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1% Of US Doctors Account For Over $10 Billion Of Medicare Billings

Tyler Durden's picture


The top 1% of 825,000 individual medical providers accounted for 14% of the $77 billion in medicare billing in 2012, according to new federal data reported by the WSJ. The data shows a very small number of doctors and medical providers account for a huge amount of the costs for treating the elderly and, as WSJ notes, suggest in some cases, may be enriching themselves in the process. As Bloomberg notes, one doctor, who treats degenerative eye disease in seniors, was paid $21 million (twice the 2nd highest paid doctor on the list) with some top earners making 100 times the average for their respective fields. One researcher summed it up, "There's all sorts of services that are low-value for patients, high-revenue to providers," and leaves us wondering, once again, how the government will manage as Obamacare's "success" washes ashore.



Top-down the data is concerning (but sadly reflects on the broad economy's inequalities)...

A tiny sliver of doctors and other medical providers accounted for an outsize portion of Medicare's 2012 costs, according to an analysis of federal data that lays out details of physicians' billings.


The top 1% of 825,000 individual medical providers accounted for 14% of the $77 billion in billing recorded in the data.


Medicare paid 344 physicians and other health providers more than $3 million each in 2012. Collectively, the 1,000 highest-paid Medicare doctors received $3.05 billion in payments.

Which, as WSJ notes, exposes some grave concerns...

The long-awaited data reveal for the first time how individual medical providers treat America's seniors—and, in some cases, may enrich themselves in the process. Still, there are gaps in the records released by the U.S. about physicians' practice patterns, and doctors' groups said the release of such data leaves innocent physicians open to unfair criticism.




One-third of those top-earning providers are ophthalmologists, and one in 10 are radiation oncologists. Both specialties were singled out in a late 2013 report by the inspector general for the Department of Health and Human Services urging greater scrutiny of doctors who consistently receive large Medicare payments.




"There's all sorts of services that are low-value for patients, high-revenue to providers," said Elliott Fisher, a Dartmouth University researcher who studies variation in health-care practice between doctors and places. The new data "will show some meaningful things about the high outliers," Dr. Fisher said.

And some specific cases (as Bloomberg notes)...

A doctor who treats a degenerative eye disease in seniors was paid $21 million by Medicare in 2012, twice the amount received by the next ophthalmologist on a list of 880,000 medical providers released by the government.


Salomon Melgen, a Florida ophthalmologist who specializes in injections for age-related macular degeneration, was paid $20,827,341 in 2012, or 64 times the average in his field, the data show. His appeal of a 2009 ruling that found he overbilled Medicare by $8.9 million was rejected last year. Farid Fata, a Michigan oncologist paid $10,063,281 in 2012, was charged with Medicare fraud in August, according to court records. The data opens fresh questions about Medicare’s payment policies.




Two doctors listed, who together were paid about $30 million, spent time in court in 2013 on claims they defrauded the government. While Medicare fraud cases aren’t unusual, the data released will provide a new level of transparency into the agency practices that may force doctors to become more careful in how they bill for Medicare patients.


Other doctors that were highest paid included Asad Qamar, a cardiologist based in Ocala, Florida, who was paid $18,154,816 by Medicare in 2012. The next highest cardiologist was paid $4,499,469.


The third and fourth-highest paid doctors, Michael McGinnis and Franklin Cockerill, both pathologists, were paid $12,577,017 and $11,068,463 respectively in 2012.


Cockerill, who is based in Rochester, Minnesota, billed for 56,628 unique patients in the year, providing over a million services. McGinnis, based in Wrightstown, New Jersey, saw 33,154 patients. The two doctors are received more than twice the amount of the third highest paid pathologist, who received about $5 million in 2012 for 8,976 patients.

And to get a feel for most rewarding medical actions...


Source: Bloomberg


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Wed, 04/09/2014 - 09:16 | 4638859 Infinite QE
Infinite QE's picture

Khazars them all.

Wed, 04/09/2014 - 09:19 | 4638869 A_Nejad
A_Nejad's picture

Oy vey, they caught us...

Wed, 04/09/2014 - 09:35 | 4638903 Vampyroteuthis ...
Vampyroteuthis infernalis's picture

Isn't this similar to 1% of all doctors results in 90% of accidental patient deaths?

Wed, 04/09/2014 - 09:45 | 4638932 Richard Chesler
Richard Chesler's picture

Obozocare, the gift that keeps on giving.


Wed, 04/09/2014 - 09:57 | 4638967 Ignatius
Ignatius's picture

This is the crux of the insanity of ObummerCare, that we are forced to buy in to this thoroughly corrupt and broken system.

