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(Washington Post)   Meet the handful of doctors who've managed to get filthy rich through Medicare billing   (washingtonpost.com) divider line 103
    More: Asinine, Medicare, Medicare payments, perverse incentives, Salomon Melgen, American Medical Association, marketplace of ideas  
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8756 clicks; posted to Main » on 09 Apr 2014 at 9:56 AM (28 weeks ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2014-04-09 08:05:32 AM  
The average doc is not striking it rich on medicare, I assure you.
 
ZAZ [TotalFark]
2014-04-09 08:09:18 AM  
A salary cap seems to be in order, or transfer some of the reimbursement from sexy procedures like stents to routine care and ordinary doctors who are threatening to quit Medicare.
 
2014-04-09 08:16:38 AM  
Or as Rick Scott calls them: Amateurs.
 
2014-04-09 08:45:04 AM  
I am certain the GOP will not take these few anecdotal cases and use them to attack all of Medicare in a misguided attempt to link it to Obamacare. Right?
 
2014-04-09 09:58:14 AM  

NuttierThanEver: I am certain the GOP will not take these few anecdotal cases and use them to attack all of Medicare in a misguided attempt to link it to Obamacare. Right?


Well, either that or they praise these guys as Job Creators who are just playing successfully by the rules of the game like the brave entrepreneurs they are.  One or the other.
 
2014-04-09 10:04:53 AM  

HMS_Blinkin: NuttierThanEver: I am certain the GOP will not take these few anecdotal cases and use them to attack all of Medicare in a misguided attempt to link it to Obamacare. Right?

Well, either that or they praise these guys as Job Creators who are just playing successfully by the rules of the game like the brave entrepreneurs they are.  One or the other.


Is comprehension of TFA your strong suit?

Melgen's name appeared in headlines in 2012 as result of his connection to Sen. Robert Menendez (D-N.J.), a friend who received campaign contributions from the ophthalmologist. Menendez has been accused of improperly raising concerns with federal health officials on his behalf.

Corruption and the -NJ suffix showing up together again. Who'da thunk?
 
2014-04-09 10:04:57 AM  

ZAZ: A salary cap seems to be in order, or transfer some of the reimbursement from sexy procedures like stents to routine care and ordinary doctors who are threatening to quit Medicare.


Can't quit Medicare.  Medicaid's optional, Medicare's not (to my recollection).

FTA: 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.


Speaking as a former data analyst on Medicare data looking for fraud, waste and abuse, this is a filler BS article.  Somebody has to be on top.  Yup, there's fraud out there--some estimates go as high as 3% of providers.  But just because you billed a lot doesn't make you evil.
 
2014-04-09 10:07:33 AM  
"I could have been a doctor and made some real money, but nooooo....I wanted to play stupid baseball. What a fool I was".....Alex Rodriguez
 
2014-04-09 10:08:48 AM  
People's Health is a Medicare company in New Orleans that has slowly expanded to other LA cities. It is owned by a group of 20 doctors in the Ochsner hospital system. Guess which hospital you are heavily encouraged or in some cases required to go to.
 
2014-04-09 10:10:17 AM  
There are two ways for a doctor to get rich off Medicare and Medicaid. One of them is not sustainable. The other, "filthy" doesn't even begin to describe.
 
2014-04-09 10:10:39 AM  
The system is too corrupt. Replace it with single payer.
 
2014-04-09 10:10:47 AM  

NuttierThanEver: I am certain the GOP will not take these few anecdotal cases and use them to attack all of Medicare in a misguided attempt to link it to Obamacare. Right?


That's four thousand cases worth of anecdotal, for those of you having trouble keeping score at home.

This has very little to do with Obamacare. Medicare and Medicaid has been a fraud magnet from the start.
 
2014-04-09 10:14:04 AM  

jigger: The system is too corrupt. Replace it with single payer.


The trouble is getting from your first sentence to your second line. Because the system is so corrupt under centralized control, increasingcentralized control is going to help?

I dig what a place like Norway does for its citizens on social services including health care, but in terms of efficiency, honesty, oversight and culture we're nowhere near Norway.
 
2014-04-09 10:17:39 AM  

palelizard: Yup, there's fraud out there--some estimates go as high as 3% of providers.  But just because you billed a lot doesn't make you evil.


QFT

Healthcare is expensive, it's unlikely that these top few are committing fraud and without details it's impossible to know from this article.
 
