Doctors Collect $77 Billion from Medicare

Published 04/09 2014 11:05AM

Updated 04/09 2014 11:15AM

NEW YORK (CNNMoney) -- Medicare paid doctors and other health care providers $77 billion in 2012 to care for the nation's elderly, according to federal statistics.

The unprecedented data release, which covers 880,000 physicians, therapists, labs and other medical facilities, marks the first time the government has made public detailed information on the services and procedures provided to Medicare patients by individual doctors. It also shows what health care professionals billed the government and what they were paid.

 The American Medical Association had long battled to keep this data private, arguing it could be misconstrued, but a federal judge last year lifted the injunction. The Centers for Medicare and Medicaid Services, as well as other experts, cautioned against drawing conclusions based purely on the numbers.

For instance, the data doesn't reveal the conditions of the patients. Also, doctors don't always get to keep the entire payment since they may have to reimburse drug companies or other providers for part of the service.

Cancer doctors were among the highest paid, with those that focus on blood cancers receiving an average of $367,000. Ophthalmologists also reaped in big bucks, collecting $327,164, on average. Cardiologists and nephrologists, who deal with kidney disease, were also near the top of the ranks.

Federal officials said they are releasing the data to bring more transparency and accountability to Medicare billing and payments. They are also hoping the public will use the information to help fight fraud.

"Currently, consumers have limited information about how physicians and other health care professionals practice medicine," said Health Secretary Kathleen Sebelius "This data will help fill that gap by offering insight into the Medicare portion of a physician's practice."

CMS released similar information on hospitals last year, which allowed consumers to compare what hospitals charge for common inpatient and outpatient services nationwide.

The doctors' data release follows a Department of Health and Human Services' Office of Inspector General report last year that warned about fraud concerns among high billers.

The inspector general report looked at the $65 billion Medicare paid out in each year between 2008 and 2011. Approximately 2% of physicians were responsible for almost 25% Medicare payments, each pulling in more than $500,000 annually.

The inspector general found that of the 303 doctors who each provided more than $3 million of services in 2009, more than 100 were flagged for improper payment reviews. Three had their medical licenses suspended and two were indicted. And reviewers found overpayments of more than $34 million.

The primary specialties subjected to the reviews included internal medicine, radiation oncology and ophthalmology. More than a quarter of the doctors practiced in Florida, with others in California, New Jersey and Texas also ranking among the top.

(Tami Luhby, CNNMoney)

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