Medicare database reveals top-paid doctors

[Omaha Steve]

Source: AP-EXCITE

By RICARDO ALONSO-ZALDIVAR and SERDAR TUMGOREN

WASHINGTON (AP) - Medicare paid a tiny group of doctors $3 million or more apiece in 2012. One got nearly $21 million.

Those are among the findings of an Associated Press analysis of physician data released Wednesday by the Obama administration, part of a move to open the books on health care financing.

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.

AP's analysis found that a small sliver of the more than 825,000 individual physicians in Medicare's claims data base - just 344 physicians - took in top dollar, at least $3 million apiece for a total of nearly $1.5 billion.

FULL story at link.


Read more: http://apnews.excite.com/article/20140409/DAD2HU682.html

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This Jan. 31, 2010, file image released by Miami Dade College shows Dr. Salomon Melgen, posing for a photo at the book signing of "Growing American Roots", a book by Sen. Robert Menendez, D-N.J., at the college in Miami. Topping Medicare's list of highest paid physicians from it's claims database 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. (AP Photo/Miami Dade College, Phil Roche, File)

[fasttense]

1. Something is very fishy about that.

I think any doctor or group that is making millions off our Medicare dollars should be routinely examined to ensure there is no fraud.

[pipoman]

3. It's my understanding that CMS is auditing hospital charges

With their RAC audits, not yet extended to doctors. Further it is my understanding that when RAC locates a problem billing at a hospital, it doesn't automatically link to the same services billed by the doctor. This failure leads to doctors refusing to comply with the rules. RAC should extend to doctors beginning yesterday.

[cosmicone]

6. Before we start shooting at the doctors

They are probably employers of many other doctors. The practice bills under the employer's name rather than the employees who are paid a salary.

In the case of a Florida ophthalmologist, it is obviously due to cataract surgeries which are common in medicare enrolees. Each cataract diagnosis and preop are $1K, operation is about $2500 so for two eyes it amounts to $7K. Each surgeon can do 30 operations a week. So $20.8 million can be explained easily as 3 or 4 ophthalmologists treating cataracts out of 4 or 5 offices around Florida.

[fasttense]

7. I didn't suggest shooting them

but think all large billings to Medicare should be looked at. If they have nothing to hide, they wont mind showing their books. We do the same thing with large transfers of money into and out of banks.

[cosmicone]

9. Right to audit is standard

in all Medicare-Physician agreements.

[ForgoTheConsequence]

21. He is a single practitioner.

And he is under investigation by the FBI and DHHS.

[passiveporcupine]

19. Using your numbers

cataract surgery for one eye (including pre-op and diagnosis) is $3500. It takes about 30 minuted to do one eye. So lets say this guy Mengan does 20 actual hours a week of cataract diagnosis and surgery. That is half of his time doing nothing but cataracts. He can make 70K a week. Now mult that times 52 (unrealistic he'd be doing this 52 weeks a year but what the hell) and he's making 3, 640, 000 a year. How do you get 21 million out of that? He would have to be doing nothing but cataracts for 116 hours a week to make that much.

So...according to his web site:

Dr. Melgen performs all of his out-patient surgical procedures at the Northpoint Surgery & Laser Center and the Port St. Lucie Surgery Center.

It sounds like he works alone. There are no other doctors listed as working at his offices. I am guessing he is making a lot more than 3500 an hour at his "state of the art" retinal centers. (He has four of them).

[GusBob]

23. He is not doing cataracts he is a retinal specialist

He is billing for lucentis/ avastin injections which are very expensive due to cost of medicine. Not defending the guy but we cant compare apples to oranges. avastin injection can probably be done on dozens of pts a day, its not surgery, again apples and oranges. there are other procedures retinal specialists do as well, lasers for diabetic retinopathy, etc. there are also associated diagnostic tests they can do in office which are billable

Our local paper released a list the top billers in our area the 2 eye drs are both retina drs, the cataract drs are not on the list

the top billers around here are cancer drs again due to the cost of the drugs

[passiveporcupine]

28. I don't care if he is delivering baby elephants

The man owns a private jet. And charges more than any other doctor on Medicare, by a long shot. There are no other retinal specialists who care for Medicare patients? Why aren't they making as much?

