Skip to comments.1% Of US Doctors Account For Over $10 Billion Of Medicare Billings
Posted on 04/09/2014 8:30:06 AM PDT by Rusty0604
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... 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.
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.
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.
(Excerpt) Read more at zerohedge.com ...
On the surface, that is a meaningless statistic/headline. What percent of Medicaid is $10 billion?
Yes, I know it is in the first line of the excerpt, but the headline on its own is meaningless and sensationalist.
Assuming the 'doctor' works 5 days a week with no vacation, this means an average of 218 patients and 3,846 services ... per DAY!
According to the first sentence:
“The top 1% of 825,000 individual medical providers accounted for 14% of the $77 billion in medicare billing in 2012”
Most headlines are written to get someone to read the article. That doesn’t bother me a bit, I am free not to read it.
The billed amount is totally meaningless. For example, I looked up my own profile in the database, and one of the codes I bill for was billed at $576. Medicare reimbursed $119. And this was just one code out of about 2 dozen. The average reimbursement from Medicare for me was 30.33% of billed charges.
A doctor a banker and a lawyer who do you trust?.
“Salomon Melgen, a Florida ophthalmologist who specializes in injections for age-related macular degeneration, was paid $20,827,341 in 2012”
So if this guy was paid 20.8 million he actually billed over 60 million? In any normal business not run by gov’t, this would not have happened.
The NY Times has just revealed who he is:
“The doctor who was paid the most by Medicare is a South Florida ophthalmologist whose offices were twice raided last year by the F.B.I. and whose generous political contributions and cozy relationship with a New Jersey senator, Robert Menendez, are under investigation by federal public corruption prosecutors, a New York Times analysis of Medicare data shows.”
“The release of the Medicare figures was the latest in a series headline-grabbing disclosures that have dogged the doctor since January of last year. The millionaire surgeon, who lives in a 5,000-square-foot home in North Palm Beach and travels by private jet, is better known as the generous campaign contributor whose close relationship with Mr. Menendez, a Democrat, has been scrutinized by federal prosecutors.”
“He is a central figure in two different federal investigations. In January and October last year, F.B.I. agents were spotted carrying boxes out of his offices.”
One thing to keep in mind...there are a lot of services where a physician is listed as the provider, but the patient comes in for multiple appointments to have serially administered shots, therapy, etc.
It doesn’t mean the physician had direct contact each and every time, but it comes under their name (because someone has to be the responsible, authorized person)
I don’t know if that is the case here, but it is the kind of thing you see. One patient might come in for ten follow-up appointments, etc.
The title left out “and donate heavily to democrats”.
That’s the point of headlines. To be sensationalist so people’s curiosity is piqued. And to my knowledge, when you post on FR, the title you write is simply a copy of the title of the article.
The union rats set up a big truck outside a non-union hospital up here in Boston a few years back with the side of the truck painted like a billboard saying something like “Hospital X had to return X millions of dollars to Medicare last year...”
Which is a completely inflammatory thing, because every large hospital “returns” millions of dollars to insurance providers (including Medicare) because things are charged that in retrospect, should have been done differently.
And I believe the largest portion of these are charges that the hospitals themselves have discovered may have been accidentally billed a certain way. (a CT of the brain without contrast is billed as one with contrast by accident, etc)
The old saying many parents used to use with kids getting a whipping: “Don’t make me come after you...” is a good analogy for the payers, specifically Medicare. If you go to them (self-police) with an error, it is treated as such.
If they see problems and come to you, they are going to bring an audit with them if the problems are big enough or numerous enough.
By the way, that famous hospital eventually caved and went to the union rats after the head of the SEIU at the time (Andy Stern) said “We are going to destroy their relationships with their patients”.
So if this guy was paid 20.8 million he actually billed over 60 million? In any normal business not run by govt, this would not have happened.
He needs to be audited by Medicare.
That said, this ophthalmologist had nothing to do with development of these therapies, you could train a ton of people to do these injections for a lesser price (it's just an intraocular injection), and for someone to become so incredibly wealthy in this manner really angers me. I'm a sub specialist, and I don't do primary care, but if I were a primary care doc and knew that I could spend 45 minutes with a patient going over all of their issues, then additional time researching their condition afterwards, and get paid a small fraction of what this guy gets by having an eye injection factory, I'd be very upset.
“Activists protested a New York City hospital over the weekend for its decision to accept a monetary donation from political mega-donor David Koch.
Groups including the New York State Nurses Association, the NAACP New York State Conference and SEIU Local 1199 held banners and chanted songs in protest of New York-Presbyterian Hospitals plans to add an ambulatory care center, to be called the David H. Koch Center.”
It’s not like we are paying for it. It’s government money........
Rush says this is part of the new push by the Obama Administration to mount a campaign against greedy doctors to distract from the failures of Obamacare.
That story was in the NYT?
I’m shocked to be honest.
I take it that you’re not familiar with the engineers who oversaw the work on the Oakland Bay Bridge or the one up north in MI or WI that collapsed.
I detest union rats. I don’t detest all union workers...there are a lot of people who have to belong to one in order to work.
I despise the ideological union rats.
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