5 ms·

I am curious about that one opthalmologist who made $21m in a single year from Medicare alone. That's top hedge fund manager or Fortune 500 CEO territory... Is

by arbuge 13y ago

I am curious about that one opthalmologist who made $21m in a single year from Medicare alone. That's top hedge fund manager or Fortune 500 CEO territory... Is it possible that this is a businessman with many clinics collecting payments in his name, or is that really one individual who somehow billed this much?

vonmoltke 13y ago
While that is a very large number, its the gross Medicare payments to the ophthalmologist's practice via doctor/surgeon charges, not his salary. He personally only gets a fraction of that. Granted its a multi-million dollar fraction, but still a fraction.
mikeyouse 13y ago
The FBI is asking the same questions of this doctor: http://www.nytimes.com/2014/04/10/business/doctor-with-big-medicare-billings-is-no-stranger-to-scrutiny.html?_r=0 http://www.nytimes.com/2014/04/10/business/doctor-with-big-m...
riahi 13y ago
The way Medicare for these high-reimbursement specialties (Ophthalmology, Radiation Oncology, and Medical Oncology) is that the Doctor's practice will pre-purchase the medications/injections/treatments before administering to patients and then Medicare will reimburse the practice. These doctors are certainly not taking home anywhere near a fraction of that number. See: http://oig.hhs.gov/oei/reports/oei-03-10-00360.pdf http://oig.hhs.gov/oei/reports/oei-03-10-00360.pdf The executive summary discusses how two injections used for treatment of Age-Related Macular Degeneration are purchased.
- refurb 13y ago
  That's called "buy and bill" and that is paid separately from the physician fees discussed in the article. If you did include the cost of drugs, you'd be correct that physician salary is only a small fraction of the cost of treating a patient. Since some cancer drugs cost over $10,000/month, some clinics spend 90%+ of their revenue just on drugs.
  - riahi 13y ago
    I'm pretty sure they are including buy-and-bill numbers here. The #1 doctor, Salomon Melgen, is a retinologist who is currently being investigated by CMS for suspected Medicare fraud. The numbers in this article match the numbers from the CMS data dump. See http://www.breitbart.com/Big-Government/2013/02/14/Medical-Expert-on-Alleged-Practices-of-Melgen-It-Doesn-t-Seem-Possible-You-Could-Get-4-Doses-Out-of-a-Single-Vial http://www.breitbart.com/Big-Government/2013/02/14/Medical-E...
    - refurb 13y ago
      Turns out you were correct! I wouldn't have imagined that Lucentis would have such a impact on the numbers.
refurb 13y ago
My guess, and this is only a guess, is that the physician is focusing on routine procedures (cataract surgery) and has optimized the procedure greatly. Someone else preps the patient, doc walks in, spends 15 minutes doing the surgery and then moves to the next patient. Nurses or other medical professionals care for the patient after that. Unfortunately I can't find it anymore, but there was an article a while back about physicians performing an amazing number of surgeries and if you calculated it out (based on the time estimate by Medicare) they were working 200 hrs per week. In the end, the physician had just chosen to specialize in one procedure and optimized everything about his clinic around that.
joshAg 13y ago
That's kind of answered by some of the other doctors in the article: "Michael McGinnis, a New Jersey pathologist who was the third highest paid in the Medicare data, said that payments made to multiple doctors may be recorded under just one in the Medicare data released, making that person look like they were receiving a suspect amount of money. Provider Codes "McGinnis’s provider code was used for about 27 doctors at Plus Diagnostics in Union, New Jersey, where he is the medical director, he said in a telephone interview today. "'I don’t really work directly at the facility, I’m doing administrative work,' McGinnis said, 'I’m not offended by it, but it’ll need to be interpreted correctly so the wrong ideas and wrong statements won’t be made.' "Franklin Cockerill, listed as the fourth-highest paid physician listed within the Medicare data, is in a similar situation, said Bryan Anderson, a spokesman for the Mayo Clinic where Cockerill is employed as chair of the Departmenet of Laboratory Medicine and Pathology. "Cockerill’s 'name is listed as the billing physician for claims submitted for payment under the clinical lab fee schedule,' Anderson said. While he clinic’s labs performed more than 23 million lab tests in 2013, Cockerill is a salaried physician who doesn’t receive Medicare payments." Course, that just raises the question of why Medicare allows for A to bill medicare for a procedure under B's name. I'd think there'd be a way to have separate code for doctors in the same practice.

