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