Data trove shows U.S. doctors reap millions from Medicare
NEW YORK (Reuters) - In 2012, an enterprising ophthalmologist in south Florida received $20.8 million in Medicare payments, the highest amount the government health plan for the elderly paid an individual provider that year, according to a preliminary analysis of federal data.
A family-practice doctor in Maryland may have received an average of more than $86,000 per patient that year, according to a Reuters review of the data. And a California laboratory apparently received $190 million, the most Medicare paid a single entity in 2012.
After decades of litigation and over the strenuous objections of the American Medical Association, the leading U.S. doctors group, the federal Centers for Medicare and Medicaid Services (CMS) on Wednesday made public for the first time how much Medicare pays individual doctors.
The massive data release, totaling nearly 10 million lines, also includes which medical services each of more than 880,000 physicians and other healthcare providers nationwide billed Medicare for in 2012.
"While the data are not perfect, this is a major milestone in healthcare transparency," said cancer surgeon Marty Makary of Johns Hopkins School of Medicine, whose 2012 book, "Unaccountable," argues for making public more information on doctors and hospitals.
In addition to allowing patients to see which doctors perform a particular procedure most frequently - often a proxy for expertise in rare and difficult surgeries such as colon operations - the data are expected to offer a roadmap to where waste and fraud are most rampant not only in the Medicare program but throughout the American healthcare system.
"If you see that a doctor is doing a procedure hundreds or thousands of times that should be done only on a small number of patients, you wonder," said Dr. John Santa, medical director of Consumer Reports. "Are they committing fraud by billing for something they're not actually doing, doing unnecessary procedures because they're greedy, or do they practice someplace where so many people need the procedure?"
Medicare paid physicians, physical therapists, nurse practitioners, chiropractors and other individual providers $77 billion in 2012. About two-thirds of Medicare's total $540 billion in payments that year went to hospitals and most of the rest to prescription drugs.
The providers on the list all participate in Medicare Part B, which covers services from eye exams and physical therapy to knee replacements, cataract surgery and CT scans.
Doctors are not required to accept Medicare, which covers some 50 million elderly and disabled Americans, but most do. Excluding pediatricians, 91 percent of U.S. doctors accept new Medicare patients, according to a 2013 report from the Kaiser Family Foundation, and even more continue to see existing Medicare patients.