2014-04-09 10:20:27 AM  
Medicare has long been rife with fraud and abuse and CMS attempts to eliminate it, but unscrupulous docs and other providers always find ways to game the system. Until we decide as a nation that healthcare should not be a for-profit industry, nothing is going to change. We spend the largest percentage of GDP on healthcare in the world and we are absolutely nowhere near the top in terms of outcomes on the investment. Our healthcare system sucks and costs us way too much money. As long as the incentive is there and there is no disincentive to cheat, these procedure docs are going to continue to screw the taxpayers and their patients. They know that the worst that is going to happen to them if they get caught is that they will be asked to return some of the payments made to them and they may be suspended from Medicare payments for a short time, even though imprisonment can be imposed for Medicare fraud. It almost never happens because the AMA is too powerful and pays off Congress to pressure CMS not to pursue criminal charges against offenders.
 
2014-04-09 10:26:54 AM  

Voiceofreason01: it's unlikely that these top few are committing fraud


TFA says three out of the top ten were already under federal scrutiny and a fourth is up on charges already.

Throw in Florida's status as a mecca for Medicare/Medicaid sleaze, note that Florida is unusually well-represented among the highest billers, and you should be smelling something rotten by then.
 
2014-04-09 10:31:18 AM  
The guy who sold me my last car billed me $35,000 - if he's making $35k off everyone who buys a car he must be insanely rich!  I demand the gov't look into these bills!  I bet he rakes in $20M a year... for selling cars!
 
2014-04-09 10:33:30 AM  
My hospital is under investigation for that. :(
 
2014-04-09 10:34:15 AM  
Is not RICK SCOTT, governator of, where else, Florida, the Champion Medicare Fraud?

I mean, who could come close?
 
2014-04-09 10:37:06 AM  

Gulper Eel: TFA says three out of the top ten were already under federal scrutiny and a fourth is up on charges already.


I didn't read the article but that's good to know. The main point is that while there is fraud under medicare and it's a bad thing and fraud should probably be more aggressively prosecuted ultimately fraud is a relatively small part of Medicare's overall cost and if you want to spend less money on healthcare there are greater systemic problems that need to be addressed and the argument that always comes out of these articles that "Medicare/Medicaid should go away because fraud" are stupid at best and dishonest at worst.
 
2014-04-09 10:38:05 AM  

JackieRabbit: Until we decide as a nation that healthcare should not be a for-profit industry wharr wharr wharr...


(notthisshiatagain.jpg)

People put a value on their health (regardless of how well or poorly they take care of themselves) and it's something that can be measured both in dollars and in political power. Deal.

Once you get beyond the lifestyle factors and anything else you (and then your primary care doctor) can take care of yourself, every other outside decision about your health care is going to be some combination of business decision and political decision.

The more you know.
 
2014-04-09 10:38:12 AM  

jigger: The system is too corrupt. Replace it with single payer.


I agree, as long as that single payer is Warren Buffett. I bet he could pay for at least 5-8 years.

/Then the Waltons.
 
2014-04-09 10:41:11 AM  

Gulper Eel: Is comprehension of TFA your strong suit?


This is fark.  I didn't even click on TFA.
 
2014-04-09 10:42:13 AM  

Voiceofreason01: I didn't read the article but that's good to know. The main point is that while there is fraud under medicare and it's a bad thing and fraud should probably be more aggressively prosecuted ultimately fraud is a relatively small part of Medicare's overall cost


Fraud has been estimated at around ten percent of Medicare's budget for decades. Do you know of any private-sector corporation that lets 10% of its revenue simply go flying out the door that way?

Even one percent fraud would be close to five or six billion dollars a year.
 
2014-04-09 10:44:33 AM  

NuttierThanEver: I am certain the GOP will not take these few anecdotal cases and use them to attack all of Medicare in a misguided attempt to link it to Obamacare. Right?


Don't the republicans depend on the votes of Medicare recipients? "Scared, ill, old people" being the only demographic they have left.
 
2014-04-09 10:46:43 AM  

Gulper Eel: People put a value on their health....


More to the point someone has to. Hospitals are expensive to run, doctors take years/decades of training, medication and sterile supplies cost money and high tech equipment like MRI's and dialysis machines cost a boatload of money. Ultimately someone has to pay for this stuff. A profit motive is not a bad thing, the problem comes when you have rampant fraud or profits, operating costs and patient costs have been totally separated from each other so that a market based system no longer operates like a free market.
 
2014-04-09 10:47:57 AM  

Voiceofreason01: Gulper Eel: TFA says three out of the top ten were already under federal scrutiny and a fourth is up on charges already.

