Medicare data disclosure reveals top-paid doctors

04/09/2014 8:19 PM

04/10/2014 9:22 AM

Doctors and other healthcare providers in the Tarrant County area who treat Medicare patients typically earned about $37,000 from the federal health program in 2012.

That’s a little more than the median of $30,000 paid nationally, but it’s a lot less than the top-paid physicians, according to the first public disclosure of Medicare payment data that identifies individual providers.

Nationally, 344 physicians were paid at least $3 million by Medicare in 2012, with the most, $20.8 million, going to a Florida ophthalmologist, according to an Associated Press analysis.

The data cover $77 billion in payouts to more than 880,000 healthcare providers in 2012. About 2 percent of clinicians accounted for 25 percent of payments.

In the Tarrant County area, payments amounted to $1.4 billion.

In a conference call with reporters Wednesday morning, Medicare officials said ophthalmologists, who treat eye diseases, and oncologists, who treat cancer, could have higher reimbursements partly because they often buy and administer expensive drugs. But high payments could also be unjustified, they said.

“We know there is waste in the system. We know there is fraud in the system,” said Jon Blum, Medicare’s deputy administrator. “We want the public to help identify spending that doesn’t make sense.”

Employers, insurers, consumer groups and media organizations pressed for release, arguing that the data could help guide patients to doctors who provide quality cost-effective care. A federal judge last year lifted the main legal obstacle, and the Obama administration recently informed the American Medical Association that it would open the claims data.

The AMA, which had long opposed the release, was critical.

“We believe that the broad data dump … has significant shortcomings regarding the accuracy and value of the medical services rendered by physicians,” AMA President Ardis Dee Hoven said.

About 1 in 4 of the top-paid doctors — 87 of them — practices in Florida, a state known for both high Medicare spending and widespread fraud. Rounding out the top five states were California, with 38 doctors in the top group; New Jersey, with 27; Texas, with 23; and New York, with 18.

Area physicians were led by Arlington radiation oncologist Peter LaNasa, who was paid $3.5 million by Medicare in 2012, according to the report. Nineteen Tarrant-area doctors were paid $1 million or more.

LaNasa is director of radiology at the USMD Prostate Cancer Center in Arlington. A company representative said that LaNasa was not available for comment and that the company could not comment on the accuracy of the Medicare report.

Larry Marshall, a Fort Worth rheumatologist and president of the Tarrant County Medical Society, said the AMA asked to review the information before it was released, which could catch problems such as a group of providers reported under a single doctor’s listing.

But the government needs to keep an eye on unusual spending, he said.

“When they pay millions of dollars, they should look and see, ‘What did we buy?’ ” Marshall said. “But to sensationalize it, to say they’re overpaying” without providing any other context, is not useful, he said.

In rural Hastings, Neb., ophthalmologist John Welch said the vast majority of the $9.5 million that Medicare paid him went straight from his practice to drug companies for expensive medications used to treat macular degeneration.

“I’m concerned that people in the community will get the wrong idea of how these billings reflect doctors’ income,” said Welch, who was No. 8 in Medicare payments.

As for No. 4 on the list, the Mayo Clinic in Minnesota said a large number of tests were billed under Dr. Franklin Cockerill, chairman of laboratory medicine and pathology. According to the Medicare database, Cockerill was paid more than $11 million.

“Dr. Cockerill is a salaried employee of the Mayo Clinic and is not making big money from Medicare,” spokesman Bryan Anderson said.

Medicare officials said multiple providers should not use one doctor’s identification number for billing.

Another case, from Michigan, suggests that following the money can turn up problems. Detroit-area cancer doctor Farid Fata, among the top billers, is awaiting trial on federal charges that he intentionally misdiagnosed patients and ordered unnecessary treatments.

Fata has said he is innocent.

The overall top-paid doctor in 2012 was Florida ophthalmologist Salomon Melgen, who received $20.8 million. Melgen’s lawyer said the doctor’s billing conforms with Medicare rules and reflects drug costs.

Staff writer Jim Fuquay contributed to this report, which includes material from The Associated Press.

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