as well as attracting more visit,, and it will help to protect endangered species. we want to thank you for watching aljazeera america. "inside story" is next, and check us out 24 hours a day by going to aljazeera.com. >> the government lifts the veil on how much medicare pays doctor. the deep data dive and what it means for you is the inside story. hello, i'm libby casey. millions of dollars are going to a handful of doctors. do they deserve it for treating america's elderly, or are they gaming the medal care system? the release of doctors' payments

may help patients make smarter choices and may help to root out fraud. but the data only tells part of the story. the centers for medicare and medicaid services made a three-decade secret public wednesday, it's health provider spending data. medicaid is an entitlement program that is not based on income. it insures 34 million americans a year, primarily the elderly. the data says that among more than 880,000 medicare providers, $252 billion were spent on medical charges and $77.4 billion were spent on doctor payments. a few records that stand out f for 2012, seven doctors each received more than $10 million. and three doctors in florida tried billing $22 billion.

one of those doctors was an ophthalmologist, and his offices have been raided by the fbi. the american medical association has historically led the effort in blocking the budget release citing privacy concerns and misuse of information. in a statement released tuesday the organization said: >> their point, doctors could not review the data before it went public. and the mam said high payouts don't necessarily indicate improper billing or fraud.

doctors of sicker patients may get more money from medicare . still last year the centers for medicare and medicaid services recommended that all providers who bill over a certain threshold should be audited because fraud prosecutions have reached record numbers over the past two years. since 2007 the task force has charged 215 defendants. each convicted has been sentenced to an average of four years in prison. >> joining me now to discuss the significance of the newly released medicare data is from new york, dr. john stanz. from massachusetts, , and here with me in washington why hasn't this data been released before?

it's a huge deal to get access to it. >> it is a big deal, and consumer advocates have been trying for it. courts have blocked it for the last three and a half decades , listing objections which you alluded to lack of context and understanding of it. what change is a federal judge in florida accepted appeal of the block and ruled that it had to be made public. cms working over the last several months decided they were going to release it, and they did so this week. >> doctor, how significant is this in your eyes? >> well, this is a big victory for consumers. for 30 years decision makers have for various reasons decided

consumers shouldn't see this. that can be a bit frustrating when you're told this is a market, and consumers need to be better buyers. it's tough to be a better buyer when you don't have any information about what you're buying, and this is a big piece that eventually i think will inch consumers much more about what they're buying here and what they're actually getting. >> as you look at this data, what are you pulling out of it already? >> well, i think it's a conversation starter. i certainly don't think it's the holy grail in terms of transparency, or really helping patients make decisions. i think there is a lot more work and a lot more analysis. that said its long over due. i think the arguments, are we

comparing for release , it's deeply disturbing in terms of the outliers. the numbers are just causing one to wonder and bears scrutiny. the bigger issue for all ever us is that business is a big business, and we need to think about how we can make treatment decisions that take the money out and keep the patient and the data in. >> how useful is this as journalists and consumers. >> those are two different issues. the obama administration in realizing the information explicitly said that they're looking for the assistance of the media to go through this data to identify patterns, to look for those outliers and identify those physicians who

are maybe charging more. just because a physician charges more, he's in the top ten or top 100 or 200 is not necessarily a proof of fraud or waste. there is a lot going on with this data. but what we're seeing already today is that newspapers around the country are beginning to look at this data, and look at the physicians in their area and begin asking the questions about what is going on. as i mentioned there may be innocent and good explanations for why physicians have high medicaid and medicare volume, but there could be physician who are causing waste. >> is there concern over the highest billers and not taking a look at the data as a whole or what consumers can learn from it? >> absolutely. i think that's a key message for all of us. look, i was in prior practice for many years. i took care of many medicare

patients. that said for all of us as consumers, and for most physicians in general the bigger story is that we need to make healthcare affordable, more compassionate, and it means building a system that is quite different from what we have now. >> doctor, when you said there was head scratching, what stuck out to you? >> well, i saw the "la times" story. the idea that one physician to get paid by medicare, and i assume this is accurate, that these are payments and not charges, you know, 20-some million dollars for 900 patients is astonishing to me. i think at a minimum it requires serious explanation. similarly in my own field in cardiology i have lots of colleagues who do very well and

