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Medicare claim data raises suspicions

BY RICARDO ALONSO-ZALDIVAR AND SERDAR TUMGOREN Associated Press

WASHINGTON - How is it that a few doctors take in millions of dollars from Medicare?

Explanations for Wednesday's eye-popping numbers from Medicare's massive claims database ranged from straightforward to what the government considers suspicious, as the medical world confronted a new era of scrutiny.

The long-sought release of Medicare data revealed just how much the program paid individual doctors in 2012. An analysis by The Associated Press found that a tiny group, 344 out of more than 825,000 doctors, received $3 million or more apiece - a threshold that raises eyebrows for the government's own investigators. Overall, about 2 percent of clinicians accounted for one-fourth of payments.

Deputy administrator Jon Blum said Wednesday that Medicare will now take a closer look at doctors whose payments exceed certain levels. Blum told reporters he did not want to reveal those thresholds because that would tip off people trying to game the system. "We know there is waste in the system, we know there is fraud in the system," he said.

Blum said an even bigger goal in making the data public is to help find more cost-effective, quality-conscious pathways for America's health care system.

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