns physicians, as an ophthalmologist it needs to be clarified drug costs are included as physician payment. The drug Lucentis costs $1950, I am paid 4% over that price to buy it, store it and provide to the pt. I do not get $2000 for the drug. The drug companies somehow got the drug cost included in physician payments.

This will skew what ophthalmologists make as it is not a true full payment to us. Medicare allows $125 for the physician service to inject that medication in a person's eye. The 4% over drug invoice is to cover our carrying costs for a drug. If you think 4% pays my staff time, drug management issues you are not considering whats involved.

BTW, I still have to wait to be paid by medicare, supplemental insurance or pt for non-covered drug cost

For those who do not know, Medicare covers only 80% of allowable charge.

This type of information is so misleading to the public regarding your average physician it is so sad. It deliberately makes physicians look bad.

People need to learn to be more scrutinizing when given information"
 
Please start being pro-active and educating your family/friends/patients/posting comments on articles about physician reimbursement and how many hoops we have to go through to even get reimbursed.

Explain how insurance, government, pharma, medical device companies and hospital administrations dictate prices/reimbursement not doctors. Don't let these stakeholders pin the blame on doctors when they're making billion of dollars every year. Explain that the hospital bill doesn't go directly to your pocket, that hospitals charge more for aspirin because they have to cover for loses they face from patients who don't pay, are unisured, or when insurance companies and government refuses to reimburse for services rendered. They're doing it for sustainability not to maximize profits.

No other industry has to go through so many hoops to get paid for services rendered. Majority of dentists in private practice/for-profit and make $160,000-$200,000/yr without the academic rigors or years of rigourous residency/fellowship that physicians have to go through (dentists don't have to do a residency), do you see a media campaign against them?

Discuss the fact that doctors have to pay a significant amount for high malpractice insurance/disability insurance.

Only 1% of all doctors will make decisions SOLELY for money at the expense of the patient's best interest while 100% of government and insurance industry will make decisions based only on their interest (government = saving money, insurance industry = profit).

Not all doctors are of equal quality. But never bash another specialty or say they make too much.

Explain over-head costs of operating a clinic and the need to hire staff (nurses, billing managers) because of the burearcacy imposed by the insurance industry and government.

Remind them of the amount of time/education/training/sacrifice/debt that we have to go through before we can be full-fledged doctors (12-15 years of education with hundreds of thousands of debt plus interest and then getting paid minimum wage per hour for several years during residency and fellowship working 60-80+ hrs/week without weekends off or much time off), etc.

Please educate the average person whenever you can. We have government, insurance industry, media, mid-levels all going against our profession. If the government drastically cut salaries for doctors today do you think there would be outrage by the average person? No, the average person has no sympathy for us. If the government hypothetically cut salaries of elementary school teachers would there be outrage? Yes. Ideally, that's the response we should be getting from the average person when it comes to our profession but we need to pro-actively educate them. Especially keep an eye out on nurses who are notorious for telling patients that doctors don't deserve their salaries or complaining of doctors to patients behind the doctors back, nurses have the most interaction with the patient and gain the trust of the patient..patients listen to nurses. So be pro-active if you want to protect your future profession.
 
here is some more context from the actual physicians that were called out by the media just based on the raw numbers provided by the government because the government refused to provide context or explain the numbers to the average person. As you can tell these numbers are extremely misleading--purposefully. Guess who ends up benefitting from this media onslaught of doctor salaries? government, insurance industry, pharma and hospital administrations

http://www.washingtonpost.com/blogs...hy-they-charged-121m-in-one-year/?tid=up_next

Michael McGinnis, a pathologist who received the third-highest payout from Medicare in 2012, said the numbers provided by CMS don’t tell the whole story. He is the medical director for PLUS Diagnostics, a New Jersey-based company. He said because the company uses his medical ID number to do all the billing, the $12.6 million in Medicare funds billed in his name actually represents the work of 26 pathologists, each of whom can complete hundreds of tests in a day. Biopsies account for much of that work, he said.

“The money doesn’t come to me,” McGinnis said. “It goes to the company. It goes to PLUS Diagnostics.”

Franklin Cockerill, a doctor for the Mayo Clinic in Rochester, Minn., is No. 4 on the list with $11.1 million in reimbursements. As the government-recognized director for Mayo Clinic Laboratories, Cockerill is routinely listed as the billing physician on more than 23 million tests a year, a Mayo spokesman explained.

