Sunday, April 22, 2018
Opinion

Column: First, do no harm — to your bank account

After being sued by the Wall Street Journal, the government finally released its Medicare reimbursement data last week. It included the less-than-stunning revelation that 28 of the 100 doctors who received the largest payments in 2012 were from Florida.

No other state came close. And no physician in the country billed Medicare for bigger bucks than Dr. Salomon E. Melgen, a West Palm Beach ophthalmologist who operates several clinics and is tight with a powerful Democratic senator.

Melgen got almost $21 million from Medicare in 2012. (No, you don't need your vision checked — $20,827,341 is the actual number, for one year.)

Records show Melgen filed claims for 894 patients and 92,000 procedures, meaning Medicare paid him approximately $11,700 for every eyeball that was eyeballed by him and his staff.

Even in Florida, the mecca for Medicare tricksters, Melgen's billing habits drew notice. The government had already forced him to give back $8.9 million from 2007 and 2008, alleging he overbilled for injectable Lucentis, an expensive medication that combats macular degeneration.

The disorder is common in the elderly, and nationwide the treatment costs Medicare $1 billion a year. In 2012, Melgen reported administering more than 37,000 doses of Lucentis in South Florida.

Currently he's under investigation for possible fraud, and twice FBI agents have swarmed his offices in search of evidence. His attorney says he's done nothing wrong, and has taken action to recover the nearly $9 million that Melgen repaid the agency in charge of Medicare and Medicaid.

The doctor has an important ally in Sen. Robert Menendez, the New Jersey Democrat, who has traveled on Melgen's private jet and hung out at his posh spread in the Dominican Republican.

When Melgen first got in trouble, Menendez called the U.S. Department of Health and Human Services to defend his pal's prolific billing. Another time the senator argued in favor of a company owned by Melgen in a dispute over a seaport contract in the Dominican Republic.

For his part, the doctor donated $700,000 to a Democratic political action committee that gave $582,000 to Menendez's re-election efforts. So far, Melgen's friendship with Menendez has failed to deflect the FBI's interest.

Second on the national scoreboard of Medicare's top billers is Dr. Asad Qamar, an Ocala cardiologist who was paid $18.2 million in 2012. He told the New York Times that his charges are fair, and that the sum is so large partly because he works in an outpatient facility for which the government pays added fees.

Like Melgen, Qamar is an enthusiastic donor to Democrats, including President Barack Obama. He gave more than $100,000 to the Democratic National Committee, and distributed other contributions to congressional candidates in five states, including Florida.

Any physician who rakes in $18 million from Medicare in 12 months deserves special attention, because such a massive volume of medical claims definitely isn't business as usual.

In fact, according to a New York Times, only about 2 percent of doctors collected almost 25 percent of the country's Medicare payouts in 2012. Expanding that graph, just 25 percent of doctors accounted for 75 percent of Medicare's total spending, which reached $77 billion that year.

It's hardly a shocker that Florida leads the way. No place in the nation hosts more Medicare fraud prosecutions, a grim distinction.

The good news is that the conviction rate is high; the bad news is that we could quadruple the number of prosecutors, and they'd still be overworked.

Meanwhile, soaring Medicare costs cut deeper and deeper into federal tax revenues. The program is so huge that it practically defies effective auditing, but certainly a much better job of that could be done.

Publicizing the payment database is a start. Some medical practices are more complex than others, and the numbers only tell part of the story for each physician on the list.

However, it's more than a statistical blip when two doctors collect a total of $39 million, more than hundreds of other practitioners in those same specialties added together.

California, which has twice the population of Florida, had only 10 doctors in the top 100 Medicare billers, compared to our stellar 28.

It's not that Florida has more sick and elderly people than California, because we don't. We just happen to attract more opportunists.

© 2014 Miami Herald

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