I didn't read the article but that's good to know. The main point is that while there is fraud under medicare and it's a bad thing and fraud should probably be more aggressively prosecuted ultimately fraud is a relatively small part of Medicare's overall cost and if you want to spend less money on healthcare there are greater systemic problems that need to be addressed and the argument that always comes out of these articles that "Medicare/Medicaid should go away because fraud" are stupid at best and dishonest at worst.


It is an agenda thingie.
Just like "Sell the USPS, it is losing money".
Business as usual, asshats trying to sell off your country for their profit.

This would appear to be a tipping point where we could actually kick the current Moneygrubbers out of the system and hand it to other moneygrubbers, maybe with a better deal for the citizens.

The ACA is a step, next step is The Decider.
 
2014-04-09 10:50:47 AM  

Gulper Eel: TFA says three out of the top ten were already under federal scrutiny and a fourth is up on charges already.

Throw in Florida's status as a mecca for Medicare/Medicaid sleaze, note that Florida is unusually well-represented among the highest billers, and you should be smelling something rotten by then.


Florida does suck in terms of FWA. But the representation among high billers is also an issue of demographics.  Plus, there's the issue of specialty--oncology is expensive all around.  Does that mean oncologists are all fraudulent?

Looking for FWA is more complicated than simply listing the top billers.
 
2014-04-09 10:54:22 AM  

Voiceofreason01: so that a market based system no longer operates like a free market.


There are so many levels of intervention into the healthcare marketplace by governmental and regulatory means that it is far far from a free market.

In fact, it's the worst kind of hodge-podge crony capitalistic crap market you could frankenstein together.
 
2014-04-09 10:55:41 AM  
Ironically this is why so many people complain about Medicaid but give Medicare glowing reviews. Medicare has very little negotiating power because the rates are set by Congress and there is enough lobbying power among the elderly voting bloc that maintaining high quality of care outweighs efficacy, and it's only going to get worse with the boomers retiring. Look at Medicare Advantage: Congress just delayed the cuts to the program outlined in the ACA because "OMG SENIORS CAN'T LOSE COVERAGE", when at issue is that Advantage allows private insurers to purposely take the healthiest seniors out of the public program (since they can pick and choose which applicants they actually take), then turn around and charge the US government a premium for the cost greater than what Medicare would have paid to keep them in the traditional program. The ACA called for a cap to gradually lower this premium until they couldn't charge more than the average cost of insuring a Medicare patient (and remember: they get to pick and choose so they only have to take the ones they think will be cheaper than average) and they still screamed bloody murder and got their way.

Meanwhile, Medicaid has rates set by state boards and the federal program just pays a portion of the cost. If the Medicaid expansion drama proves anything, it's that there is virtually zero political cost for messing with the care of poor people. Medicaid as a result often has a very limited coverage map, but damn if it isn't effective at taking care of health concerns effectively. Sure you don't get the pick of the litter when it comes to which doctors will take your insurance, but there really aren't horror stories about how well treatment goes compared to having no insurance and relying on overflowing emergency rooms. And thanks to the negotiating power a large user base provides the larger the Medicaid enrolled population is the more doctors will agree to accept those rates because treating more people for less per patient profit is more and more effective. Honestly the biggest challenge facing Medicaid politically is how many people want to cut it, or at least try to transform it into a block grant program with a "pinky swear we will still cover low income people and not just use the money to divert general funds away from the program."
 
2014-04-09 10:57:19 AM  

Gulper Eel: Voiceofreason01: I didn't read the article but that's good to know. The main point is that while there is fraud under medicare and it's a bad thing and fraud should probably be more aggressively prosecuted ultimately fraud is a relatively small part of Medicare's overall cost

Fraud has been estimated at around ten percent of Medicare's budget for decades. Do you know of any private-sector corporation that lets 10% of its revenue simply go flying out the door that way?

Even one percent fraud would be close to five or six billion dollars a year.


The article you linked had a value less than 10% and was referring to payment errors which include but are not limited to fraud. I agree that Medicare fraud is a problem and personally I think that replacing it with a national single payer system built from the ground up could fix a lot of those problems but simply killing medicare because there are some problems with a program that millions of Americans rely on strikes me as throwing the baby out with the bathwater.
 
2014-04-09 10:57:32 AM  

Gulper Eel: Do you know of any private-sector corporation that lets 10% of its revenue simply go flying out the door that way?


Pretty much any company that pays its executives to say "I don't know the daily goings-on of my company" when they're indicted does this by design.
 
