Skip to comments.Data trove shows U.S. doctors reap millions from Medicare
Posted on 04/08/2014 10:20:05 PM PDT by blueplum
(Reuters) :snip: After decades of litigation and over the strenuous objections of the American Medical Association, the leading U.S. doctors group, the federal Centers for Medicare and Medicaid Services (CMS) on Wednesday made public for the first time how much Medicare pays individual doctors.
The massive data release, totaling nearly 10 million lines, also includes which medical services each of more than 880,000 physicians and other healthcare providers nationwide billed Medicare for in 2012.
Last December, the inspector general of the Department of Health and Human Services, CMS's parent agency, found that 303 clinicians each collected more than $3 million from Medicare Part B in 2009, triggering "improper payment reviews" for 104. Those reviews identified $34 million in overpayments. Three of the clinicians had their medical licenses suspended; two were indicted.
Although CMS has had the data all along, outside healthcare experts are eager to scrutinize it, said healthcare analyst and Medicare expert Cristina Boccuti of the Kaiser Family Foundation. One thing they will look for is high-volume doctors. If some providers are billing for many more services per patient than others in the same community, she said, it could indicate overtreatment.
(Excerpt) Read more at reuters.com ...
Not that unusual for a segment of doctors in a community to deal almost entirely with medicare patients. Certain diseases are almost exclusive to people who are age 60+, and some doctors are located in retirement communities.
Let’s see, get rid of doctors? Or get rid of Medicare?
Yeah, that’s the reason Obamacare is sh*t. It’s the doctors.
Up yours, Rueters.
that will be the new mantra for the dems seeking reelection, watch and see. There’s a reason behind the timing of the release.
Uh, yeah. This has been public knowledge since the early 80s when the entire medical system started coding illnesses and injuries and determined how long a stay and what procedures and equipment.
It was widely stated that MDs had bled the system dry.
Of course it was a stupid system to start with.
Like in depending on foreign oil, the system has continued until this, and it’s still chugging along, now as obamacare.
I don’t hear this much, but there really is no way this thing is going to work. Ted Cruz is the very and only one speaking about this with any kind of sanity.
anyway, we’ve known this all along. And by the way, medicaire has maintained firmly our medical system’s problematic way of functioning - thriving on sick people, MDs taking over domain of our bodies, and actually taking away domain.
It has spun up an dout of control and there will be no money, no research, no new cures, no good doctors, clinics, It will not work no way.
Geeze to think theyre out with this headline It’s from the 80s, this knowledge. Under the Reagan administration
So 5 out of 303 “clinicians” were found to be engaged in questionable billing. That leaves >98% appropriate billing. But the EVIL spectre has been affixed to those EVIL doctors.
I actually applaud the auditors for using a reasonable methodology for locating bad apples. (Of course, guilt is yet to be determined in a court of law.)
I think until the country caves to accept a single payer system we will hear increasingly shrill accusations leveled against the medical community and those insurers who can manage to hang on in the face of increasing regulations.
Go and look at the amount of medications that older folks now get. Various ailments and treatments underway....leading to more medications and treatments. Free money for the doctors who can milk it.
3 docs out of 303 targeted for extra scrutiny had licenses suspended. That’s 1%.
On the other hand, 3 docs out of 880,000 total participating is absolutely nothing.
Unless we’re not getting the full stats, and the article is incomplete with regards to any statistically meaningful conclusions.
Government meddling in health care has given us a system where “cheating” on medicare/medicaid billing is necessary to remain solvent and provide care. It’s either that or refuse to treat the hapless medicare/medicaid patients. I can imagine how hard it would be to turn away a suffering patient because you cannot afford to treat them.
doctors do not try curing diseases. all they do is prescribe meds to manage symptoms. the ones who would actually like to try to cure a problem half the time cannot b/c they aren’t allowed to try certain things that stray from standard protocols.
Sure, the crooked doctors and providers con the taxpayers out of not just millions, but hundreds of millions... While the honest ones are lucky to break even.
When my mother was in a ‘nursing home’, a visiting podiatrist came in and clipped her toenails (I usually did it for her, but I was away that week) He charged Medicare $8,000.00 for “Foot Surgery”. I reported him to Medicare, but they didn’t care. They told me: “If you can get him to write us a letter admitting to fraud, then we will take the money back from him.”.
Then her ‘physical therapy’ sessions, which consisted of tossing a ball back and forth between her, the ‘therapist’ and the 5-7 other patients in each session, resulted in charges to Medicare of up to $400 per hour. And I assume that the ‘therapist’ charged similar amounts for each patient in those group sessions.
Medicare didn’t care about that either, when I told them what was going on.
Does the article mention wellcare, a company partially owned by soros, which admitted to fraud. They paid a small fine and go on their merry way.
I doubt the fox will care about henhouse raids. But the farmer might. I hope all the appropriate Congressional representatives were alerted.
If it is MedicAID, then state government should also be alerted.
You have nailed it. I worked in the medical industry for almost two decades. Many doctors are pill-pushing money-grubbers who order tests based on Medicare reimbursements more than actual symptoms. Not all are this way, but enough of them are to make me skeptical of all of them.
The system is cruel to those who try to do right. The love of money is a root of all kinds of evil... the bible knew it almost 2000 years ago.
These are probably specialists like orthopedic surgeons doing hip/knee replacements and ophthalmologists doing cataract surgery.
Here’s the moneyline:
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.
Dave 31 minutes ago 0 3
Im in a 20+ group of ophthalmologists, and I cant wrap my head around billing more than a million to medicare per doctor as a high max, and most of us bill about half that and that amount doesnt even cover overhead per doc, because of expensive high tech equipment and trained personnel needed to run it, dependent on other insurances. Eye surgeons get paid a standard fee per state for cataract surgery, typically about $650 to $700 per case, you can google the amount, and cataract surgery has a high overhead. The hospital/surgery center fee is much higher, but that goes to the hospital.
I read that $21 million or even the $3 million and not possible....this guy is clearly not practicing ophthalmology, he must own several hospitals or a very busy one or ambulatory surgery centers. Either that or he personally sees thousands of patients per day, ie not possible. I would be willing to bet each one of those billing that much is from owning surgery centers that many other surgeons operate at and most of that goes to overhead, otherwise, just not possible to bill anywhere near that amount practicing ophthalmology.
So. Fla. eye surgeon under scrutiny with Sen. Menendez frequently prescribed expensive drug
A South Florida eye surgeon whos a friend of a U.S. senator is under federal criminal investigation for billing Medicare millions of dollars to treat elderly patients for services they may not have needed, The Miami Herald has learned.
Federal agents began investigating Dr. Salomon Melgen last year, sources say, after investigators suspected he overbilled the taxpayer-funded health program by overprescribing a high-priced drug called Lucentis, which is injected into patients eyes.
Several sources familiar with the doctors practice said he used the drug, which costs $2,000 a vial, to treat patients with macular degeneration more than any other ophthalmologist in Florida and possibly the country. His high patient volume also raised red flags for investigators, the sources said.