The headline news today is awash with stories about the release of Medicare data from 2012 detailing payments to doctors around the nation:
- “Small Slice of Doctors Account for Big Chunk of Medicare Costs.” — The Wall Street Journal
- “Release of Medicare doctor payments shows some huge payouts.” — Los Angeles Times
- “Sliver of Medicare Doctors Get Big Share of Payouts.” — New York Times
- “Release of Medicare pay data puts hard focus on top-billers.” — Politico
Here’s how the Associated Press put it:
“Medicare paid a tiny group of doctors $3 million or more apiece in 2012. One got nearly $21 million.
“Those are among the findings of an Associated Press analysis of physician data released Wednesday by the Obama administration, part of a move to open the books on health care financing.
“Topping Medicare’s list was Florida ophthalmologist Salomon Melgen, whose relationship with Sen. Robert Menendez, D-N.J., made headlines last year after news broke that the lawmaker used the doctor’s personal jet for trips to the Dominican Republic. Medicare paid Melgen $20.8 million.
“AP’s analysis found that a small sliver of the more than 825,000 individual physicians in Medicare’s claims data base — just 344 physicians — took in top dollar, at least $3 million apiece for a total of nearly $1.5 billion.”
The payouts do raise concerns. As the Associated Press highlights, “about 1 in 4 of the top-paid doctors — 87 of them — practice in Florida, a state known both for high Medicare spending and widespread fraud.”
The L.A. Times points out that it may not be unusual at all:
“Federal officials cautioned against drawing sweeping conclusions about individual doctors from the numbers. High payouts do not necessarily indicate improper billing or fraud, they say. Payments could be driven higher because providers were treating sicker patients who required more treatment or because their practice was focused more on Medicare patients.”
The L.A. Times also concedes that “the data could serve as an early warning for potential waste and abuse.”
Charles Ornstein, a reporter with ProPublica in New York, also points out:
“There are many reasons why a doctor may receive large payments from Medicare. For one, the doctor may treat exclusively Medicare patients. In such cases, the doctor’s payments would naturally look larger compared to peers who also see a lot of privately insured patients (this is called a provider’s payer mix). Another explanation is that the doctor may provide services, such as eye surgery or cancer care, that are reimbursed at higher rates than typical office visits. A third explanation is that the provider may have other professionals billing under his/her Medicare number, which is allowed in some circumstances.”
Want to see if your doctor is socking it to Medicare and raking in millions? The WSJ has put up an interactive database tool that lets you search the Medicare database to see the types and number of procedures performed and the amounts paid to each health care provider.
Elsewhere on the WSJ you can read “A Long and Winding Road” detailing the release of the data, beginning with the Carter administration in 1977.
While this story is unfolding, you can read about real Medicare fraud in Miami, Florida. Yesterday, federal agents made ten arrests, including one “sham” patient, on charges of conspiring to use a pair home health agencies to fleece the government out of millions of dollars in Medicare payments. The alleged scheme used kickbacks to patient recruiters and beneficiaries.