Oh, and according to wiki:
When bevacizumab (Avastin) is used in the treatment of macular degeneration, only tiny and relatively inexpensive doses (compared to amounts used in colon and other cancers) are required. Some investigators believe that bevacizumab at a cost of around $42 a dose is as effective as ranibizumab at a cost of over $1,593 a dose.

[pipoman]

2. Do we know what the senator was doing in DR?

[okaawhatever]

17. Yes, there was a bogus claim that he slept with prostitutes CREW and others investigated the claims

and they were totally bogus. The two "prostitutes" admitted under oath that they were paid to make the claim. It is sad that the media didn't do a good job of investigating who created the bogus scandal in the first place. The two girls, not sure if they were actual prostitutes or not (prostitution is legal in DR) appeared on some right-wing radio show and made their claims. That was after an anonymous claim was made to CREW that Menendez had gone to DR to sleep with prostitutes at the home of this DR. When CREW investigated they couldn't find anything and the anonymous source failed to provide any additional info and refused to give identifying info or cooperate with the investigation. When the investigation didn't go forward, another anonymous claim was made to CREW that one of the girls was underage. That led to right wing media screaming an investigation of pedophilia. That was timed to coincide with the two girls appearing on the radio show.
Interestingly, this all happened not long after Hurricaine Sandy when Chris Christie was being described as the front-runner for potus 2016. Sen Menendez would have caused problems for Christie due to his actions when he was US Prosecutor for NJ. Christie was behind an "October Surprise" for Menendez. In October of the year Menendez first ran for Senate, Christie issued a subpoena for Menendez over alleged financial wrongdoings. Of course, after the election nothing ever came of it, he was cleared. It was later discovered during the investigation of Bush's firing of US Attorneys that Christie was on the list of "to be fired" US Attorneys. Just after he issued the subpoena for Menendez, his name was removed from the list.
Menendez and this Dr. are friends, and have been for some time. Taking some vacation days at a friends house in the DR isn't a big deal.

[siligut]

4. I worked in healthcare in Florida

Last edited Wed Apr 9, 2014, 09:18 AM - Edit history (1)

Medicare fraud is a business model down there. I had to speak with Blue Cross regarding a patient who was charged, meaning Medicare was charged, for services she didn't receive and the collusion was palpable. Hillary Clinton went to Sarasota in the early nineties to address the problem, she left without changing anything.

[cbdo2007]

12. My job is to find medicare fraud and abuse....

and yep, the criminals have it down to a science! Any data like this helps us find potential fraudulent providers who are billing for services not received, or even upcoding the services provided and tacking on additional charges.

[siligut]

15. Thank you for the work you do

Dealing with white-collar criminals can be depressing. I found that patient care suffered as a result of medicare fraud, the focus was more on money than health.

[pangaia]

5. Is this Medicare Datebase report available anywhere?

[PADemD]

10. Here

https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/

[SmittynMo]

8. How does one make that much money in a year?

You would have to work 100 hours in a 24 hour day, 365 days a year to make this amount. I mean, how does one make that much money is a year? Auditing anyone over a certain amount should be mandatory.

[pangaia]

11. The highest paid MLB players make MORE than that..

for no service to society..other than.. fun!

Although I do love minor league baseball. :&gt

At $21,000,000/annum-
That's $129,000/game (not counting spring training)
A starting pitcher--5x that much per game.

Mariano..? depending on how many appearances-- say 50 average in a season .. 1 inning each (that's stretching it) 15-- or say even 20 pitches/inning I think his highest salary was around $16,000,000 ??

= about.. $16,000 PER PITCH !!

Of course nobody could hit him either.. for the most part

[Sgent]

16. The payment

Is not income, it's revenue.

10 patients a day with leucentis injections = Medicare payments of 5 million just to pay the cost of the drug.

[Igel]

18. I'd add another point.

My insurance was routinely billed for one partner at the place where I had my PCP. Didn't matter who I actually saw--that one partner was the name submitted to the insurance company.