Wed, 04/09/2014 - 10:09 | 4639027 greyghost
greyghost's picture

chesler and ignatius how ignorant can you two be? medicare is single payer system by the goverment. obama care is an exchange by which you purchase health insurance from "Private" companies. stupid does as stupid thinks

Wed, 04/09/2014 - 10:56 | 4639222 Double.Eagle.Gold
Double.Eagle.Gold's picture

to: greyghost


fuck you.

Wed, 04/09/2014 - 11:10 | 4639250 dryam
dryam's picture

No, that chart does not give a good feel for what various specialities get paid for the work they do.  For example, surgeons, anesthesiologist, and ER docs are paid vastly more than what that table would imply.

For full discloser I'm an internist/hospitalist.

Medicare has always been completey out of touch with what really goes on in medicine.  They are a typical federal agency that is completely incompetent in all areas that they dabble in.

How to justly pay doctors in a way that is commensurate with the actual work they do is a complicated task.  There are many variables that go into that no particular order, average amount of time to care for certain conditions, stress involved (dermatology is minimal stress, ER doc has major stress), night or on-call hours required, requirement for working weekends/holidays, years of training required for the specialty, the quality of care that is provided (hacks see 40 patients/day and give them crappy care versus a thorough quality doctor seeing only 15 patients/day but having far superior patient outcomes).

I'm very much a free market guy & want the government out of almost all business dealings.  However, medicine and the business of medicine are at complete opposite ends of the spectrum.  The only good solution I see is to have a 2 tiered system where most of medicine is completely socialized with doctors getting paid straight uniform salaries from the socialized care they provide, and then could get paid the going market value of the non-socialzed care they provide.  The non-socialized care costs would drop like a rock due to competitive market forces, and their business would either thrive or go bankrupt based on the quality of care they provide and competitive pricing.

Getting medical care is not a God given right.  If people want top quality care, then they can either choose being born to rich parents, or they can work their ass off, save for a rainy day, have money to receive top quality care in the private system, and actually take personal responsibility for their health as in not relying on medications for diabets, hypertension, high cholesterol, and hip replacements when not eating likes pigs and being fat could have avoided many of their problems in the first place.  Or, they can choose to go way in debt buying all sorts of stupid crap they don't need, not work their ass off, and go the socialized path for their healthcare knowing that it's going to be subpar.

It's not rocket science like corrupt politicians, special interst groups, and the talking heads try to make it sound.

Wed, 04/09/2014 - 11:57 | 4639466 RaceToTheBottom
RaceToTheBottom's picture

I hear what you are saying but the existing situation was exasperated, if not caused by the AMA refusing to punish bad DRs, even hiding their incompetence. 

The Marketplace is not smart enough to do so.  Maybe in the future, yes, and that would enable more patient responsibility but the marketplace provides no control over bad DRs.

In that vacuum, the government would wade in, it was inevitable.

Wed, 04/09/2014 - 12:23 | 4639584 disabledvet
disabledvet's picture

the only solution is the VA.

if you're a quack, a drunk, a psycho or just don't come to work then the General and Admiral get to kill the doctor.

Wed, 04/09/2014 - 13:04 | 4639750 dryam
dryam's picture

I've been in medicine for 14 years and have never met another doctor who is or was a member of the AMA. The AMA is anything but a mouthpiece for physicians.

Policing doctors is a complicated task and is almost impossible to to do other than sanctioning doctors who perform the most egregious acts. A majority of doctors are pretty good. It's the bad apple minority that cause a majority if the problems. Great medical care comes at a price just like everything else in this world. The good docs would migrate to more private paying patients and the not-so-good would migrate to seeing purely socialized patients. Market forces would help sort out which docs are good and which ones aren't. Fare is what you pay to ride the bus. Contrary to little league soccer giving everyone a trophy win or lose, or people demanding that fast food workers get paid artificially higher wages for their completely non-skilled jobs, life isn't fair. There are winners and losers. People work harder and exercise more self control when they are forced to take on more personal responsibility. The truly sickly and impaired do get taken care if left to free market forces, maybe not by to 1%'ers but by the next 29%'ers.

Wed, 04/09/2014 - 13:28 | 4639886 short'n nekkid
short'n nekkid's picture

"The good docs would migrate to more private paying patients and the not-so-good would migrate to seeing purely socialized patients."


What oversimplified rubbish! Great doctors choose to work in "socialised" medicare because they actually contribute something to the patients they see. Private health care outcomes are CONSISTENTLY worse than public ones and that is true in the US, Australia etc. The notion that 'the best' migrate to private health care is wishful (and likely self aggrandizing) thinking. Realistically, the majority of people do not know enough about the provision of healthcare to know whether or not they are getting value for their private dollar. Paying more does not equate to 'getting better healthcare' in ANY system. Look up "the Dunning Kruger Effect" -- I suspect you are a shining example of it. 