"When anything is billed out to Medicare, it will have Dr. Cockerill’s name on it,” said Andy Tofilon, marketing administrator with Mayo Medical Laboratories. “He is the chair of a large laboratory medicine practice and the buck stops at his desk.”

Cockerill has been at the Mayo Clinic for more than 30 years and held his current position for more than five years, Tofilon said. Cockerill is salaried and has “no financial stake by being included in all of these reports,” Tofilon said.

The laboratory performs testing for Mayo Clinic patients and clients nationwide, and Cockerill does not personally review or approve each test, according to Tofilon. “No human could look at this much paperwork,” he said.

Tofilon said the number of tests billed through Mayo Clinic Laboratories is especially large because the vast majority of the clinic’s testing is done in Rochester. Other labs, he noted, often have locations scattered across the country.

“His name is submitted on all the claims,” Tofilon said. “Anytime someone puts in a request to Medicare and we did the test at Mayo Clinic, they will include his information on the claim.”

Vasso Gadioli, a vascular surgeon from Bay City, Mich., is No. 6 on the list with $10.1 million. He said he gets paid about $3,000 per procedure for inserting stents in his office, but he said he is still saving Medicare money. If he did the procedure in a hospital, he gets $500 and the hospital receives $8,000, Gadioli said.

About 70 percent of Medicare payments to Gadioli went to overhead. Then he has to factor in other costs, like employee salaries and taxes.

“Roughly a surgeon will take home 10 cents a dollar," said Gadioli, who has been in practice 12 years. "If I earned for myself one-tenth of [$10 million], that’s pretty good."

Jean Malouin, a family practitioner in Ann Arbor, Mich., and the highest-ranking woman on the list, suggested her perch at No. 17 is misleading. "I am most definitely not a high volume Medicare biller!" she wrote in a email.

Malouin said that she has a small private practice but is also the medical director of an experimental University of Michigan project trying to improve care and cost-efficiency at nearly 400 clinics across the state. All the project's claims are paid in her name, which probably explains why the data show she treated more that 200,000 patients and collected about $7.6 million from Medicare.

Minh Nguyen, a hematologist-oncologist at Orange Coast Oncology in Newport Beach, Calif., was listed as the 10th-highest biller of Medicare in 2012. He said all the billings for chemotherapy drugs at his five-physician practice were under his name.

“It looks like I’m getting paid $9 million ... but it’s a pass through,” he said. “The majority of the billing goes to pay the drug companies."

John C. Welch, an ophthalmologist in Hastings, Neb., ranks eighth on the list of top billers. Like most ophthalmologists on the list, a majority of his billings come from the shots he gives patient with macular degeneration — and that money is passed onto the drug companies, he said.

He said he bills so often because he is only one of a few local doctors who can perform the procedure. That generally keeps him working a 12- or 13-hour day.

“I service a large rural area,” he said. “I’ve been trying to recruit another doctor out here for years.”

He also notes: “I don’t control what Medicare decides to pay the drug company.”
 
Last edited:
and so I ask again, how can physicians be ok with this? There should be outrage for even an extra cent that is displayed on these lists in our names that should be appropriated to pharma or overhead. Any executive in pharma would demand the same thing. This is what they learn in business school.

For those arguing this is great for transparency then why half-ass it. Let's release the EMR for these medicare patients so we can fry the baby boomer physicians that partook in cognizant over treatment for personal gain. They have driven medicine into the ground. Our generation must hold them accountable and restore the faith in medicine
 
LOL, what exactly are you proposing? An armed insurgency? Perhaps the Radiation Oncologist Front de Libération (ROFL)? ;)

Seriously though, doctors take this abuse because (a) we are politically obtuse, (b) we are politically divided, (c) we have no unifying organization, (d) we rely on the federal government for a high percentage of our income, and (e) doctors/pre-meds/medical students tend to be vote for the same numbskulls who make them feel warm and fuzzy inside but damage their political/financial interests.

Really, I see threads like this as venting from physicians and a warning for residents/med students. At the end of the day, the most successful among us will see changes coming ahead of time and adapt accordingly.
 
  • Like
Reactions: 1 users
and so I ask again, how can physicians be ok with this? There should be outrage for even an extra cent that is displayed on these lists in our names that should be appropriated to pharma or overhead. Any executive in pharma would demand the same thing. This is what they learn in business school.

