5 Top Medicare Billers Explain Their Charges

The top 10 billers to Medicare received a combined $121.4 million for Medicare Part B payments in 2012, and the Washington Post reached out to them to hear what's behind those numbers.

The Washington Post received CMS' Medicare data Monday, but it was embargoed, meaning the publication could only contact physicians today. While not every physician had responded at the time of publication, those that did are included below.

Not all of the top 10 physicians are keeping millions. "A clear trend emerges from the data and from interviews with these physicians: The high cost of drugs is a huge driver of the robust Medicare payouts," according to the Washington Post. A little more than half of the Medicare payments to the 10 physicians, or $61.9 million, went toward drugs and "other costs." Several physicians said their charges actually represent those of an entire practice, company or department.

Michael McGinnis, MD. A pathologist, Dr. McGinnis received the third-highest payout from Medicare in 2012 ($12.6 million). He said CMS' numbers don't tell the whole story. As medical director for Union, N.J.-based PLUS Diagnostics, he said the company uses his medical ID number for all of its billing. That means the $12.6 million in Medicare funds billed in his name really represents the work of 26 pathologists, he said, each of whom can complete hundreds of tests in a day, most of which are biopsies.

"The money doesn't come to me. It goes to the company. It goes to PLUS Diagnostics," he said in the report.

Franklin Cockerill, MD. Dr. Cockerill is chair of laboratory medicine and pathology at Mayo Clinic in Rochester, Minn. He is No. 4 on the list with $11.1 million in reimbursements. But a Mayo spokesperson told the Washington Post Dr. Cockerill is the government-recognized director for Mayo Clinic Laboratories, meaning he is routinely listed as the billing physician on upwards of 23 million tests a year.

"When anything is billed out to Medicare, it will have Dr. Cockerill's name on it," Andy Tofilon, marketing administrator with Mayo Medical Laboratories, told the Washington Post. "He is the chair of a large laboratory medicine practice, and the buck stops at his desk."

Vasso Gadioli, MD. A vascular surgeon from Bay City, Mich., Dr. Gadioli is No. 6 on the list with reimbursements totaling $10.1 million in 2012. He said he gets paid about $3,000 per procedure for inserting stents in his office, according to the report, but he said he is still saving Medicare money. If he did the procedure in a hospital, he gets $500, and the hospital receives $8,000, he said. About 70 percent of Medicare payments to Dr. Gadioli went to overhead.

John C. Welch, MD. Dr. Welch, an ophthalmologist in Hastings, Neb., sits at No. 8 on the list of top billers. Like most ophthalmologists on the list, a majority of his billings come from the shots he gives patient with macular degeneration. That money, he said, is passed onto drug companies. "I don’t control what Medicare decides to pay the drug company," he said in the report. Dr. Welch said he bills so often because he is only one of a few local physicians in a large rural area who can perform the procedure, which leaves him working a 12- or 13-hour day.

Minh Nguyen, MD. Dr. Nguyen is a hematologist-oncologist at five-physician Orange Coast Oncology in Newport Beach, Calif. He was listed as the 10th-highest biller of Medicare in 2012. Dr. Nguyen said all the billings for chemotherapy drugs at his practice were under his name. This means it looks as though he is getting paid $9 million, "but it's a pass-through," he said in the report. "The majority of the billing goes to pay the drug companies."

More Articles on CMS' Medicare Data Dump:
7 Predictions on Medicare's Release of Physician Payment Data
CMS Data: 25% of Physicians Account for Most Medicare Spending
CMS Extends Transparency Movement to Physician Payment


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