It’s not just the total number of visits that could raise red flags among auditors — repeat complex visits by individual patients could also be a cause for concern.
Dr. Gary Ordog is listed in Medicare’s billing database as an outpatient emergency medicine doctor in Newhall, a suburb of Los Angeles. Typically, this kind of physician sees patients at an outpatient urgent care center for any range of simple, non-urgent complaints, like sore throats, to more urgent matters, like a broken wrist.
According to KQED’s analysis, Ordog’s patients received – on average — 30 of the most complex office visits in 2012. The average for other emergency medicine doctors is 1 complex visit per patient.
“That’s a little suspect,” says Patrice Morin-Spatz, a medical coding expert and trainer.
This is not the first time questions have arisen around Ordog’s medical practices. In the mid-2000s, Ordog served numerous times as an expert medical witness in court cases arguing that mold in residential units and work environments made his patients severely ill.
The California Medical Board tried to revoke Ordog’s medical license in 2006 for “repeated negligent acts, incompetence, making false statements, and inadequate record keeping,” according to legal documents. He was put on probation and permitted to continue practicing medicine but prohibited from participating in any litigation. Ordog was found to have violated the terms of his probation by preparing reports for four patients in workers’ compensation claims. He signed a settlement agreement in September that extended his probation until March 2015.
Ordog did not respond to repeated requests for comment made via phone, fax, and to his attorney.
How We Did This
KQED partnered with ProPublica to analyze provider billing patterns for regular office visits for Medicare patients. ProPublica released its national report Thursday. We used data released in April by the Centers for Medicare and Medicaid Services showing the payments made to providers in Medicare’s Part B program in 2012.
KQED focused its analysis only on California providers who billed Medicare for at least 100 office visits for established patients in 2012.
We looked at the doctors who billed Medicare at the highest level (5) for the majority of their office visits. We also looked for other unusual patterns, including providers whose patients received an unusually high number of level 5 visits, or doctors who provided level 5 visits to an unusually high percentage of their patients.
Matt Levin and Brittany Patterson of KQED contributed to this report.
This story is part of a reporting partnership that includes KQED, NPR and Kaiser Health News.
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.
Tue, May 20 2014