Medicare releases physician billing practices

In an effort to expose fraud, inform consumers and improve senior wellness and care, Centers for Medicare and Medicaid Services officials on April 9 released data about physician billing practices around the country.

The public will now have access to such data, which consumer groups and news outlets have been requesting for years, according to The Washington Post. The American Medical Association and other physician groups, however, skirted the issue, saying the release of such information would violate doctor privacy and skew the public’s opinion about doctors.

“This data is important because it will make it possible for consumers to identify physicians that will best meet their needs,” Robert Krughoff, president of Consumers’ Checkbook, which sued for the release of the information, told the Post.

Who are the biggest earners?
The Medicare data shows that the doctor who earned the most from Medicare billing in 2012 treats a degenerative eye disease in seniors. He pulled in a whopping $21 million that year, which was twice the amount of the next ophthalmologist on the list, according to Bloomberg.

Pharmaceuticals play a major part in Medicare billing, with the data showing that $8.6 billion of the $64 billion billed in 2012 was for drugs. The Post reported that Medicare typically pays physicians the price of the drug plus 6 percent.

Another report from the Post found that most of the 4,000 doctors who earned $1 million from Medicare in 2012 billed for patient injections, infusions and other drug treatments.

Seniors should educate themselves
The Medicare data is evidence that seniors should make sure they read up on area doctors and their billing practices before opting to remain in their care. It’s important to not only look at numbers, but also their practices and habits, as opponents of the data release say patients may only see dollar signs and jump to conclusions.

“The AMA is concerned that CMS’s broad approach to releasing physician payment data will mislead the public into making inappropriate and potentially harmful treatment decisions, and will result in unwarranted bias against physicians that can destroy careers,” Ardis Dee Hoven, president of the AMA, said in an email to Bloomberg.

Billing prices also vary widely by region, so seniors should make sure they pay attention to local rates and practices when looking at the numbers.

To maximize your Senior Health Insurance benefits, visit for quick, simple and easy information.

Pete Blasi