Doctors who lost licenses get millions from Medicare

Medicare records released last month show the agency paid at least eight doctors with suspended or revoked medical licenses collectively more than $7 million a year, including doctors disciplined for gross malpractice, battery and violating prescription drug laws, according to Bloomberg Businessweek.

A doctor who lost his license in Ohio after embezzling $1 million from the Cleveland Clinic in 1995, then got a license to practice in New Mexico, received more than $660,000 from Medicare in 2012, according to the article. Another doctor with a suspended license billed Medicare for more than 6,000 services for only 42 patients, totaling more than $500,000, and claimed repeated office visits for unspecified treatments.

The article poses the question: Why didn't Medicare investigators find these red flags?

The federal government spent $1.5 billion fighting healthcare fraud last year, contracting with four recovery audit companies and seven integrity contractors to find and stop improper payments, but the payments to suspected dirty doctors continued, Businessweek noted. The government recovered $4.3 billion in healthcare fraud judgments last year, but that may be a fraction of the estimated $30 to 98 billion lost every year.

Industry leaders aren't happy about healthcare dollars going to disciplined doctors. "If a doctor is thrown out of one state, that should be enough to exclude them from Medicare," Sidney Wolfe, a physician who founded Public Citizen, a Washington consumer advocacy group, told Businessweek.

Medicare kicked out 17,000 providers for fraud violations, Shantanu Agrawal, director of Medicare's Center for Program Integrity, said in during Senate testimony in March.

The Medicare payment data brings more than a few doctors into question. Florida ophthalmologist Salomon Melgen earned $20.8 million from Medicare in 2012. A 2009 ruling found he overcharged Medicare by $8.9 million for multidosing the injectable macular degeneration drug Lucentis (Ranbizumab), FierceHealthPayer previously reported. Farid Fata, a Michigan oncologist who received more than $10 million from Medicare in 2012, was arrested in August for submitting false claims.

To learn more:
- here's the article
- check out the payment database
- here's Agrawal's testimony (.pdf)

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