Wed, 04/09/2014 - 14:43 | 4640168 dryam
dryam's picture

My comments were generalizations because there is no perfect system. Sure, there will always be a lot of great doctors that will take very good care of patients even if they were paid in chicken eggs. Sorting out which docs are the best is even difficult for fellow physicians when it's another speciality, but market forces are helpful in deciding which business is good and which are not over a long enough period of time.

It's juvenile type behavior to throw barbs at other people's proposals when one has no proposals of their own. Until you do, I would recommend you shut the fuck up.

Wed, 04/09/2014 - 20:15 | 4641395 StychoKiller
StychoKiller's picture

"'I quit when medicine was placed under State control, some years ago,' said Dr.
Hendricks. 'Do you know the skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill?  That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout fradulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun.'  I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward.  I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything — except the desires of the doctors.  Men considered only the ‘welfare’ of the patients, with no thought for those who were to provide it.  That a doctor should have any right, desire or choice in the matter was regarded as irrelevant selfishness; his is not to choose, they said, only ‘to serve.’  That a man who’s willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards never occurred to those who proposed to help the sick by making life impossible for the healthy.  I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind — yet what is it that they expect to depend on, when they lie on an operating table under my hands?” - Dr. Hendricks, on why he went Galt, Atlas Shrugged

Thu, 04/10/2014 - 19:06 | 4645429 RaceToTheBottom
RaceToTheBottom's picture

You do realize that you quoted a fictional book, don't you?

Nothing more

Thu, 04/10/2014 - 19:31 | 4645547 RaceToTheBottom
RaceToTheBottom's picture

Thanks for answering about the AMA.

One thing I do is compare career paths.  Compare Engineering VS Medicine.  Now some paths in Engineering take at least a Masters but on average they are a little shorter , but the selection process is just as rigorous.  But the numbers of graduates are not managed like they appear to be in Medicine.  

The ability to practice in the US is not really controlled in Engineering.  It is more driven by School and history.  Hence the positions can be filled with H1 and cheaper  foreign resources and push salaries in Engineering lower than medicine.

In my research of Medicine it appears to be more pattern recognition skills rather than process like engineering.  But the standardization presently occurring will introduce more process and should lead to more measurability of the delivery and diagnosis of medicine.  It will also lead to more cost searching driven by bean counters.

It is interesting that it is occurring later in medicine than any other career except being a WS CEO

Wed, 04/09/2014 - 13:27 | 4639880 Infinite QE
Infinite QE's picture

One thing that is never mentioned in these discussions is that MD-medicine is the only care that is covered by the vast majority of insurance plans but in most cases is the least effectual. Chiropractic, TCM and other modalities are much more related to keeping people healthy than traditional MD medicine is. Most doctors are under the control of big pharma and have become simply pill pushers. MD medicine does have it's place in cases of trauma and ER situations but is vastly unqualified to manage the greater health needs of the population.

Nothing will change in regards to the expense of this form of `healthcare' until the AMA/Big Pharma monopoly is crushed.



Wed, 04/09/2014 - 15:03 | 4640235 dryam
dryam's picture

I completely agree with the pill-pushing. Many chronic illness can be prevented and treated by big diet & lifestyle changes, but most people prefer the easy route of popping a pill. This makes the doctor happy because he feels like he's done something good & the patient walks away thinking everything is going to be just dandy with his pills and he can continue eating at McDonalds and sitting in the sofa all day. A big chunk of healthcare expense is taking care of obese patients and ones that continually bring on their own abuse to their bodies via smoking, drinking, etc. the whole system is geared towards having the responsibility of healthcare on every entity except the one that can have the greatest impact: the effin patient. Don't get me wrong, I'm not talking about patients that have unavoidable diseases. The broken healthcare system is just a reflection of a broken society that frowns on the concept of personal responsibility & self-reliance.

Don't even get me started on our heavily polluted, highly processed, fructose-laden (government subsidized) food system that makes it damn there impossible not be obese if you eat any of that crap.

Wed, 04/09/2014 - 15:21 | 4640343 TheMeatTrapper
TheMeatTrapper's picture

+ 10,000


Wed, 04/09/2014 - 15:52 | 4640514 Its_the_economy...
Its_the_economy_stupid's picture


Thank you. Reasonable, out of the box thinking. Not often found in the box. Also calm. I learnin' from you. (need less coffee.)

Thu, 04/10/2014 - 19:09 | 4645447 RaceToTheBottom
RaceToTheBottom's picture

Once people start claiming more ownership of their own health, that will sort itself out.

I don't think humans are ever going to self select the 400 pound obese person wanting a knee replacement and not doing anything to help the solution, but it will be a step in the correct direction


Wed, 04/09/2014 - 21:05 | 4641581 Buck Johnson
Buck Johnson's picture

Exactly, so broken and corrupt that its not viable to have a system he wants unless he remakes it and he messed that up with the software from the start.

