Original Story: latimes.com
Ending decades of secrecy, Medicare is showing what the giant health care program for seniors pays individual doctors, and some physicians got as much as $10 million in 2012.
The Obama administration is releasing a detailed account Wednesday of $77 billion in payouts to more than 880,000 health care providers nationwide in 2012. The release of payment records involving doctors has been blocked legally since 1979, but recent court rulings removed those obstacles. No personal information on patients is disclosed.
The two highest-paid doctors listed in the Medicare data are already under government review for improper billing. They include an ophthalmologist in the retiree haven of West Palm Beach, Fla., who topped the list by taking in more than $26 million to treat fewer than 900 patients. That is 61 times the average Medicare payout of $430,000 for an ophthalmologist.
A Florida cardiologist received $23 million in Medicare payments in 2012, nearly 80 times the average amount for that specialty. The overwhelming majority of doctors billed the government very modest amounts. Overall, 2 percent of health care providers accounted for 23 percent of these Medicare fees, federal data show.
Medicare officials said disclosing physician payment data marks an unprecedented opportunity to make the nation's health care system more transparent for consumers and accountable to taxpayers. Consumer advocates and employers applauded the move.
"Providing consumers with this information will help them make more informed choices about the care they receive," Jonathan Blum, Medicare's principal deputy administrator, said last week.
Still, federal officials cautioned against drawing sweeping conclusions about individual doctors from the data. They have warned that high payouts are not necessarily indicative of improper billing or fraud. Payments could be driven higher because providers were treating sicker patients who sometimes require more treatment.
These new figures reflect only Medicare Part B claims, which include doctor visits, lab tests and other treatment typically provided outside a hospital. The physician payouts include what Medicare paid plus any money the providers received from patients for deductibles and coinsurance.
Spending on the Medicare program, which covers about 60 million elderly and disabled Americans, is expected to exceed $600 billion this year. There is broad agreement that fraud is rampant in Medicare and Medicaid, the government health program for the poor, but estimates of the scope vary from $20 billion annually to more than $100 billion.
The American Medical Association and other physician groups have long opposed the release of the Medicare data.
AMA President Dr. Ardis Dee Hoven said the group remains concerned that inaccuracies in the data or misinterpretation of the figures may unfairly tar some physicians as outliers.
She said some individual physicians may appear to be billing huge amounts to Medicare, when in fact it is their whole practice that bills under a single physician's name. In other cases, high-volume physicians may actually be experts in their field who will be portrayed in a bad light.
"How does a physician or a practice get their reputation back?" Hoven said. "And even more problematic, what happens to their referral base? What happens to their patients who end up going someplace else?"
For 2012, the top recipient of Medicare money in the country was a Florida ophthalmologist, Dr. Salomon Melgen. Melgen has been a heavy donor to Sen. Robert Menendez, D-N.J. Last year, federal officials said a grand jury was looking into Melgen's billing practices, and a separate investigation was examining whether Menendez had improperly intervened on his behalf.
An attorney for Melgen, Kirk Ogrosky, said the physician has billed at all times in accordance with Medicare rules. Ogrosky said that the vast majority of the money attributed to Melgen reflects the cost of drugs used in treatment and that physician reimbursement is set at 6 percent above what is paid for the medications.
"Dr. Melgen strongly supports transparency in government," said Ogrosky, a former federal prosecutor on health care fraud cases, "but engaging in speculation based on raw data is irresponsible."
Cardiologist Asad Qamar in Ocala, Fla., ranked second nationally with $22.9 million in payments for seeing Medicare patients in 2012. He said specialists like himself who provide a wide variety of services inside their own medical facility have much higher bills because they reflect both the physician's professional fee and other technical fees to cover staffing, medical devices and supplies.
Likewise, some oncologists say their payouts appear so much higher than their peers because they are covering the price of expensive cancer drugs that other doctors operating inside a hospital wouldn't bill for.
"By doing everything in your office, your numbers will be astronomical," Qamar said. "Looking at the sheer volume of payments is a gross mistake."
Qamar said Medicare put his billing on a heightened review and delayed reimbursements more than a year ago.
"I am 100 percent confident we are not doing anything wrong," he said.
Sen. Chuck Grassley, R-Iowa, an advocate for health care transparency, warned that the Obama administration should carefully explain the data. "Transparency isn't just raw data," he said. "It's also making sure the information is in context and makes sense."