Dr. Salomon Melgen, a Florida opthamologist, received the biggest total payout to an individual physician from Medicare in 2012, according to data released Wednesday by the Obama administration. More than 300 physicians – a small segment of the 825,000 individual doctors in the database – collected $3 million or more in Medicare claims.
A Florida opthamologist was paid nearly $21 million by Medicare in 2012, topping a list of more than 300 doctors who collected $3 million or more apiece in Medicare claims that year.
Salomon Melgen — the same doctor who last year made headlines for having loaned his personal jet to Sen. Robert Menendez, D-N.J., for trips to the Dominican Republic — received $20.8 million from Medicare, according to new physician data released Wednesday by the Obama administration.
Of the more than 825,000 individual physicians in Medicare’s claims data base, a small sliver — just 344 physicians — took at least $3 million apiece for a total of nearly $1.5 billion.
About 1 in 4 of the top-paid doctors — 87 of them — practice in Florida, a state known both for high Medicare spending and widespread fraud.
Rounding out the top five states were California with 38 doctors in the top group, New Jersey with 27, Texas with 23, and New York with 18.
The data was released by the Obama administration as part of a move to open the books on health care financing. Employers, insurers, consumer groups and media organizations had pressed for its release, over the protest of physician organizations, who say the release violates doctors’ privacy.
In the $3 million-plus club, 151 ophthalmologists — eye specialists — accounted for nearly $658 million in Medicare payments, leading other disciplines. Cancer doctors rounded out the top four specialty groups, accounting for a combined total of more than $477 million in payments.
The $3 million threshold is the figure used by the Health and Human Services inspector general in an audit last year that recommended Medicare automatically scrutinize total billings above a set level. Medicare says it’s working on that recommendation.
Overall, Medicare paid individual physicians nearly $64 billion in 2012.
An analysis of the data conducted by the Associated Press focused on individual physicians, excluding about 55,000 organizations that also appear in the database, such as ambulance services. None of those entities was paid $3 million or more.
The Medicare claims database is considered the richest trove of information on doctors, surpassing what major insurance companies have in their files. Although Medicare is financed by taxpayers, the data have been off limits to the public for decades.
A federal judge last year lifted the main legal obstacle to release, and the Obama administration recently informed the American Medical Association it would open up the claims data.
The American Medical Association, which has long opposed release of the Medicare database, is warning it will do more harm than good.
The AMA says the files may contain inaccurate information. And even if the payment amounts are correct, the AMA says they do not provide meaningful insights into the quality of care.
“We believe that the broad data dump … has significant shortcomings regarding the accuracy and value of the medical services rendered by physicians,” AMA president Ardis Dee Hoven said. “Releasing the data without context will likely lead to inaccuracies, misinterpretations, false conclusions and other unintended consequences.”
The AMA had asked the government to allow individual doctors to review their information prior to its release.
Melgen, the top-paid physician in 2012, has already come under scrutiny. In addition to allowing the use of his jet, the eye specialist was the top political donor for Menendez as the New Jersey Democrat sought re-election to the Senate that year.
Menendez’s relationship with Melgen prompted Senate Ethics and Justice Department investigations. Menendez reimbursed Melgen more than $70,000 for plane trips.
The issue exploded in late January 2013, after the FBI conducted a search of Melgen’s West Palm Beach offices. Agents carted away evidence, but law enforcement officials have refused to say why. Authorities declined to comment on the open investigation.