For those arguing this is great for transparency then why half-ass it. Let's release the EMR for these medicare patients so we can fry the baby boomer physicians that partook in cognizant over treatment for personal gain. They have driven medicine into the ground. Our generation must hold them accountable and restore the faith in medicine

see below..this would be a good first step..comment on articles as much as you can to inform the average person of the truth and mobilize other physicians to do the same..it doesnt matter who is in power (republicans or democrats) they're both excellent at manipulating their constituents with their polarizing rhetoric to divide and conquer..the media campaign they have going now greatly benefits government, insurance companies, pharma, medical device companies and hospital administrations because the blame is being shifted away from them and being placed solely on physician salary for the high health care costs instead of the actual issues that all those stakeholders contribute to..email AMA/ASTRO/etc and demand that they be more pro-active in dealing with the government and media or else you will stop paying their yearly membership fees

Please start being pro-active and educating your family/friends/patients/posting comments on articles about physician reimbursement and how many hoops we have to go through to even get reimbursed.

Explain how insurance, government, pharma, medical device companies and hospital administrations dictate prices/reimbursement not doctors. Don't let these stakeholders pin the blame on doctors when they're making billion of dollars every year. Explain that the hospital bill doesn't go directly to your pocket, that hospitals charge more for aspirin because they have to cover for loses they face from patients who don't pay, are unisured, or when insurance companies and government refuses to reimburse for services rendered. They're doing it for sustainability not to maximize profits.

No other industry has to go through so many hoops to get paid for services rendered. Majority of dentists in private practice/for-profit and make $160,000-$200,000/yr without the academic rigors or years of rigourous residency/fellowship that physicians have to go through (dentists don't have to do a residency), do you see a media campaign against them?

Discuss the fact that doctors have to pay a significant amount for high malpractice insurance/disability insurance.

Only 1% of all doctors will make decisions SOLELY for money at the expense of the patient's best interest while 100% of government and insurance industry will make decisions based only on their interest (government = saving money, insurance industry = profit).

Not all doctors are of equal quality. But never bash another specialty or say they make too much.

Explain over-head costs of operating a clinic and the need to hire staff (nurses, billing managers) because of the burearcacy imposed by the insurance industry and government.

Remind them of the amount of time/education/training/sacrifice/debt that we have to go through before we can be full-fledged doctors (12-15 years of education with hundreds of thousands of debt plus interest and then getting paid minimum wage per hour for several years during residency and fellowship working 60-80+ hrs/week without weekends off or much time off), etc.

Please educate the average person whenever you can. We have government, insurance industry, media, mid-levels all going against our profession. If the government drastically cut salaries for doctors today do you think there would be outrage by the average person? No, the average person has no sympathy for us. If the government hypothetically cut salaries of elementary school teachers would there be outrage? Yes. Ideally, that's the response we should be getting from the average person when it comes to our profession but we need to pro-actively educate them. Especially keep an eye out on nurses who are notorious for telling patients that doctors don't deserve their salaries or complaining of doctors to patients behind the doctors back, nurses have the most interaction with the patient and gain the trust of the patient..patients listen to nurses. So be pro-active if you want to protect your future profession.
 
Last edited:
What do you guys think about a database showing how much Medicare pays for the most common big pharma drugs ?? (What % is profit)
 
Well if data shows that somebody is in 99th percentile by IMRT percentage and number of simulations/plans per patient, maybe there is something for that person to worry about...
 
Well if data shows that somebody is in 99th percentile by IMRT percentage and number of simulations/plans per patient, maybe there is something for that person to worry about...

It is a list. Someone will be at the top and someone will be at the bottom, as is the nature of lists. Simply being at the top/bottom alone is not a reason to assume malfeasance. Imagine posting a list of people on welfare - do we assume that the people in the 99% percentile are committing welfare fraud? Why not post a national registry of gun owners and how many firearms each individual owns? Should the people with the most guns be placed under increased scrutiny by private citizens? Or perhaps people without guns will be at risk for armed home invasion.

The bottom line is that this data has no reason to be in the public domain.

The federal government has every right (and in fact has a mandate!) to internally review reimbursement data and audit aggressively and invasively if they suspect fraud. However, dumping data to common citizens to have it picked over by non-government entities is shameful.
 
crowdsourcing, I guess
works well for yelp.com
 
However, dumping data to common citizens to have it picked over by non-government entities is shameful.

Especially RAW data with no qualifiers, or ways to understand it. The lay person is not going to grasp the idea of technical and personnel overhead coming from those payments.
 
Top