Medicare Discloses Individual Physician Payments

MAY 22, 2014

After an intense legal battle regarding the non-transparency of payments made to individual Medicare providers, Medicare data for physician and other healthcare provider payments was released to the public April 9, 2014. Payments to hospitals, institutions, clinical laboratories, and ambulance services, among others were not a part of the report.

The data revealed that the greatest percentage of fees overall were paid for routine office visits but the largest concentration of higher paid fees went to a very small fraction of the 80,000 physicians and healthcare providers enrolled in the Medicare program. These providers collected one quarter of the $77 billion dollars in fees paid under the federal program, with the largest percentage of payments made to ophthalmologists and oncologists.

In 2012, 100 doctors received a total of $160 million. The highest paid were ophthalmologists, mainly for treatment of macular degeneration. Approximately 3,300 ophthalmologists were paid a total of $3.3 billion from Medicare. One Florida ophthalmologist alone collected $21 million.

Analysts predict that fraud investigators and health care insurance plans will be poring over this data in the coming weeks to locate which doctors perform an unusually high volume of services to then determine whether every test or procedure was medically necessary.

Some physicians and medical institutions expressed concerns that some of the data would be misconstrued with regard to the treatment of severely ill patients who suffer, for example, from heart disease or cancer, and for physicians who direct large projects overseeing a substantial number of other doctors or patient populations. One example cited was a physician at the University of Michigan Health Systems who oversees 1,600 primary care physicians, who each receive a small payment each month.

Ophthalmologists also claim that their high representation in the figures quoted is misleading because a large percentage of the fees pad goes to the cost of drugs they administer for patient treatment, which, in turn, is paid to drug companies. Read more about the data behind Medicare’s payouts to physicians.

The Atlanta healthcare attorneys at Frances Cullen, P.C. represent physicians and other healthcare professionals with Medicare and Medicaid issues. Contact us immediately if you believe you may be subject to an audit, appeal, or fraud prosecution.

Read more about Medicare and Medicaid Fraud.