Wed, 04/09/2014 - 12:03 | 4639501 MeBizarro
MeBizarro's picture

No but if state medical associations didn't protect all their members even worse than cops you would see real improvements in safety and quality without any additional dollar change. 

Wed, 04/09/2014 - 09:41 | 4638923 toys for tits
toys for tits's picture; position: absolute; height: 9px; width: 9px; bottom: -5px; right: -5px; background-position: 100% 100%;">

Cockerill, who is based in Rochester, Minnesota, billed for 56,628 unique patients in the year


If this doctor worked 12 hours a day every day of 2012, he would have had to see 13 patients an hour for less than 5 minutes per patient.

Wed, 04/09/2014 - 11:16 | 4639293 caconhma
caconhma's picture

The best and easiest way to become rich in Amerika is by stealing from/defrauding US taxpayers via any government (local, state, federal and any of its agencies and departments). The Amerika socialism at its best. The Banking Mafia is the frontrunner in this business.

Just look at our former President Bill Clinton. From being a poor  local hoodlum in a small Southern State to becoming a superrich with the payout of over $250,000,000++ after leaving the office. 

Wed, 04/09/2014 - 12:11 | 4639536 JR
JR's picture


It isn’t that they are making money, they are stealing money.

Wed, 04/09/2014 - 13:29 | 4639893 short'n nekkid
short'n nekkid's picture

Nah he is probably just working at a big hospital where he manages to get paid for every single test that gets ordered whether or not he rubber stamps the tech's work. Slimy thouugh. 

Wed, 04/09/2014 - 12:22 | 4639573 Titus
Titus's picture

Oy vey, they caught us...

Naked, unfettered truth. Except the oy vey don't care.

Wed, 04/09/2014 - 09:24 | 4638877 Two-bits
Two-bits's picture

This had better stay quiet or contagion will spread and we will be in a full on golf course sector flash crash!

Wed, 04/09/2014 - 09:17 | 4638864 Flakmeister
Flakmeister's picture

The free market will fix this....


Wed, 04/09/2014 - 09:20 | 4638870 Poor Grogman
Poor Grogman's picture

Makes you sick

Wed, 04/09/2014 - 09:20 | 4638872 BandGap
Wed, 04/09/2014 - 10:17 | 4639070 Flakmeister
Flakmeister's picture

We be fucked... but it has nothing to do with the alignment of the planets...

Wed, 04/09/2014 - 14:03 | 4639996 newdoobie
newdoobie's picture

In Canada the list for gender change is shorter than foot surgery. Over 5 years to see a foot doc in NB.

Wed, 04/09/2014 - 09:23 | 4638876 Spungo
Spungo's picture

Fuckery in my governments?? Oh noes!

Wed, 04/09/2014 - 09:24 | 4638878 ebworthen
ebworthen's picture

A microcosm of the entire sick-care industry.

Don't think that corporate hospitals and clinics aren't churning volume either.

And what they can't get out of Medicare they will get out of insurance companies, which will simply pass the cost onto individuals who are now forced to buy insurance or be penalized by the I.R.S.

U.S.S.A. = one giant penal colony serving the Kleptoligarchy.

Wed, 04/09/2014 - 09:28 | 4638890 LawsofPhysics
LawsofPhysics's picture

Please, see my post below.  Cronyism/fascism can be found in all sectors of the eCONomy.

Like I have been saying;

get long black markets, sharecropping, and a dependable tribe...

get ready for the global third world eCONomy...

Wed, 04/09/2014 - 10:19 | 4639076 Comte d'herblay
Comte d'herblay's picture



Wed, 04/09/2014 - 10:36 | 4639143 Offthebeach
Offthebeach's picture

Maybe "Klepto" and "Oligopoly". Um...Kleptoligoply? An entrenched, generational thieving class?

Once again America pushes the frontiers. USA! USA! USA!

Wed, 04/09/2014 - 11:11 | 4639278 Comte d'herblay
Comte d'herblay's picture


Wed, 04/09/2014 - 09:25 | 4638880 q99x2
q99x2's picture

Give the decent people the trillions and give the banksters the billions and leave me alone to look out the window for thise mushroom cloud.

Hey Ben Davidson is from Pittsburgh. No wonder I like his work.

Wed, 04/09/2014 - 09:25 | 4638882 Seasmoke
Seasmoke's picture

I have noticed a lot of the Tribe are in the eye care field. 

Wed, 04/09/2014 - 09:42 | 4638925 flacorps
flacorps's picture

Their pornmongering is hampered if customers go blind.

Wed, 04/09/2014 - 09:25 | 4638883 replaceme
replaceme's picture

Meanwhile, a family practicioner that gives vaccines to Medicare will lose money on each patient.  Seems like the government at its best to me.

Wed, 04/09/2014 - 09:26 | 4638884 LawsofPhysics
LawsofPhysics's picture

look guys, absolute power corrupts, absolutely...

