Medicare Releases Billing Records: 10 Quick Observations

CMS released data Wednesday that shows the dollar amount more than 888,000 physicians received in Medicare Part B payments in 2012. It's the first time such information has been made publicly available in roughly 35 years.

It takes some time to identify trends and patterns in the raw data, which was made available on CMS' website. The comprehensive data set requires use of database or statistical software to access, but The Wall Street Journal (which has played a prominent role in the release of the information) has created an easy-to-use search engine.

As we continue to explore this data, here are 10 initial takeaways to note.

1. Salomon Melgen, MD, was the No. 1 recipient of Medicare dollars in 201, receiving $20.8 million dollars in Medicare Part B reimbursement. He is an ophthalmologist who founded the Melgen Retina Eye Center in West Palm Beach, Fla. in 1988.

2. The New York Times reported today that several of the largest Medicare recipients were huge donors to political causes, contributing hundreds of thousands of dollars to political action committees and/or campaigns. One could infer that the physicians were protecting particular reimbursements.

For instance, Dr. Melgen's firm donated more than $700,000 to Majority PAC, which then spent $600,000 to help re-elect New Jersey Sen. Robert Menendez (D), a friend of Dr. Melgen. When Dr. Melgen was sued for allegedly overbilling CMS $9 million for Lucentis, the physician reached out to Sen. Menendez for help, according to The New York Times. The report says Mr. Menendez's aides acknowledged that the senator called the Medicare director at CMS in 2009 and later brought the matter up at a meeting with the acting administrator in 2012. The two now find themselves under FBI scrutiny.   

3. An oncologist who practices in Rochester Hills, Mich., received $10.1 million in Medicare Part B reimbursement in 2012. An anesthesiologist who practices in East Providence, R.I., received $3.5 million. Both physicians have been indicted for fraud in federal courts, and the oncologist is now in jail.

4. On average, nephrology, ophthalmology and radiation oncology had the highest reimbursement per specialty. There are a couple of considerations here. Nephrologists who care patients with end state renal disease are generally eligible for Medicare reimbursement regardless of patients' age. For ophthalmology and radiation oncology, both generally treat an older patient population and are highly dependent on Medicare patients.

The New York Times also reported that California and Florida were homes to the largest numbers of billers in 2012. This may make sense given the older population residing in those states.

5. Gastroenterologists, on average, received $111,000 dollars. This likely reflects the fact that their patient base is made up of approximately 30 to 40 percent of Medicaid patients.

6. Some of the largest recipients were providers of imaging and specifically cardiac diagnostic imaging. One physician received $2.7 million.

7. Dermatologists did very well under Medicare, which is likely attributable to Mohs surgery, or chemosurgery, which treats common types of skin cancer. Part B reimbursements averaged $212,000 per dermatologist.

8. Pain management remains a high recipient of Medicare dollars, with averages at about $197,000 per physician.

9. Nearly 50 percent of the top 100 recipients were ophthalmologists. The top 10 recipients over all received a total of $121.4 million in Medicare payments in 2012. The four ophthalmologists in that group accounted for $50.3 million of the total.

10. It is predicted by at least one outlet that the release of the data will lead to a huge increase in false claims litigation. Some experts say CMS' data dump will likely "galvanize False Claims Act litigation for years to come," according to a Law360 report.  

More Articles on Medicare Reimbursements to Physicians:
5 Top Medicare Billers Explain Their Charges
CMS Data: 25% of Physicians Account for Most Medicare Spending
7 Predictions on Medicare's Release of Physician Payment Data


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