6 Western Pa. doctors received more than $1M each in Medicare payments in 2012
Six doctors in Western Pennsylvania received more than $1 million each in Medicare payments in 2012, bringing in a total of $10.5 million from the government's health insurance program for seniors.
The six received the largest payments from Medicare in Western Pennsylvania. Among them were two ophthalmologists from a West Mifflin practice and two ophthalmologists from an Uptown practice who each received from $1.4 million to $2.3 million, according to federal data released on Wednesday.
The database for the first time disclosed all Medicare payments to more than 825,000 doctors across the country.
Statewide, Medicare paid $2.55 billion to more than 42,000 physicians, including 115 doctors receiving at least $1 million, a Tribune-Review analysis of the data found.
Nationwide, Medicare paid individual physicians nearly $64 billion. The median payment, the point at which half the amounts are higher and half are lower, was $30,265.
Stephen Foreman, associate professor of health care administration at Robert Morris University, called the data “stupendous” for its insights into billing differences by doctor, speciality, region or state.
“If you're curious how much your doctor gets, you can go look,” Foreman said. “But more importantly, what's the amount of Medicare money being spent in the area and who's getting it? Are there any individuals or segments that appear to be out of line? If we're going to try to hold down costs, are there any obvious targets here?”
Ophthalmologists consistently were among the top Medicare billers in Pennsylvania, accounting for 42 percent of doctors getting $1 million or more. The eye specialists claimed the top 11 spots in a ranking of the state's doctors, with each of those physicians receiving more than $3 million.
Seven were employed by Mid-Atlantic Retina, a multi-ophthalmologist practice based in Wyndmoor, outside Philadelphia, and were paid a total of $29.7 million in 2012. Doctors with the practice could not be reached for comment.
Across the country, Medicare paid 344 physicians $3 million or more apiece, including one who got nearly $21 million.
Topping the list was Florida ophthalmologist Salomon Melgen, whose relationship with Sen. Robert Menendez, D-N.J., made headlines last year when news broke that the lawmaker used the doctor's personal jet for trips to the Dominican Republic.
Medicare paid Melgen $20.8 million. His lawyer said the doctor's billing conformed with Medicare rules and reflects high drug costs.
The Health and Human Services inspector general used the $3 million threshold in an audit last year that recommended Medicare automatically scrutinize total billings above that level. Medicare said it's working on that recommendation.
The high number of ophthalmologists in the top tier may reflect the doctors' choice of medications to treat patients with eye problems.
The database is considered the richest trove of information on doctors. Although taxpayers finance Medicare, the data have been off limits to the public for decades. Physician organizations went to court to block its release, arguing it would invade doctors' privacy.
A federal judge last year lifted the main legal obstacle to release, and the Obama administration recently told the American Medical Association it would open up the claims data.
The American Medical Association, which opposed releasing the information, warned it will do more harm than good.
The AMA says the files may contain inaccurate information. Even if payment amounts are correct, the AMA says they do not provide meaningful insights into quality of care.
“We believe that the broad data dump ... has significant shortcomings,” AMA president Ardis Dee Hoven said. “... Releasing the data without context will likely lead to inaccuracies, misinterpretations, false conclusions and other unintended consequences.”
Alex Nixon is a Trib Total Media staff writer. Reach him at 412-320-7928 or firstname.lastname@example.org. The Associated Press contributed.
Add Alex Nixon to your Google+ circles.
Show commenting policy
TribLive commenting policy
You are solely responsible for your comments and by using TribLive.com you agree to our Terms of Service.
We moderate comments. Our goal is to provide substantive commentary for a general readership. By screening submissions, we provide a space where readers can share intelligent and informed commentary that enhances the quality of our news and information.
While most comments will be posted if they are on-topic and not abusive, moderating decisions are subjective. We will make them as carefully and consistently as we can. Because of the volume of reader comments, we cannot review individual moderation decisions with readers.
We value thoughtful comments representing a range of views that make their point quickly and politely. We make an effort to protect discussions from repeated comments either by the same reader or different readers.
We follow the same standards for taste as the daily newspaper. A few things we won't tolerate: personal attacks, obscenity, vulgarity, profanity (including expletives and letters followed by dashes), commercial promotion, impersonations, incoherence, proselytizing and SHOUTING. Don't include URLs to Web sites.
We do not edit comments. They are either approved or deleted. We reserve the right to edit a comment that is quoted or excerpted in an article. In this case, we may fix spelling and punctuation.
We welcome strong opinions and criticism of our work, but we don't want comments to become bogged down with discussions of our policies and we will moderate accordingly.
We appreciate it when readers and people quoted in articles or blog posts point out errors of fact or emphasis and will investigate all assertions. But these suggestions should be sent via e-mail. To avoid distracting other readers, we won't publish comments that suggest a correction. Instead, corrections will be made in a blog post or in an article.
- Microsoft keeping $93B offshore, off U.S. tax rolls
- Thousands of American steel jobs believed lost to import surge
- Beware mergers’ bad spawn
- Utility regulator seeks $639,000 in penalties from electric supplier
- GM’s legal team targeted in federal investigation
- McDonald’s names president of U.S. division
- Central banks around globe moving in different directions
- Instead of clarity, Federal Reserve Chair Yellen offers more uncertainty on interest rate hikes
- Dynegy to spend $6.25B on power plant acquisitions
- Advocacy group requests investigation of Chrysler power system failures
- Deere to lay off about 460 from Iowa tractor plant