As experts, analysts and reporters continue wading through newly public Medicare data, more questions are coming to light about how the government pays its doctors.
A new analysis by The Wall Street Journal reveals that more than 2,300 Medicare doctors earned $500,000 by practicing a single procedure or service multiple times. Many of these doctors over billed for these procedures or services, which were outside of the physician’s specialty and went against standard medical protocol.
Related: Medicare Data Shows Huge Cost Disparity
In one case, Medicare paid about $2 million to a Los Angeles doctor for a rare cardiac procedure that involves strapping patients to a bed with cuffs that inflate and deflate to increase blood flow. The procedure is seldom used by cardiologists and is typically seen as a last resort to treat people with chest pain without surgery.
Still, according to government data, the Los Angeles doctor, who is not a heart specialist, administered it to 99.5 percent of his Medicare patients—or 615 in all. He billed the government at least $16,619 for the procedure. To put that into context, out of thousands of cardiologists who treated in Medicare patients in 2012, just 239 billed the government for that procedure, using it on fewer than 5 percent of their patients.
The doctor, Ronald Weaver, told The Journal that he learned about the procedure by "reading lots of articles, studies and clinical trials" and decided to build his practice around it. He added that financial incentives do not play a role in his decision to use the procedure and said that it improves his patients' health.
In another case, a Florida dermatologist, Gary Marder, received a total of $3.7 million from Medicare in 2012—$2.41 million of which came from regularly using a rare high-voltage radiation procedure to treat melanoma patients. The data shows that only two other doctors in the country had billed Medicare for that procedure and neither came close to billing as much for it as Dr. Marder, The Journal noted.
Related: Medicare by the Numbers
Dr. Marder has a picture of a lower-voltage machine on his website, which would be reimbursed at a rate of $22 per treatment. Instead, he uses the higher-powered machine, which Medicare reimburses at a rate of $154 per treatment. The data shows that in 2012 alone, Dr. Marder billed Medicare 15,610 times for that procedure—on 94 patients administering about 166 treatments each.
Though using the higher-voltage machine is legal, some doctors call into question whether the use is necessary. Dr. David Beyer, an Arizona radiation oncologist, told The Journal patients are typically subjected to 20 radiation treatments—with 35 being the maximum number. Usually, he said, they are treated simultaneously and billed for a single treatment.
The data puts Dr. Marder’s billing practices under the spotlight. As the Journal notes, the Florida physician was previously called into question for “alleged fraudulent billing” by Florida's Board of Osteopathic Medicine He was fined $2,500 in 1998 and ordered to take courses in medical record-keeping and medical risk management.
The unusual practices and billing procedures are just the latest analysts have unearthed from the trove of Medicare data that the Centers for Medicare and Medicaid Services released in April. The massive data dump includes how Medicare doled out $77 billion to some 880,000 providers in 2012—the first glimpse in decades of how the federal government pays its doctors.
Consumers and media outlets have long pressured Medicare to release the data—and now CMS officials say the new information will provide more transparency for Medicare patients and more accountability for doctors’ billing practices.
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