Tiny Share of Doctors Get Big Slice of Medicare Pie

A single Florida ophthalmologist was paid $21 million by Medicare in 2012, according to federal data released Wednesday that shows a tiny sliver of U.S. doctors who accept Medicare account for an outsize proportion of the insurance program’s costs.

Medicare payments to 880,000 doctors nationwide totaled roughly $77 billion in 2012. But the top 2 percent of highest-paid doctors who accept Medicare accounted for about $15 billion in payments under the system, almost a quarter of the total not including commercial entity payments, according to data analyzed by the New York Times.

The data shows in detail for the first time how Medicare pays doctors for specific procedures. Fraud investigators, health insurance plans and researchers will sort through the new data with a fine-tooth comb in the upcoming weeks, likely leading to lawsuits and changes in insurance practices.

“There’s a lot of potential for whistle-blowers and justified worry for fraudsters,” Steven F. Grover, a lawyer who represents whistle-blowers who sue doctors they claim have committed Medicare fraud, told the Times. “There’s going to be a lot of litigation over this.”

In 2012, 100 doctors received a total of $610 million from Medicare payouts, and about 3,300 ophthalmologists were paid $3.3 billion from Medicare, the Times reports. Medicare paid $12 billion for 214 million office and outpatient visits—most of them outpatient visits between 15 and 25 minutes long. The doctors and nurse practitioners were paid an average of $57 per visit.

Ophthalmology and oncology both accounted for a large chunk of Medicare spending.

The doctor’s group the American Medical Association has withheld Medicare data for decades, but a federal judge ruled last year the information could be made public. This release marks the first time since the 1970s that detailed figures on Medicare reimbursements have been made available.

[NYT]