In other words, cronyism and fascism has firmly taken hold in all sectors of the economy.

hedge accordingly.

Wed, 04/09/2014 - 09:26 | 4638885 trillion_dollar...
trillion_dollar_deficit's picture

It should be pointed out that the $21 million Doc is best pals with Senator Menendez (D-NJ). So, any chance there would be an investigation into improper billing practices should be put to rest now.

Wed, 04/09/2014 - 09:38 | 4638914 nickels
nickels's picture

And because of a recent Supreme Court ruling, enough free speech can now be donated to make sure that this topic never sees the light of day again.

Wed, 04/09/2014 - 09:59 | 4638897 Mercury
Mercury's picture

One-third of those top-earning providers are ophthalmologists, and one in 10 are radiation oncologists. Both specialties were singled out in a late 2013 report by the inspector general for the Department of Health and Human Services urging greater scrutiny of doctors who consistently receive large Medicare payments.


How about greater scrutiny of this stupid payments system that Washington developed and makes this kind of thing possible?

Or, just kill all the doctors and replace them with bureaurcrats.

Actually, if assume that at least some of these high paid docs are actually high-value add, top specialists, the "reform" that this article is begging for will likely drive them away from Medicare patients and toward caring for cash paying elites only - which would amount to the same thing.


"There's all sorts of services that are low-value for patients, high-revenue to providers," said Elliott Fisher, a Dartmouth University researcher...

Well maybe it wasn't such a hot idea to have designed a system where patients are completely blind to and disinterested in what specific types of medical care actually cost.

Wed, 04/09/2014 - 09:35 | 4638905 adr
adr's picture

So the doctor in Rochester saw 6.5 patients per hour 24 hours a day over 365 days? All seeing a specialist? Really? Man what a trooper never sleeping and seeing patients for his entire life.

Nope, no fraud going on at all. 

Wed, 04/09/2014 - 09:58 | 4638971 FredFlintstone
FredFlintstone's picture

If we would all work just half this hard as this patriotic physician, America would not be in the mess it is.

Wed, 04/09/2014 - 10:00 | 4638984 scubapro
scubapro's picture

he didnt see the patients, his PA or NP, or even RN saw them and he gets to sign the papers....very common

Wed, 04/09/2014 - 10:46 | 4639177 IridiumRebel
IridiumRebel's picture

Well it's good to see a 24 hour/ 365 day practice up and running if I want to see a doctor and fake....errr....have an injury checked. 

Wed, 04/09/2014 - 09:36 | 4638910 SWCroaker
SWCroaker's picture

Don't blame people who abuse a system, that's human and to hope for otherwise is naive.  Blame the system, for being abusable, and blame the authority that insists the system be used.

Remove government from health care (heck, all things), let true free markets reign, and this type of abuse/idiocy dies a quick, unprofitable death.


Wed, 04/09/2014 - 10:16 | 4639063 Comte d'herblay
Comte d'herblay's picture

Butt then the "Free Market" that is the government-sponsored micro-economy --- and no city is more successful than D.C. and a hundred mile radius of it---as well as the tit suckers all over the place would not be able to flourish.

Who do you know that commits suicide when they have all the Beluga, Cristal, and Foie Gras they can eat 366/24/7?  Round the clock lubricious mistresses and poofters? 

The Government is another country, that produces nothing but corruption, earns not single shilling, but siphons it off of the rest of humanity with one Machiavellian trick after another.

The 9/11 bombers took down the wrong buildings, when they should have all the jets at the Capitol building in full session. 

Wed, 04/09/2014 - 09:37 | 4638912 spanish inquisition
spanish inquisition's picture

Hardly seems like a big deal when you see its less than a month of QE.

Wed, 04/09/2014 - 09:41 | 4638924 mrpxsytin
mrpxsytin's picture

It is everywhere I look. How much longer can our structures support the cronyism?

Wed, 04/09/2014 - 10:10 | 4639034 Comte d'herblay
Comte d'herblay's picture

As Cheney said the "Deficit"  doesn't matter.  And the deficit is comprised of past debt accumulation, so, ergo, therefore, hence, National Debt doesn't matter. 

These questions should be on the SAT exams. 

Wed, 04/09/2014 - 11:28 | 4639352 silentsock
silentsock's picture

I have no great affection for Cheney, but that remark was taken a bit out of context.

When he said that, the debt/deficit wasn't anywhere NEAR what they are today.


(PS: your down vote wasn't by me)

Wed, 04/09/2014 - 09:47 | 4638938 Spungo
Spungo's picture

The corruption will continue until the country is officially bankrupt and forced to cut spending

Wed, 04/09/2014 - 09:59 | 4638976 scubapro
scubapro's picture

a lot of Drs are choosing not to accept medicare due to low reimbursal rates.  so seeing a greater and greater concnetration of billings to certain practices makes sense.  they have to do a volume biz with low reimbursal rates.

medicare people should have to pay $100 copay to visit and use usually a social scene in the waiting rooms, as the visit is their whole day

Wed, 04/09/2014 - 10:08 | 4639020 Comte d'herblay
Comte d'herblay's picture

It's easy for the government to pay for theBamster Care Act.

