Small number of doctors billed Medicare for over a billion dollars

Rick Moran
Medicare fraud is rampant with some estimates  in the 8-10% range, costing the federal government up to $50 billion a year. A good place to start looking for the cheats is the 344 doctors who received more than $3 million each in Medicare billings last year.

Associated Press:

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.

AP picked the $3 million threshold because that was the figure used by the Health and Human Services inspector general in an audit last year that recommended Medicare automatically scrutinize total billings above a set level. Medicare says it's working on that recommendation.

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. Rounding out the top five states were California with 38 doctors in the top group, New Jersey with 27, Texas with 23, and New York with 18.

In the $3 million-plus club, 151 ophthalmologists — eye specialists — accounted for nearly $658 million in Medicare payments, leading other disciplines. Cancer doctors rounded out the top four specialty groups, accounting for a combined total of more than $477 million in payments.

Overall, Medicare paid individual physicians nearly $64 billion in 2012.

The median payment — the point at which half the amounts are higher and half are lower — was $30,265.

AP's analysis focused on individual physicians, excluding about 55,000 organizations that also appear in the database, such as ambulance services. None of those entities was paid $3 million or more.

The Medicare claims database is considered the richest trove of information on doctors, surpassing what major insurance companies have in their files. Although Medicare is financed by taxpayers, the data have been off limits to the public for decades. Physician organizations went to court to block its release, arguing it would amount to an invasion of doctors' privacy.

If a business gets a contract from a government agency, most of its records are scrutinized and made public to protect the interests of the taxpayer. Doctors should be no different and publicizing these records will discourage fraud, if not detect it.

Senator Menendez's crony Dr. Melegen, who got a cool $21 million in Medicare reimbursements, is already under investigation:

Salomon Melgen’s practice charged the Medicare program for 37,075 injections of a macular degeneration drug to 645 different patients. The government paid him back at an average reimbursement of nearly $320 for each procedure, according to the records.

The figures were part of a massive release of data by the Centers for Medicare and Medicaid Services, which disclosed detailed information on physician reimbursements in response to several Freedom of Information Act requests. The New York Times posted a searchable database of the records on its site, which disclosed the millions paid out to Dr. Melgen’s practice.

Early last year, the FBI raided Dr. Melgen’s Palm Beach office, drawing attention to his relationship with Mr. Menendez. Dr. Melgen and his family members have donated more than $400,000 to Mr. Mendendez’ campaigns or political causes since 1992. 

Months later, agents from the Department of Health and Human Services raided the office again in connection with a reported Medicare billing probe.

In an email to the Washington Times Wednesday, Dr. Melgen’s attorney said that the surgeon had four offices across southeast Florida with 30 employees who have treated thousands of patients.

The attorney, Kirk Ogrosky, a former federal prosecutor, said Dr. Melgen  “billed in conformity with Medicare rules.”

“While the amounts in the CMS data release appear large, the vast majority reflects the cost of drugs,” he wrote. “The facts are that doctors receive six percent above what they pay for drugs, the amount billed by physicians is set by law, and drug companies set the price of drugs, not doctors.”

“Dr. Melgen strongly supports transparency in government, but engaging in speculation based on raw data is irresponsible,” Mr. Ogrosky added. “Dr. Melgen and his employees provide a substantial amount of free services and drugs to patients who cannot afford to pay.”

I'm sure Melgen is a saint but how many of those billings are for real customers? I'm sure HHS would like the answer to that question too.

Across the board, the government simply isn't doing enough to weed out fraud - especially in so-called "anti-poverty" programs. And the government contracting process for business could use some heavy duty scrutiny too. On any level, it's just too easy to defraud the taxpayer. Too much money is floating around and it's too easy to get away with it.


 
 

Medicare fraud is rampant with some estimates  in the 8-10% range, costing the federal government up to $50 billion a year. A good place to start looking for the cheats is the 344 doctors who received more than $3 million each in Medicare billings last year.

Associated Press:

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.

AP picked the $3 million threshold because that was the figure used by the Health and Human Services inspector general in an audit last year that recommended Medicare automatically scrutinize total billings above a set level. Medicare says it's working on that recommendation.

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. Rounding out the top five states were California with 38 doctors in the top group, New Jersey with 27, Texas with 23, and New York with 18.

In the $3 million-plus club, 151 ophthalmologists — eye specialists — accounted for nearly $658 million in Medicare payments, leading other disciplines. Cancer doctors rounded out the top four specialty groups, accounting for a combined total of more than $477 million in payments.

Overall, Medicare paid individual physicians nearly $64 billion in 2012.

The median payment — the point at which half the amounts are higher and half are lower — was $30,265.

AP's analysis focused on individual physicians, excluding about 55,000 organizations that also appear in the database, such as ambulance services. None of those entities was paid $3 million or more.

The Medicare claims database is considered the richest trove of information on doctors, surpassing what major insurance companies have in their files. Although Medicare is financed by taxpayers, the data have been off limits to the public for decades. Physician organizations went to court to block its release, arguing it would amount to an invasion of doctors' privacy.

If a business gets a contract from a government agency, most of its records are scrutinized and made public to protect the interests of the taxpayer. Doctors should be no different and publicizing these records will discourage fraud, if not detect it.

Senator Menendez's crony Dr. Melegen, who got a cool $21 million in Medicare reimbursements, is already under investigation:

Salomon Melgen’s practice charged the Medicare program for 37,075 injections of a macular degeneration drug to 645 different patients. The government paid him back at an average reimbursement of nearly $320 for each procedure, according to the records.

The figures were part of a massive release of data by the Centers for Medicare and Medicaid Services, which disclosed detailed information on physician reimbursements in response to several Freedom of Information Act requests. The New York Times posted a searchable database of the records on its site, which disclosed the millions paid out to Dr. Melgen’s practice.

Early last year, the FBI raided Dr. Melgen’s Palm Beach office, drawing attention to his relationship with Mr. Menendez. Dr. Melgen and his family members have donated more than $400,000 to Mr. Mendendez’ campaigns or political causes since 1992. 

Months later, agents from the Department of Health and Human Services raided the office again in connection with a reported Medicare billing probe.

In an email to the Washington Times Wednesday, Dr. Melgen’s attorney said that the surgeon had four offices across southeast Florida with 30 employees who have treated thousands of patients.

The attorney, Kirk Ogrosky, a former federal prosecutor, said Dr. Melgen  “billed in conformity with Medicare rules.”

“While the amounts in the CMS data release appear large, the vast majority reflects the cost of drugs,” he wrote. “The facts are that doctors receive six percent above what they pay for drugs, the amount billed by physicians is set by law, and drug companies set the price of drugs, not doctors.”

“Dr. Melgen strongly supports transparency in government, but engaging in speculation based on raw data is irresponsible,” Mr. Ogrosky added. “Dr. Melgen and his employees provide a substantial amount of free services and drugs to patients who cannot afford to pay.”

I'm sure Melgen is a saint but how many of those billings are for real customers? I'm sure HHS would like the answer to that question too.

Across the board, the government simply isn't doing enough to weed out fraud - especially in so-called "anti-poverty" programs. And the government contracting process for business could use some heavy duty scrutiny too. On any level, it's just too easy to defraud the taxpayer. Too much money is floating around and it's too easy to get away with it.