by arbuge 13y ago

vonmoltke 13y ago

While that is a very large number, its the gross Medicare payments to the ophthalmologist's practice via doctor/surgeon charges, not his salary. He personally only gets a fraction of that. Granted its a multi-million dollar fraction, but still a fraction.

mikeyouse 13y ago

The FBI is asking the same questions of this doctor: http://www.nytimes.com/2014/04/10/business/doctor-with-big-medicare-billings-is-no-stranger-to-scrutiny.html?_r=0 http://www.nytimes.com/2014/04/10/business/doctor-with-big-m...

riahi 13y ago

The way Medicare for these high-reimbursement specialties (Ophthalmology, Radiation Oncology, and Medical Oncology) is that the Doctor's practice will pre-purchase the medications/injections/treatments before administering to patients and then Medicare will reimburse the practice. These doctors are certainly not taking home anywhere near a fraction of that number. See: http://oig.hhs.gov/oei/reports/oei-03-10-00360.pdf http://oig.hhs.gov/oei/reports/oei-03-10-00360.pdf The executive summary discusses how two injections used for treatment of Age-Related Macular Degeneration are purchased.

refurb 13y ago
That's called "buy and bill" and that is paid separately from the physician fees discussed in the article. If you did include the cost of drugs, you'd be correct that physician salary is only a small fraction of the cost of treating a patient. Since some cancer drugs cost over $10,000/month, some clinics spend 90%+ of their revenue just on drugs.
- riahi 13y ago
  I'm pretty sure they are including buy-and-bill numbers here. The #1 doctor, Salomon Melgen, is a retinologist who is currently being investigated by CMS for suspected Medicare fraud. The numbers in this article match the numbers from the CMS data dump. See http://www.breitbart.com/Big-Government/2013/02/14/Medical-Expert-on-Alleged-Practices-of-Melgen-It-Doesn-t-Seem-Possible-You-Could-Get-4-Doses-Out-of-a-Single-Vial http://www.breitbart.com/Big-Government/2013/02/14/Medical-E...
  - refurb 13y ago
    Turns out you were correct! I wouldn't have imagined that Lucentis would have such a impact on the numbers.

refurb 13y ago

My guess, and this is only a guess, is that the physician is focusing on routine procedures (cataract surgery) and has optimized the procedure greatly. Someone else preps the patient, doc walks in, spends 15 minutes doing the surgery and then moves to the next patient. Nurses or other medical professionals care for the patient after that. Unfortunately I can't find it anymore, but there was an article a while back about physicians performing an amazing number of surgeries and if you calculated it out (based on the time estimate by Medicare) they were working 200 hrs per week. In the end, the physician had just chosen to specialize in one procedure and optimized everything about his clinic around that.

joshAg 13y ago

That's kind of answered by some of the other doctors in the article: "Michael McGinnis, a New Jersey pathologist who was the third highest paid in the Medicare data, said that payments made to multiple doctors may be recorded under just one in the Medicare data released, making that person look like they were receiving a suspect amount of money. Provider Codes "McGinnis’s provider code was used for about 27 doctors at Plus Diagnostics in Union, New Jersey, where he is the medical director, he said in a telephone interview today. "'I don’t really work directly at the facility, I’m doing administrative work,' McGinnis said, 'I’m not offended by it, but it’ll need to be interpreted correctly so the wrong ideas and wrong statements won’t be made.' "Franklin Cockerill, listed as the fourth-highest paid physician listed within the Medicare data, is in a similar situation, said Bryan Anderson, a spokesman for the Mayo Clinic where Cockerill is employed as chair of the Departmenet of Laboratory Medicine and Pathology. "Cockerill’s 'name is listed as the billing physician for claims submitted for payment under the clinical lab fee schedule,' Anderson said. While he clinic’s labs performed more than 23 million lab tests in 2013, Cockerill is a salaried physician who doesn’t receive Medicare payments." Course, that just raises the question of why Medicare allows for A to bill medicare for a procedure under B's name. I'd think there'd be a way to have separate code for doctors in the same practice.