have very high volume practices, but you know over $20 million in one year kind of is hard to understand. but, the outliers don't tell the more important story as we said before. most estimates from the institute and others are that there is more in the system. more is better, and the more you do, the healthier you are. >> dr. are these outliers as described significant, the folks who are really pulling in the high numbers, the handful of numbers who are getting the most money? >> well, sure, but like the doctor, i've seen this data and worked with it, and i can assure you you're going to find some crooks, and you're going to find

some saints, and you're going to find it throughout the database. it may be a patient who is taking care of hundreds of patients with macular degeneration, those are hundreds of dollars are charged with drugs. now who knows, they may be using the brand drug, and it may be or experience. and so this is very ticky date tax and i think it will show that the system we have is a mess. and it's bankrupting us, and in some cases it's encouraging unsafe and potentially show us care. we can't expect to continue

paying doctors like this and we need to have more data. >> we'll look at how more data could be used by doctors themselves. this is inside story.

>> welcome back to inside story, i'm libby casey. 6 million americans are covered by medicare and the total cost is approaching $600 billion. as the population ages that number is expected to double over the next decade. for the first time in 35 years the government has released how much medicare pays to individual doctors. i want to get a sense of why this matters to the average american. if you're not on medicare, why should you still care? >> if you're not on medicare, you're presumably hoping that you'll make it to 65 and you'll get on medicare. all of us pay for this program through our taxes.

medicare as you said is a $600 billion a year program that is driving a huge amount of the federal budget, and it is leading the healthcare spending that the federal government does, it's the leading driver of future deficit. so there is an enormous amount of discussion in washington about how you control that medicare spending and what needs to be done. and there is a school of thought, i think broadly accepted by policymakers here that you can't begin to tackle some of these problems unless you get more transparency about what the program is currently paying for. you continue to have the conversations about what could be done more efficiently, and you can't begin to do that unless you know what you're paying for, and what works. >> dr. you're a patient. you want to know how much your doctor in florida is taking in in medicare patients.

why is that information relevant to you as a consumer. >> first of all let's hope that communities in ngo and california all figure this out. i think this data will be most bite size at a community level. you deserve to know often your surgeon has performed this procedure, once or 100. you deserve to know if your physician charges a lot or fair amount for this. you deserve to know whether there is any tricks in the way that your physician is building for a service. believe me, there is a lot of variation in our fissions are billing for medical services. >> they have warned about this data and said it could not be a complete picture, and doctors have not had a chance to vet it themselves. why is that significant? >> well, it's important to remember that many

physicians, medicare is only part of their business. millions of pictures, 170 million americans who get their health insurance through an employer. a lot of that is not going to be reflected in this data. medicaid , that data is not going to be included here. the of a manufacture of a right in that it is a please value that it is wetalked about the ophthalmologt and the type of drugs they are prescribing. that is in the background in the discussions of healthcare in america. i guarantee you that will come to the forefront as people raise

their eyebrows and say why is an ophthalmologist at the top of the list? i think that's something that immediately is going to have some value. >> doctor, certainly some doctors say look, i treat the he would alreadily. i work in a practice that specialized in elder care. of course i'm taking more money from medicare. >> yes, but this is data that is all medicare patients. which means regardless of what else you do you outside of your medicare practice this is how you treat medicare patients compared to other doctors. that argument does not have a lot of force in thigh view. >> how do you use this data? >> well, i'm a clinician in massachusetts, so in my work it's going to be very useful.

as a patient i think right now in the way that the doctor mentioned that often i as a physician have trouble figuring out which surgeons have the highest volume and therefore may have the most expertise. this kind of data is actually hopeful for that, but i think it's going to take a lot of our data analysts. some of the concerns are valid, but the solution is a charge forward in addressing foes concerns, and i think hopefully that will happen. the value of the data really for me is that part of what we need to do is to take the financial incentive and the patient,

clinicians, civic leaders, all need to stand up to do that. this is a first step. >> there has been some experience in the healthcare system around the country with the use of data on what physicians are doing. the interesting thing is that experience suggests that consumers may have a hard time looking at what a doctor has done. but in those case where is the communities have come together and track data, it's the physicians themselves who look at that data and change their behaviors accordingly. there has been happen something physicians will look at that and say i didn't know that was an outlier. i'm not doing this to commit fraud, i've been doing it this way for the last 10, 15 years. i didn't realize that there

could be a way to do it that gets better results. in these community-based interventions patients have gotten better care. >> you see such differences knowing what a patient may be experiencing even one town over. has doctors been grappling with that? >> sure they have. but it's integrated in a way that medicine is practiced. that's something in the way medicine is being practiced. it's different in minnesota than floor. in many cases the data being used in a place like minnesota is a result of local efforts to get that data out there. if those efforts haven't been under taken in florida or louisiana or some other places where this was left as part of the culture, i think this data will help futures like that. >> before we take a break, what is happening on the national level.

