6 Western Pa. doctors received more than $1M each in Medicare payments in 2012

| Wednesday, April 9, 2014, 11:36 p.m.

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 anixon@tribweb.com. The Associated Press contributed.

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