They'll just have Janet print it.

There.  Fini.

Stop asking stupid questions.

Wed, 04/09/2014 - 10:18 | 4639072 corporatewhore
corporatewhore's picture

when my father was dying of acute myelogenous leukemia at age 80 his oncologist assured me he could cure it.  two rounds of chemo, felt like shit, looked like shit, no quality of life improvement and he managed to survive 4 months.  Each round was about 100,000 dollars.  This fucking doctor should have had his license stripped rather than ripping off old people with no chance of survival giving false hope but "earning" his fee.

medicare doctors are bloodsuckers

Wed, 04/09/2014 - 12:07 | 4639522 RaceToTheBottom
RaceToTheBottom's picture

This will probably get better as people take more responsibility for thier own and loved ones healthcare, but this is so obvious that it should not be reliant on the person or his healthcare decision maker making the right decision

Wed, 04/09/2014 - 17:32 | 4640927 thtmnbhndthecrtn
thtmnbhndthecrtn's picture

Did you tell them to FUCK OFF? It is your dad's and your decision to carry on with this lunacy, not the doctors'. Believe me they won't do it if you tell 'em. You, sir, are the fucking idiot.

Wed, 04/09/2014 - 20:28 | 4641445 StychoKiller
StychoKiller's picture

Don't Fear the Reaper!  How long would this person have lived without the chemo?  Don't know, do you?

Wed, 04/09/2014 - 10:26 | 4639103 cynicalskeptic
cynicalskeptic's picture

Much of our health care system costs are going to people in the last months, weeks and days of their lives - simply prolonging death at no real benefit to the patient or any real 'point' at all.  

Technology allows life to be technically prolonged even when it should NOT be but we have yet to come to terms with the moral and ethical issues at work here.  why NOT allow people to die when that is clearly happening and will happen no matter what you do?

On a more basic level - WE HAVE FORGOTTEN HOW TO DIE.  In times past, as you neared the end of your life you KNEW this was the case and accepted it.  You were allowed to die at home - taken care of as best as possible and hopefully with pain controlled as much as possible.  You got to say your goodbyes if you could and were allowed to 'pass'.  No efforts were made to revive you when this occurred.  Nobody was forcing your body to keep breathing, your heart to keep beating.

A relative is an ICU nurse.  There's a patient in her 90's being kept alive 'by whatever means necessary' at - supposedly - her request and the insistence of her children.  The STAFF is having psychological issues in dealing with this travesty it's SO bad.  

Even if you WANT to die, the system will often not let you if they can make money.  In my own experience I saw my mother kept alive by means she specifically PROHIBITED.  I was going to have to fight to get her OFF the respirator she never wanted to be put on  - a supposedly 'temporary' measure.  But she had good insurance and the hospital made a couple hundred thousand off the couple weeks longer she took to die.

There are times when 'enough is enough'.  My father had a major infection in early adulthood that wiped out his pancreas.  He was diabetic for well over 30 years.   On dialysis for almost a decade, he lived to see his children grown and knew his wife was well taken care of in retirement.  His health was getting worse and worse - no real 'quality' to it so he said 'enough'.  He didn't make it to 60 but saw no point in extending a life that only continued to deteriorate.

Too many people have NOT come to terms with the fact that THEY ARE GOING TO DIE.  You cannot escape it.  Perhaps they've never come to terms with that, have no 'belief' system to explain it or are simply scared of the whole thing they seek to escape what can't be escaped.  But there's no rhyme or reason to what now occurs.  We spend obscene amounts to keep 90 year olds alive for a few more weeks or days while letting heatlhy children get VERY VERY sick though a lack of care.

Frankly, I am astounded at the attitudes I see in some elderly.  They feel more self-entitled than ANY small child, that they 'deserve' whatever they can get simply because they have lived so long.  A few are actually downright nasty about it.  Government has a 'obligation' to give them anything and everything.   Pretty odd coming from some who proclaimed their 'independence' and contempt for 'socialists' like FDR.  But politicians pander to this group and feed this attitude.

We also allow money to be spent on utterly pointless procedures simply because they WILL be paid for.  I had a knee replacement and was in a week's in-patient therapy(and months of outpatient therapy afterwards).  The therapy is brutal, painful and NECESSARY if you are to regain reasonable use of your new knee.  But I saw elderly people REFUSING to do ANY therapy because 'it hurt' and a couple GROSSLY obese people (over 300 lbs in - literally - double wide wheelchairs) who would not or could not do the therapy.  There was NO POINT in doing this surgery if the patients would not or could not do the therapy.   If they're going to sit in a wheelchair they could have done so WITHOUT a new knee that taxpayer money paid for refusing to do therapy that taxpayer money was paying for.


