fb-pixelNation's top Medicare billers revealed in data - The Boston Globe Skip to main content

Nation's top Medicare billers revealed in data

WASHINGTON — The Medicare program is the source of a small fortune for many US doctors, according to a trove of government records that reveal unprecedented details about physician billing practices around the nation.

The government insurance program for older people paid nearly 4,000 physicians in excess of $1 million each in 2012, according to the new data. Those figures do not include what the doctors billed private insurers.

The release of the information gives the public access for the first time to the billing practices of individual doctors nationwide. Consumer groups and news outlets have pressured Medicare to release the data for years. And in doing so Wednesday, Medicare officials said they hope the data will expose fraud, inform consumers, and lead to improvements in care.

The American Medical Association and other physician groups have resisted the data release, arguing that the information violates doctor privacy and that the public may misconstrue details about individual doctors.

Among the highest billers were a cardiologist in Ocala, Fla., who took in $18.1 million, mainly putting in stents; a New Jersey pathologist who received $12.6 million performing tissue exams and other tests; and a Michigan vascular surgeon who got $10.1 million.

Some of the highest billing totals may simply reflect a physician who is extremely efficient or who has an unusually large number of Medicare patients.

The highest numbers also may reflect a physician who specializes in procedures that require costly overhead, and in those cases, a large portion of the money may wind up not with the doctor but with pharmaceutical companies or makers of medical devices.

But in some instances, the extremely high billing totals could signal fraudulent doctor behavior, as government inspectors have previously found.

Three of the top 10 earners already had drawn scrutiny from the federal government, and one of them is awaiting trial on federal fraud charges.

The greatest tallies also may signal that the Medicare payments for some procedures are too high for the amount of work involved or that perverse incentives lead doctors to overuse a procedure.

The specialties most common at the top ranks of the Medicare payments were opthalmologists, oncologists, and pathologists.

This information gives the public ‘‘unprecedented access to information about the number and type of health care services’’ doctors provided during the year, Jonathan Blum, principal deputy administrator of the Centers for Medicare and Medicaid Services, said in a blog post.

The Medicare program is the nation’s largest medical insurer. By virtue of its breadth, the forthcoming billing data are expected to shed light on an array of questions that have arisen about health care costs as the nation has confronted decades of rising medical bills.

Overall, the information covers $77 billion in billing involving 880,000 practitioners in 2012.

The AMA has warned that the data could contain errors, and in some cases, one doctor’s billing number may have been used by multiple support personnel for billing purposes.

In addition, the billing figures reflect what a doctor receives in payment but does not show the actual profit after paying for equipment, support personnel, and malpractice insurance.

For some procedures, the overhead can reach three-quarters or more of the payment amount.

Many of the highest billers, for example, were in fields with unusually high expenses, and that was likely to limit their personal share of the money. Using the assumptions that Medicare and the AMA make when setting payment rates, only 23 of the 4,000 biggest billers personally earned $1 million or more, according to a Washington Post analysis.

Consumer and public interest groups argued that the information will help consumers make better decisions.