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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Infinite QE's picture

Khazars them all.

A_Nejad's picture

Oy vey, they caught us...

Vampyroteuthis infernalis's picture

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

Richard Chesler's picture

Obozocare, the gift that keeps on giving.


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.

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

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 equation....in 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.

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.

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.

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.

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. 

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.

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

RaceToTheBottom's picture

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

Nothing more

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

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.



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.

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.)

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


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.

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. 

toys for tits's picture
http://www.zerohedge.com/sites/all/modules/blockquote/images/menu-leaf.g...); 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.

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. 

JR's picture


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

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. 

Titus's picture

Oy vey, they caught us...

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

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!

Flakmeister's picture

The free market will fix this....


Flakmeister's picture

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

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.

Spungo's picture

Fuckery in my governments?? Oh noes!

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.

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...

Offthebeach's picture

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

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

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.

Seasmoke's picture

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

flacorps's picture

Their pornmongering is hampered if customers go blind.

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.

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.

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.

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.

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.

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. 

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.