we heard what groups with doing, but what does the national level look like. >> it's time for doctors to prioritize acting professionally. they're supposed to be honest. they're supposed to be fair. they're supposed to be just in terms of hour our resources are allocated. believe me, if there isn't a lot of soul searching as they look at what is going on in their communities, then we're in trouble. i think there will be, and it's great that the ama has finally enabled this to happen. >> we'll take a short break. when we come back we'll talk more about why the obama administration released this

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>> welcome back to inside story. i'm libby casey. well, the numbers have been a secret for 35 years, but now we know what medicare pays individuals doctors, what they charge, which procedure and the numbers vary. the small group of doctors who get medicare money get millions of dollars. this is new information, and we're talking about how it will shape healthcare policy. still with us, our guests. before we went to the breaker we were talking about how the ama put up less of a resistence of this information getting out. what role does the obama administration pay getting this data out there publicly? >> well, the obama

administration has been on record supporting transparency and healthcare . they've done a better administration bringing sunlight to the healthcare industry. and this is the latest. i think for a lot of us they're keeping the promise they made to change things up. the way healthcare is working isn't working. it's great that they have the guts to do this today. >> what is the justice department doing in cases of fraud and abuse? >> there has been an up tick in the federal government's efforts to stop fraud and put in systems that can detect fraud earlier. one of the raps the way medicare and medicaid for that matter as well policed the

medical profession it was often difficult to recover the money, they put in programs to detect suspicious billing practices before billions of dollars have gone out the door. but unquestionably there has been an increase in efforts to combat fraud. >> as a clinician doctors have a lot of over head. they have--they're making everything from having to buy medicine to pass along to their patients, having to buy equipment . talk to us what doctors experience. >> doctors have breezingly been experiencing pressure, a lot of pressure on the revenue side for cost containment and cost control. but you know, i think--and there is more demoralization in the medical community. i think however as

dr. santos said we need to move forward. in many ways clinicians need to take on a leadership role that they haven't in the past. we started the right care alliance. we see clinicians, civic leaders patients need to ban together because the data is not enough. data on a website won't foster change. but if you use that data in a thoughtful way, you will. for physicians feeling the pressure, and feeling the heat of the economics of medicine i think we have to begin to understand exactly how the delivery of care can be reorganized so all of us can have a better professional experience and not bankrupt the country. we have to do it. >> how does politics factor into this and the affordable care act?

>> well, the aca is so laden with politics. is this issue ladened with politics? >> i don't think it is as much , but getting this data out there is certainly along with things that the affordable care act is trying to do. you alluded to this earlier. the health law among others things is trying to change the way doctors deliver medicare. for centuries medicine has been delivered essentially as a piecework enterprise. you go in to see the doctor, the doctor does three things for you, the doctor charges for three items. or in this case charge medicare for it. but that doesn't work. the data is useful in the sense that it helps drive conversation for a different way to pay for it. that might look something like this. if you go into the doctor's

office, you get--it comes with you a certain amount of money that the doctor will get to take care of you. if you stay healthier because the doctor does a better job then the doctor gets some part of the savings. medicare has been experimenting with this type of approach, which turns the incentive on its head. telling the doctor the less you do the better. but if the patient is healthier, then that's what counts, and this can advance this type of discussion. there are parts of the affordable care act that is trying to do that as well. >> thank you for being with us. that's all the time we have. that brings us to this edition of "inside story." thanks for being with us. our program may be over but our conversation continues. we would like to hear what you think about the issues about this or any day's shows. you can log on to our facebook page or send us your thoughts on twitter. ou ray suarez will be back tomorrow. in washington, i'm libby casey.

welcome to al jazeera america. i'm dell del in new york, these are the stories we are following for you. the department of justice preparing to weigh in on a rash of shootings in new mexico. and the president set to commemorate the 50th anniversary of the civil rights act. and fears that a widely used flu medicine has been a huge waste of money. ♪