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Follow the Money, MD

April 9th, 2014 - 12:57 pm

Whoa:

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.

It’s almost as if Medicare were just a scam to funnel money at politically-connected doctors.

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Dr. Melgen appeared on investigators’ radar when a Medicare contractor noticed that he, a single practitioner, was billing for Lucentis at a significantly higher rate than his peers, Justice Department lawyers wrote in response to a suit the doctor filed against the Health and Human Services Department.
Continue reading the main story

Each vial of the medication comes with up to four times the amount that a patient requires. Investigators said the doctor was using one vial to treat three or four patients, and billing as if he had purchased a new vial each time. The doctor would be reimbursed $6,000 to $8,000 for a vial that cost him $2,000.

The investigation concluded that in 2007 and 2008 alone, he overbilled by $9 million, which he was forced to pay back.

1: He's "a single practitioner"
2: He was caught stealing from Medicare, and bought Menendez to try to escape from punishment.

Yes, it's fraud.
29 weeks ago
29 weeks ago Link To Comment
Look at the source. This is an AP article. They publish administration talking points as "news stories". In this case the argument is that doctors are crooks. Who can you trust to trust to assign the correct value for a medical procedure? Not you. Not your crooked doctor.
The nameless, faceless bureaucrat in DC, that's who.
I've heard this argument before from liberals: "doctors are overpaid". Ricj coming from a humanities student with a BA degree who can't add a set of numbers and come up the same answer twice in a row.
Using a third-party online collection website, Medscape surveyed 24,216 physicians across 25 specialties from Feb. 1 to 17, 2012. Doctors’ earnings ranged from about $156,000 a year for pediatricians to about $315,000 for radiologists and orthopedic surgeons. The highest earners — orthopedic surgeons and radiologists — were the same as last year, followed by cardiologists who earned $314,000 and anesthesiologists who made $309,000.

The lowest earning doctors are the family guys. Pediatricians and family practitioners make about $156,000 and $158,000, respectively. Internists and psychiatrists rank a notch above, at about $165,00 and $170,000, respectively.

http://healthland.time.com/2012/04/27/doctors-salaries-who-earns-the-most-and-the-least/
29 weeks ago
29 weeks ago Link To Comment
"It’s almost as if Medicare were just a scam to funnel money at politically-connected doctors."

having taken care of a lot of Medicare patients, i find this conclusion mildly offensive. i don't know if Melgen is a crook or not. but assume that he has a practice that deals largely in the diseases of the elderly, ie cataracts, he owns his own surgical facility, call it "melscats" and that all the billing is done under the facility name. further, he decides to locate his pracitice in an area of wealthy retirees. and let him hire four other ophthamologists. all will bill under the facilities name, Melscats, even though he is a !00% owner. cataract surgery goes for about $3500 right now. one eye, surgeon and facility. that is about 6000 cases per year. 1200 per MD per year. or 115 per week in the facility. 23 per day or about 5/day per doc. very doable and most likely would have 10 not 5 ophthamologists.

anyway, perhaps he is a crook. but perhaps he is simply a good businessman, saw an opening and took it.

perhaps anyone recieving gov't money today is guilty until proven innocent. and perhaps he is-all 344 are-but i think you need more info to prove it.

but that's just me.
29 weeks ago
29 weeks ago Link To Comment
So, does Medicare pay enough for a Cataract operation to be profitable?

We already know that Melgan is a crook, see the bribes / "free trips" he gave Menendez. The only question is "what was he getting for those trips?"

Reread that last paragraph: "just 344 physicians — took in top dollar, at least $3 million apiece". You're proposing that 10 MDs each made $2 million / year off of Meidcare, just at one place, as part of a group. If was as easy as you imply it is, we'd have a hell of a lot more than 344 MDs making $3 million.
29 weeks ago
29 weeks ago Link To Comment
i'm not implying anything. i'm saying that the article doesn't give enough info to warrant the final sentence of the post.

does medicare pay enough to be profitable? beats me, i was a general surgeon, not an ophthamologist.

you seem to be assuming that "made $2 million" somehow equates to take home pay. $2 million gross billing is a lot different than take home.

you may know Melgan is a crook. Melgan may be a crook. i don't know that Melgan is a crook and this article doesn't establish anything except that he is a top grosser.

and if this article does establish that Melgan is a crook, it still doesn't justify the implication that Medicare is a scam in which Doctors are complicit.
29 weeks ago
29 weeks ago Link To Comment
1: He is a "single practitioner", not head of a group.

2: I know the difference between gross and net. But all the numbers reported are "gross" numbers. If it was as easy as you postulate for 10 MDs to gross $2 million, there's be a lot more than 394 grossing $3 million +
29 weeks ago
29 weeks ago Link To Comment
first i never said it was easy to gross $2 mill. i gave a hypothetical that takes into account a possible business structure. a structure where the doc has built a facility that allows him to bill for both hospital charges and professional services. and take on the risk and expenses of both, too. the professional services would be on the order of 1/3 of the total charges meaning that the appropriate comparison would be about 600k for someone working out of a facility that they didn't own. the hospital would bill the difference. same cost to medicare.

it seems to me that when the dems tried bashing the "Top 1%" there was, correctly, a blowback. now, doing the same thing to the top 2% of medicare billing docs the response is "scam" "fraud"and the lumping of the entire top 2% with Melgen.

29 weeks ago
29 weeks ago Link To Comment
"The top 1%" typically make their money by selling goods and services to the rest of us.

"The top 2%" of Medicare make their money off the taxpayers, and generally seem to be a politically connected group. Thus no benefit of the doubt.
29 weeks ago
29 weeks ago Link To Comment

Don't forget that Medicare is also a method of siphoning resources away from married couples with children (who by and large don't vote Democrat). Medicare doesn't cover the full cost of care for its beneficiaries, so when any of the four people in your family show up at the clinic, you get charged for the Medicare and Medicaid patients as well as yourself.

Yes, it hurts single people too, but boy those trips to the urgent-care clinic with the kids add up in a hurry.
29 weeks ago
29 weeks ago Link To Comment
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