It was the same for all the other patients. All patients were billed officially by one doctor because it made all the paperwork easier. The insurance company was fine with it. Even if there were 6 or 7 doctors, eaching putting in 35-40 hours or more per week, making it look like the one guy was billing for 28 hours/day.

Revenue versus income.

Reasonable billing fictions versus actual misbilling.

So much bad data to unravel and sort through to find good data.

[mainer]

13. Top earners are ophthalmologists

Cataract surgery must be a goldmine.

[GusBob]

14. As the article indicates, I think its retina more than cataract

The new treatments for wet macular degeneration (Avastin) are very expensive and need to be repeated every 3 months in some cases up to 6 treatments by my understanding. Well worth every penny for a condition which usually leads to a loss of vison. A lot of elderly folks in Florida afflicted with the condition. I think they are doing it also for other eye problems like diabetic eye disease which are becoming more prevalent as well

EDIT to add: the Dr in the link is a retinal specialist, they do not usually perform cataract surgery

[passiveporcupine]

31. here is another article on the retinal drugs used

http://www.washingtonpost.com/blogs/wonkblog/wp/2014/04/09/want-to-see-how-problematic-medicare-pricing-is-look-to-ophthalmology/

A dose of Avastin costs only $50. A dose of Lucentis costs $2,000. Both Avastin and Lucentis are made by the same company, and they're remarkably effective in treating a form of macular degeneration that was long the leading cause of blindness among the elderly, The Post reported. They are very similar on a molecular level and probably cost about the same amount to manufacture.
Nonetheless, doctors prescribe Lucentis almost as often as Avastin. They also make more money doing so. Medicare is legally obliged to pay for any drug a doctor prescribes, and doctors also receive commissions of 6 percent to cover their own expenses. The commission a doctor collects on each dose of Avastin would be only about $3, as opposed to $120 on each dose of Lucentis. Congress and the courts have refused to allow Medicare to save money by scrutinizing doctors' decisions.

[RebelOne]

27. I was thinking that very same thing

because I just had cataract surgery last month. My surgeon supposedly does 20 cataract surgeries per day. Medicare pays 80% of the cost, and because I do not have supplemental insurance, it cost me about $700 out of pocket. But I am extremely pleased with the final result.

[mainer]

30. As someone else pointed out, the $'s from Macular Degeneration

and the expensive drugs required to treat it. I was wrong to assume cataracts.

[ForgoTheConsequence]

20. Dr. Salomon Melgen appears to be quite the operator (or crook).

Melgen has been in the national spotlight since agents from the FBI and federal Department of Health and Human Services raided his West Palm Beach office last month and hauled away dozens of boxes of materials.

Menendez, who has received more than $700,000 in direct and indirect campaign help from Melgen and has made personal trips to the Dominican Republic on Melgen’s private plane, acknowledged last week that his office contacted CMS and “raised concerns” about billing policies in 2009 and 2012. But Menendez denied trying to intervene with government regulators on Melgen’s behalf.
Melgen family members gave $33,700 to Menendez’s 2012 re-election campaign, $50,000 to the New Jersey Democratic State Committee and $60,400 to the Democratic Senatorial Campaign Committee while Menendez was its chairman during the 2010 election cycle. Melgen’s Vitreo-Retinal Consultants also gave $700,000 last year to Majority PAC, a Democratic super PAC that poured $582,500 into Menendez’s re-election efforts.


Accused of over-billing Medicare by 8 million dollars.... where there's smoke, there's fire......


http://www.palmbeachpost.com/news/news/eye-doctor-salomon-melgen-lost-68-million-in-inves/nWK6B/

[ForgoTheConsequence]

22. This doesn't look good....

Billing Medicare While Financing Top Democrats

http://www.nytimes.com/2014/04/10/business/doctor-with-big-medicare-billings-is-no-stranger-to-scrutiny.html?_r=0



I always thought Menendez was a crook.....

[mainer]

24. OK, this is misleading. Those billings include the price of the drug.

which the physician's office has to stock, and pay for. At $2,000 an injection, with macular degeneration patients returning multiple times a year, that's a lot of money for the drug company -- not the doctor.

[Nye Bevan]

25. $21 million? No wonder that dude is smiling (nt)

[warrant46]

26. He looks like he went to the Mustang Ranch