2014-04-09 10:57:53 AM  

Gulper Eel: jigger: The system is too corrupt. Replace it with single payer.

The trouble is getting from your first sentence to your second line. Because the system is so corrupt under centralized control, increasingcentralized control is going to help?


[thats_the_joke.jpg]

jigger is closer to your side of the debate than the lib side - he's parodying the liberal position.

The liberal rejoinder (as distinct from Democrat) is that the worst corruption in our present system isn't in Medicare billing; the most lucrative fraudulent Medicare biller could be bought out with a health insurance CEO's pocket change.
 
2014-04-09 10:59:49 AM  

Gulper Eel: NuttierThanEver: I am certain the GOP will not take these few anecdotal cases and use them to attack all of Medicare in a misguided attempt to link it to Obamacare. Right?

That's four thousand cases worth of anecdotal, for those of you having trouble keeping score at home.

This has very little to do with Obamacare. Medicare and Medicaid has been a fraud magnet from the start.


Not like private health insurance.
 
2014-04-09 11:02:12 AM  

twistedmetal: The average doc is not striking it rich on medicare, I assure you.


That is evident in the stats but a few are suggesting there may be a weakness in the process that can exploited.

18.1 million for a single doc in FLA. My guess is if you do the math there are not enough hours in a year to perform the work he billed for...
 
2014-04-09 11:02:29 AM  

MugzyBrown: Voiceofreason01: so that a market based system no longer operates like a free market.

There are so many levels of intervention into the healthcare marketplace by governmental and regulatory means that it is far far from a free market.

In fact, it's the worst kind of hodge-podge crony capitalistic crap market you could frankenstein together.


I suspect the bigger issue is widespread semi-formal collaboration by providers and insurance companies to obscure costs but there definitely seems to be some regulatory issues as well.
 
2014-04-09 11:05:34 AM  
Call me crazy, but I don't think a doctor billing $1 million to Medicare over the course of a year sounds crazy at all.  That comes out to $3846 per day if his office is open 5 days a week, 52 weeks a year.
It's not like anywhere close to that amount is going in the doctor's pockets, either.
 
2014-04-09 11:07:33 AM  

NuttierThanEver: I am certain the GOP will not take these few anecdotal cases and use them to attack all of Medicare in a misguided attempt to link it to Obamacare. Right?


LOL! They've had scripts ready to read on the House floor for such occasions since 1965
 
2014-04-09 11:15:34 AM  

Voiceofreason01: I suspect the bigger issue is widespread semi-formal collaboration by providers and insurance companies to obscure costs but there definitely seems to be some regulatory issues as well.


The main foundation of the problem is that the consumers of healthcare have no interaction with the providers as far as price goes.  It all happens outside of the real marketplace.

*People getting insurance from their employers so that their actual cost of insurance is hidden and altered by the group.  There's no actuarial reason why as a health 35 year old should pay the same rate for insurance as the 60 year old obese woman in the next cube, but I do.

*Insurance companies unable to property rate people based on risk factors, forced to provide certain coverages not everybody needs/wants

*The above two lead to over use of the system.  If I don't have to pay for an MRI and my insurance won't get more expensive because I got a CT, the doctor doesn't give a shiat if I get aa CT.. I get the... it's probably nothing, but just in case let's get a CT... then the radiologist says.. it's probably nothing, but this smudge should be looked at by an MRI.  (I had this once)

*States limiting the supply of doctors and setting artificial rules as to who can do what as a doctor.  (Do you really need somebody who went to school and trained for 12 years to look down your throat to see if it's red or prescribe you a decongestant?)

*Laws limiting the availability of basic medicine via prescriptions.

*Government programs that set price levels for procedures

It goes on and on.
 
2014-04-09 11:15:40 AM  

Lou Brown: Call me crazy, but I don't think a doctor billing $1 million to Medicare over the course of a year sounds crazy at all.  That comes out to $3846 per day if his office is open 5 days a week, 52 weeks a year.
It's not like anywhere close to that amount is going in the doctor's pockets, either.


"The Doctor" is just a name/license the bills are submitted under.
Corporations and Physician Groups are 24/7.
 
2014-04-09 11:16:17 AM  

Lou Brown: Call me crazy, but I don't think a doctor billing $1 million to Medicare over the course of a year sounds crazy at all.  That comes out to $3846 per day if his office is open 5 days a week, 52 weeks a year.
It's not like anywhere close to that amount is going in the doctor's pockets, either.


