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Some Doctors Paid Millions by Medicare

By Mark Crane

Medscape Medical News

April 10, 2014 -- The Centers for Medicare & Medicaid Services (CMS) today released, for the first time, data detailing about $77 billion in payments to more than 880,000 health care professionals under its Medicare Part B Fee-For-Service program.

"We've taken a huge step today in making the Medicare program more transparent to the public and researchers," Jonathan Blum, CMS principal deputy administrator, said in a telephone news conference. "For too long this information was not available. Medicare is funded with taxpayer dollars, and the public has a right to know this information. This data release can help reduce fraud and waste in the system.

"We want the public, press, and researchers to mine the data to help us find outliers, and identify spending that doesn't make sense or appears to be wasteful or fraudulent," he says.

Almost 4,000 doctors were paid more than $1 million each in 2012 by Medicare, and the average payment per doctor was $77,000 for that year, according to multiple media reports.

Medicare paid 344 doctors $3 million or more, and one Florida eye doctor was paid $21 million in 2012, according to an analysis of the database. Cancer doctors specializing in blood work and radiation each averaged more than $360,000 in annual payments.

In the $3 million-plus group, 151 eye doctors accounted for nearly $658 million in Medicare payments, according to an analysis by the Associated Press.

Eye and cancer doctors received the highest payments because both professions use very expensive drug treatments as part of their practice, Blum says.

Florida ophthalmologist Salomon Melgen, whose relationship with Sen. Robert Menendez (D-NJ) made headlines last year after it was disclosed that Menendez used the doctor's personal jet for vacation trips, was paid $20.8 million.

About 1 in 4 of the top-paid doctors practice in Florida. 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.

CMS is looking at releasing data from previous years and plans to release updated hospital data within 8 weeks, Blum says.

"There is a common notion that some parts of the country bill much more for services," he says. "We see a more varied pattern than that. It isn't as simple as saying that Florida always spends more and Washington state spends less. We've found pockets of high spending in every state that would be either justified or wasteful."

Blum says the public should use caution when interpreting the data and not "jump to conclusions" about what drives high rates.

AMA Responds

The American Medical Association (AMA), which has long opposed release of the Medicare database, says the files may contain inaccurate information and can mislead the public.

"We believe that the broad data dump ... has significant shortcomings regarding the accuracy and value of the medical services rendered by physicians," says AMA President Ardis Dee Hoven, MD. "Releasing the data without context will likely lead to inaccuracies, misinterpretations, false conclusions, and other unintended consequences."

The AMA and other leading medical groups had asked the government to allow individual doctors to review their information before its release. The group warns that the data may contain errors and do not include explicit information about quality of care.

"Medicare and other payers pay fixed prices for services based on fee schedules; therefore the amount paid to physicians is generally far less than what was charged and is not an accurate portrayal of payment," the AMA says.

The federal government proposed a similar plan in the 1970s to reveal data about individual doctors, but a federal judge said it violated a privacy law and issued a permanent injunction. In May 2013, another federal judge lifted the injunction over the objections of the AMA and other medical groups.

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