Tags: Medicare | Doctor | Fees | Pay

Top Medicare Doctor Paid $21 Million in 2012, New Data Show

Wednesday, 09 April 2014 07:50 AM

A doctor who treats a degenerative eye disease in seniors was paid $21 million by Medicare in 2012, twice the amount received by the next ophthalmologist on a list of 880,000 medical providers released by the government.

The data on the payments was given to the public for the first time by the Centers for Medicare and Medicaid Services. The list, a detailed account of how $77 billion in federal healthcare funds were spent in 2012, showed a wide range in which some top earners were paid as much as 100 times the average for their respective fields.

Consumer groups have long urged the release of data showing Medicare’s true cost to taxpayers, saying it could help highlight fraud, while doctors’ groups argued against the release of raw payment data, saying it may lead patients to jump to the wrong conclusions.

“When I was prosecuting Medicare fraud cases years ago, it was often difficult even for us as prosecutors to get Medicare data in a timely fashion,” said Jay Darden, a partner at Patton Boggs LLP in Washington who left the Department of Justice in 2010.

“So the notion that now it’s not only being released, but released to the public, that could very well signal a recognition from CMS that it’s had a problem in the past and it needs to do something about it.”

Two doctors listed, who together were paid about $30 million, spent time in court in 2013 on claims they defrauded the government. While Medicare fraud cases aren’t unusual, the data released will provide a new level of transparency into the agency practices that may force doctors to become more careful in how they bill for Medicare patients.

64 Times Average

Salomon Melgen, a Florida ophthalmologist who specializes in injections for age-related macular degeneration, was paid $20,827,341 in 2012, or 64 times the average in his field, the data show. His appeal of a 2009 ruling that found he overbilled Medicare by $8.9 million was rejected last year. Farid Fata, a Michigan oncologist paid $10,063,281 in 2012, was charged with Medicare fraud in August, according to court records. The data opens fresh questions about Medicare’s payment policies.

“Deterring improper payments is a top priority of CMS in order to protect beneficiaries and taxpayers,” said Aaron Albright, a CMS spokesman. The agency “is working with our contractors to develop an appropriate cumulative payment threshold that considers costs, as well as potential benefits in determining which claims and providers should be selected for further scrutiny.”

Kirk Ogrosky, a former federal prosecutor who now represents Melgen’s company, said U.S. officials who combat fraud shouldn’t be looking at raw payment amounts alone.

‘Billed in Conformity’

“At all times, Dr. Melgen billed in conformity with Medicare rules,” Ogrosky said, referring to his client’s legal situation prior to the release of the 2012 data, given to media organizations with the agreement they not disclose the information before Wednesday morning.

Fata, in jail since his arrest in August, has pleaded not guilty to the charges against him, according to court records. His attorney, Christopher Andreoff of Southfield, Michigan, didn’t respond to phone and e-mail messages seeking comment on the case. CMS, meanwhile, won’t comment on any data involving individual doctors, according to spokesman Albright.

The American Medical Association, meanwhile, warned that the release of raw payment data without proper perspective on it may lead patients to the wrong conclusions.

AMA Concern

“The AMA is concerned that CMS’ broad approach to releasing physician payment data will mislead the public into making inappropriate and potentially harmful treatment decisions, and will result in unwarranted bias against physicians that can destroy careers,” Ardis Dee Hoven, president of the Chicago-based group, said in an e-mail.

Some of the numbers may be inaccurate and doctors haven’t been given a chance to review the data and make corrections, Hoven said in a telephone interview.

The data doesn’t show whether charges and payments under one doctor’s name apply to procedures done by other doctors in their employ, potentially increasing the amount of money they receive and the number of patients they care for. CMS’ Albright didn’t respond to a question on whether doctors in a large practice group could bill all their services under one name.

The listings, when seen in aggregate, offer insight into doctors’ billing practices across a variety of specialties.

Melgen and Fata were among seven individual provider who received more than $10 million from Medicare in 2012, the data show, and the top 25 doctors totaled $231.7 million from the program. Among the top 25 physicians, 12 were ophthalmologists, six were oncologists and eight lived in Florida, the only state to appear more than three times in the top-ranking list.

Twice as Much

Melgen, based in West Palm Beach, was the highest-paid doctor, according to the listings, with reimbursements that were twice as much as the next highest-paid ophthalmologist, Alexander Eaton of Fort Myers, Florida. Eaton, paid $10,726,482, was the fifth highest paid overall.

While Melgen made twice that of Eaton, half as many patients were served through his offices, according to the CMS listings. He saw 894 people compared with Eaton’s 2,721.

Melgen has been in the spotlight since 2009 when U.S. officials ruled he overbilled Medicare the previous two years for injections of a drug for age-related macular degeneration.

Melgen lost an appeal before the Medicare Appeals Council in June 2013, and sued in August in federal court in Miami seeking to overturn the decision. Last month, attorneys for his company, Vitreo Retinal Consultants of the Palm Beaches PA, urged a judge to reverse the decision arguing the ruling wasn’t backed by substantial evidence and that the doctor’s billing practices were appropriate, according to court papers filed March 27.

Suspended Payments

The Department of Health and Human Services notified Vitro of a suspension in Medicare payments in letters dated Aug. 20 and Aug. 23, 2013, lawyers for the company said in court papers filed Oct. 18. HHS agreed Oct. 29 to lift the suspension after Melgen said the company was no longer billing Medicare for multidosing Lucentis, the injection for macular degeneration, according to a joint court filing.

Fata, who owns and operates at least six oncology centers under the name Michigan Hematology Oncology PC., was arrested in August on charges he submitted false claims to Medicare for medically unnecessary services. Fata billed patients in remission for chemotherapy, deliberately misdiagnosed patients as having cancer to justify chemotherapy and fabricated diagnosis as reasons for ordering hematology treatments, prosecutors said in court papers.

Delayed Treatment

Fata also allegedly delayed emergency treatment for some patients with serious medical conditions until he could administer and bill for chemotherapy. In one instance, a patient with potentially fatal low sodium levels was given chemotherapy before being taken to an emergency room and hospitalized, prosecutors said.

The data showed that Fata received $10 million in Medicare payments in 2012, making him the highest paid oncologist out of 7,374 providers in his field.

Fata has been jailed since his arrest after prosecutors successfully argued the doctor, a Lebanon native who became a naturalized U.S. citizen in 2009, is inclined to flee and has the means to do so. Fata and his wife have a taxable estate worth more than $40 million and more than $14 million in mostly liquid assets, prosecutors said last year. The oncologist’s trial is set for August.

Other Doctors

Other doctors that were highest paid included Asad Qamar, a cardiologist based in Ocala, Florida, who was paid $18,154,816 by Medicare in 2012. The next highest cardiologist was paid $4,499,469.

The third and fourth-highest paid doctors, Michael McGinnis and Franklin Cockerill, both pathologists, were paid $12,577,017 and $11,068,463 respectively in 2012.

Cockerill, who is based in Rochester, Minnesota, billed for 56,628 unique patients in the year, providing over a million services. McGinnis, based in Wrightstown, New Jersey, saw 33,154 patients. The two doctors are received more than twice the amount of the third highest paid pathologist, who received about $5 million in 2012 for 8,976 patients.

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A doctor who treats a degenerative eye disease in seniors was paid $21 million by Medicare in 2012, twice the amount received by the next ophthalmologist on a list of 880,000 medical providers released by the government.
Wednesday, 09 April 2014 07:50 AM
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