Are we assuming that every patient is enrolled in traditional Medicare Part B (and possibly Part A, but doubt that could be assigned to just one doctor and not across a hospital)? That's part of the suspicion right there, we're only talking about how much the doctor is billing the government for treatment of Medicare patients, not anyone else. I know this is Florida (retiree central), but in 2012 Medicare beneficiaries only made up 18.26% of the state population. Sure those numbers are different in different areas of the state, but I find it hard to believe that one doctor is serving Medicare patients almost exclusively.
 
2014-04-09 11:19:35 AM  
Government exists to promote Graft

You missed your share
 
d23 [TotalFark]
2014-04-09 11:21:11 AM  
these guys are heading for the governors chair.

//still sick about putting known criminals in... what is up with Florida.
 
2014-04-09 11:22:43 AM  

Arkanaut: Not like private health insurance.


Of course not. Unlike government, their interest is not in paying claims willy-nilly to placate bluehairs, congressmen and their big contributors.

Accepting for argument's sake that private health insurance has a bias toward denying claims...that's still not so horrible compared to the alternative. An improperly-denied claim can be appealed and made right.

As for the flip side of that coin, claims improperly paid by Medicare...good luck getting that money back. It's not going to patient care. It's gone to some hospital CEO's new vacation house, some New Jersey senator's re-election campaign, or even to eastern European mobsters.

Medicare typically recovers pennies on the dollar even when they bother to chase overbillers.
 
2014-04-09 11:32:59 AM  

MugzyBrown: It goes on and on.


I mostly agree with everything you listed. The only thing I disagree with is the scope of the role that government regulation plays in the problem. Mostly the regulations placed on insurers are there for good reasons and were put into place because insurers were basically cheating their clients.

What is clear is that the current system is broken.
 
2014-04-09 11:36:30 AM  

Voiceofreason01: Mostly the regulations placed on insurers are there for good reasons and were put into place because insurers were basically cheating their clients.


Community rating?
 
2014-04-09 11:39:49 AM  

Gulper Eel: As for the flip side of that coin, claims improperly paid by Medicare...good luck getting that money back. It's not going to patient care. It's gone to some hospital CEO's new vacation house, some New Jersey senator's re-election campaign, or even to eastern European mobsters.

Medicare typically recovers pennies on the dollar even when they bother to chase overbillers.


That's not actually true, and Medicare regularly bothers to pursue overpayment recovery.  For most providers, it does take some time--typically because most can afford a lawyer, and that means court or at least a judge.  There's an entire industry devoted to preventing the government from recovering money, but it's not pennies on the dollar they get back, though it is rarely as much as was paid.  The best way to fix that is to increase the amount of money spent on FWA investigation contractors.  The industry standard several years ago was a recovery of $10-12 for every $1 spent, with the best contractors getting twice that or so.

There are some providers where the money is truly gone--providers that pop up, bill heavily for a month or two, transfer the money offshore and then shut down their business and vanish into the ether.  That is an issue, and it's fueled by the attitude that it's better to pay for a service the patient didn't need than to fail to pay for one the patient did need.  There's always going to be an FWA overhead considered as part of the cost of doing business, but again, the best way to combat that is on more preventative contractors.  There's simply a lack of manpower to properly investigate everyone, despite the obvious benefits of doing so.
 
2014-04-09 11:41:24 AM  

Voiceofreason01: MugzyBrown: It goes on and on.

I mostly agree with everything you listed. The only thing I disagree with is the scope of the role that government regulation plays in the problem. Mostly the regulations placed on insurers are there for good reasons and were put into place because insurers were basically cheating their clients.

What is clear is that the current system is broken.


It is more a problem of broken people profiteering the system than is is a broken system.
 
2014-04-09 11:42:26 AM  

Gulper Eel: Arkanaut: Not like private health insurance.

Of course not. Unlike government, their interest is not in paying claims willy-nilly to placate bluehairs, congressmen and their big contributors.

Accepting for argument's sake that private health insurance has a bias toward denying claims...that's still not so horrible compared to the alternative. An improperly-denied claim can be appealed and made right.

As for the flip side of that coin, claims improperly paid by Medicare...good luck getting that money back. It's not going to patient care. It's gone to some hospital CEO's new vacation house, some New Jersey senator's re-election campaign, or even to eastern European mobsters.

Medicare typically recovers pennies on the dollar even when they bother to chase overbillers.


Case in point, RICK SCOTT
 
2014-04-09 11:45:26 AM  
Remember who the REAL ENEMY is and may the odds be forever in your favor
 
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