Wed, 04/09/2014 - 10:43 | 4639165 IridiumRebel
IridiumRebel's picture

"A relative is an ICU nurse.  There's a patient in her 90's being kept alive 'by whatever means necessary' at - supposedly - her request and theinsistence of her children.  The STAFF is having psychological issues in dealing with this travesty it's SO bad. "


My wife's grandmother is having this done right now. She has been hanging on for about three months now. Wastes tens of thousands so her son can say, "I did all I could." I agree with you. My wife is a nurse practitioner and she thinks it was time to let her go two months ago. No quality of life just prolonging the inevitable. 

Wed, 04/09/2014 - 11:13 | 4639283 flacorps
flacorps's picture

In those days people will seek death but will not find it. They will long to die, but death will flee from them! Revelation 9:6

Just a little more technology and this will be cemented in place, with us all joining some sort of Kurzweilian Borg "singularity."

Wed, 04/09/2014 - 11:56 | 4639471 Jena
Jena's picture

We'll all be there eventually.  Get your living wills or at least make sure that your family and your doctor know how you feel about being kept alive on machines.  If you end up there because of something that may be reversible it's one thing; if it is one of those situations where you'll just deteriorate unti you finally die (which may take some time especially if you're fairly young and healthy and have considerable physiologic reserve), it's worth putting your wishes in writing.

I helped my parents write their Living Will.  Something along the lines of "Should I ever be so sick or injured that I am unlikely to recover, I do not want to be sustained on a ventilator or any other machines just to keep me alive."  There was more but you get the idea.  Just write what you want and more importantly, what you don't want.

Many long-term ICU nurses and paramedics consider getting NO CODE tattoed on their chests.  For some people a code  saves lives but for the vast majority it is the first step to a long stay in hell: the ICU.

As for the guilt that families lay on each other for not doing everything they could? Guilt is a waste of emotion. It means you have unresolved issues with the person in question.  If you know your relative wouldn't really want to be naked and tortured on a 24 hour basis, you're really doing them a massive favor.  Allowing them to die when they should, THAT is really doing all you can do for them.

Wed, 04/09/2014 - 17:29 | 4640911 thtmnbhndthecrtn
thtmnbhndthecrtn's picture

The answer to this problem is going to be sorting out "death panels" from good common sense. I am a physician and my idea is that they WILL soon start saying, as they (CMS) should, "welcome to the ICU for care, but if you are over 85-90, get out your VISA card to pay for it, yes even though you DO play 9 holes of golf a day." And then the following year, 84-89, then 83-88. There is a simple solution to this idiocy. But just wait til the anti-socialized-medicine groups get hold of that! "They are relegating him to unnecessary DEATH!" man, it's going to be painful, but your point is right on the money!

Wed, 04/09/2014 - 10:43 | 4639168 TrustbutVerify
TrustbutVerify's picture

These are very interesting figures and very important to understanding out of control healthcare costs.  But in these days of sky high taxes it would be more important to find out how much these doctors netted after taxes. 

It seems obvious that governments benefit from individuals in these highest tax brackets.  Governments get the highest percentage of that income in revenue.  Plus, they get to use that tax revenue to pay for vote buying, personal initiative destroying, and, otherwise, excessive (for decades) social services.  

Wed, 04/09/2014 - 11:25 | 4639337 thtmnbhndthecrtn
thtmnbhndthecrtn's picture

Very perceptive. I am a doctor on the list of specialities above, a surgical specialty. Since 1998, my reimbursement from medicare has increased on the average 0.25-1.0% annually. My overhead in that same period has gone from about 35% to near 60%, as my need for employees has gone from 2.5 FTE to 4.5 FTE to handle basic bureaucracy, mostly ultimately generated by CMS. My tax rate is 50% combined Federal, state, and local. We have a gross receipts tax as well in my state. In that same period, as well, an common operation I do once was reimbursed at $1800; that has dwindled to $538 over the years. This includes all follow up care for 90 days thereafter, complications, etc. This decreased remuneration for operations is common. A heart surgeon I know used to make about 5k for open heart bypass operation; now right around $1900.

So for 100K from Medicare now, minus 60% overhead and 50% taxes, the take home is about 1/5th of that. Since implenting the required electronic medical record now, my ability to see patients in the office has dropped by 20%, the extra time it takes to fill out the EMR requirements to demonstrate to Medicare that I am doing my job.

I can see where there would be a motive to cheat, as it is getting pretty close to a "break even" situation. 

Good news, though: ICD-10 delayed a year!

