Family doctor reaped more than $2M in Medicare payments

While most doctors aren't getting rich off Medicare payments, a few are. One of the best-paid family-medicine physicians in the Medicare system pulled in more than $2 million in 2008 from Medicare. She confirmed this fact for Wall Street Journal reporters.

How'd she do it? The osteopathic doctor in the New York City area administered many sophisticated tests, including polysomnography sleep analyses, nerve conduction probes and needle electromyography procedures. On average, her patients had 13 procedures or tests performed that year.

After mining a 5 percent sample of the Medicare claims database--that computerized record of the bills Medicare pays for medical treatment--WSJ reporters uncovered a number of doctors whose billing patterns also suggested either abuse or outright fraud, according to experts who looked at the records.

WSJ showed fraud and billing experts' spreadsheets that contained the doctor's billing records from the database. A former federal prosecutor who specialized in Medicare fraud called the conspicuously large number of diagnostic tests "medically improbable."

The osteopathic doctor mentioned above denied wrongdoing, but noted that she closed the office she had in 2008 after an audit by a Medicare contractor. She told the WSJ she no longer performs most of the 29 diagnostic tests she did in 2008.

What may seem strange to some is that the WSJ cannot name the physician. While the database is powerful, the names of doctors cannot be publicly identified, thanks to a court case that the American Medical Association won during the Carter era to keep secret how much money individual physicians get from Medicare.

Healthcare advocates told the WSJ that if the public were allowed access to the database with doctors clearly identified, it could expose many ways in which healthcare providers waste taxpayer dollars. Former House Speaker Newt Gingrich estimated that the feds lose up to $120 billion a year in Medicare and Medicaid to crooks. "You ought to be able to identify those," he said.

Joseph Califano, Jr., who was President Jimmy Carter's secretary of health, education and welfare, agreed. He pushed to make Medicare payments to doctors public, but courts have sided with the AMA lobby. Opening the database could help state professional review boards reveal incompetence and improve the level of medical care, he said.

To learn more:
- read the Wall Street Journal article

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