New Medicare Data Shows Big Payouts for Tiny Number of Doctors
The Obama administration has just released detailed data about the payouts it made to 880,000 doctors and other healthcare services in 2012. Of the $77 billion paid out, roughly a quarter of that went to a microscopic subset, only 2 percent of doctors.
.The Obama administration has just released detailed data about the payouts it made to 880,000 doctors and other healthcare services in 2012. Of the $77 billion paid out, roughly a quarter of that went to a microscopic subset, only 2 percent of doctors.
The Associated Press reports that 344 of the 825,000 individual physicians in the dataset received $3 million or more. According to The New York Times, 100 doctors received more than $4 million apiece. The Los Angeles Times writes that more than a dozen physicians received over $10 million.
The biggest earner was a Florida ophthalmologist named Salomon Malgen, who was paid $20.8 million by Medicare. He and the second-highest earner are already under government review on suspicion of improper billing.
Of the AP’s 344 doctors who were paid more than $3 million, 151 were ophthalmologists. In addition:
About 1 in 4 of the top-paid doctors — 87 of them — practice in Florida, a state known both for 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.
There are limitations to the dataset, however:
The new data reflect only Medicare Part B claims, which include doctor visits, lab tests and other treatment typically provided outside a hospital. They include what Medicare paid plus any money providers received from patients for deductibles and coinsurance. Altogether, the payouts totaled $99 billion paid to healthcare providers in 2012. These government figures don’t cover commercial insurance, Medicaid or even Medicare Advantage plans.
$22 billion of that $99 billion is missing from the data because only procedures performed on more than 10 patients were included, and data on durable medical equipment was omitted.
The American Medical Association has frequently opposed the release of the Medicare database. AMA president Ardis Dee Hoven said, that it “has significant shortcomings regarding the accuracy and value of the medical services rendered by physicians … Releasing the data without context will likely lead to inaccuracies, misinterpretations, false conclusions and other unintended consequences.”
You can play around with the data yourself, or if you want to dive a little deeper, the full set is available for download over at the Centers for Medicare and Medicaid Services website.