Wed, 04/09/2014 - 16:02 | 4640555 Its_the_economy...
Its_the_economy_stupid's picture


Wed, 04/09/2014 - 11:01 | 4639242 Kirk2NCC1701
Kirk2NCC1701's picture

Medical Fraud is also a huge factor.  Particularly in some regions and cities.

Years ago, while living in the Sunshine State (FL), I recall reading a paper article that southern FL (in and around Miami) had amazingly high fraud levels.  I think it's a cultural problem, and that the American culture has been subverted and coopted.

Unlike others, I am not afraid to take on the one group people are even more afraid of than "Jews":  "metastesized Christians".  Let me put it this way... Christianity has been totatlly corrupted in the last 100 years.  If the body's Immune System were Christianity, it would change its policy toward pathogens and toxins.  It would stop "discriminating" against them, and let all of them in, as long as they "promise to behave and get along".

Moral:  If you ingest something, it's either compatible with your body, or it isn't.  At the biochemical level, it's either nutriotious/sustaining, or it's an alergen, or downright toxic.  No amount of "wishing" it otherwise will make it so.  The US and other Western countries (due to US influence) have become cesspools of "anything goes".  Between the activists on the Liberal Left and the Neocons on the Right, and the 'metastesized Christians' in the Middle remaining quiet and 'dutiful', the country is falling apart.

Wed, 04/09/2014 - 11:11 | 4639275 A_Nejad
A_Nejad's picture

But, but...Christianity is by all account Judaism stripped down for export, especially the American version of it.  I'm still long on Jews...


Wed, 04/09/2014 - 11:21 | 4639309 TheMeatTrapper
TheMeatTrapper's picture

I once did an IT upgrade for a dentist in the Mississippi delta. The place was almost 100% black. One of the poorest areas in the nation. It was like being in Haiti. 

The dentist was a white guy. He closed his office every year for a month and took his family on safari, while he hunted big game in Africa. For a month. Every year. 

He'd line up all the little local black kids and provide them with government paid for dental care. This consisted of looking in their mouths, dabbing a bit of filling into a microscopic cavity in their baby teeth, kicking them out the door and billing the government for the procedure. The kid would be seen for maybe 5 minutes.

He'd handle dozens of kids a day. The pickaninnies got their 'free' dental care and he made millions. I got called in when his automated billing software crashed and stopped working. He went absolutely ape shit about it. 


Wed, 04/09/2014 - 15:47 | 4640491 4 Freedoms
4 Freedoms's picture

I MOST ardently object to the use of the term "pickaninnies" to refer to ANY human being.  Ethnic slurs demean and detract from every discussion.

Wed, 04/09/2014 - 11:50 | 4639448 EggSlayer
EggSlayer's picture

There are good doctors and there are bad doctors...

Wed, 04/09/2014 - 12:07 | 4639520 JR
JR's picture

The opening panel on today’s Dilbert cartoon easily explains the them-and-us ratio in today’s economy.

“Our CEO was injured when a steamer trunk full of Rolex watches fell out of his luggage helicopter and landed on his yacht.”

Wed, 04/09/2014 - 12:11 | 4639537 jb.mcmunn
jb.mcmunn's picture

Before everyone gets their undies in bunch let me point out that I just looked up my data and according to CMS in 2012 I did over 9,000 knee injections @ $9.75 each.

That would mean I spent about 3/4 of my clinical time on a procedure that paid less than $10. At $9.75 (which includes the cost of the meds, syringes, needles, prep, etc), that won't even keep the lights on for 2 minutes.

I do several knee injections/week but thanks to this incompetent defamation I'll probably get audited.

From the wonderfully competent folks who brought you!

Wed, 04/09/2014 - 12:21 | 4639562 Took Red Pill
Took Red Pill's picture

There's so much abuse in the system. I worked for 2 different ophthalmologists and they both did so many unnecessary tests to get as much money as they could from insurance. Both were millionaires (and cheap bastards!) They weren't doing anything illegal either. The system is broken!

Thu, 04/10/2014 - 03:33 | 4642314 payrollservices
payrollservices's picture

Wylie & accountants Glasgow is a Glasgow practice of chartered accountants, providing accountancy services to clients across a wide range of public and private sectors.

Thu, 04/10/2014 - 03:42 | 4642321 payrollservices
payrollservices's picture

Wylie & accountants Glasgow is a Glasgow practice of chartered accountants, providing accountancy services to clients across a wide range of public and private sectors.

Thu, 04/10/2014 - 13:49 | 4644093 assistedliving
assistedliving's picture

the question is, how many of the healthcare enrollees had PRECONDITIONS?  who can turn down that deal?  as for these DR's, they play a huge part of this mess to begin with, opening up clinic after clinic for 'tests' we don't need, raping the elderly et al w/ unneeded surgeries.

Too many of us want something for nothing, some Dr's WANT IT ALL (at our expense), the politicians who "give it away" get re-elected and presto, OBAMACARE.

did i mention the drug cartel? 


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