Seven Medicare doctors collected more than $10 million from the government insurance program in 2013, new data posted online shows.
Most of these high-end billers didn't actually taken home all the money, as much of it funded expensive drugs for cancer or rare diseases they provided to their patients. But that wasn't the case for the second- and third-highest-paid doctors, who are being investigated for fraudulent charges.
Florida cardiologist Asad Qamar, who is being sued by the Department of Justice, billed Medicare $46 million but was paid one-third of that sum—and almost none of it was drug-related. Salomon Melgen — a West Palm Beach ophthalmologist recently indicted alongside Sen. Robert Menendez, D-N.J. in a corruption case — billed Medicare $25 million and collected a little more than half that sum.
These high-end billers are just a tiny fraction of the 950,000 healthcare providers who received checks from Medicare in 2013. Most doctors received considerably less, with the average payment around $74,000.
It's the second year in a row the federal government has posted online detailed Medicare payment information showing how much both doctors and hospitals billed the program. The massive database offers a breakdown of the $152 billion in payments to providers through Medicare's hospital and doctors insurance programs, known respectively as Medicare Parts A and B.
The data provide insight into where and how federal healthcare dollars are used — and highlight some ongoing major concerns in U.S. healthcare, including ever more expensive drugs and doctors who try to bilk the system.
The top individual biller for 2013 was Anne Greist, an Indianapolis hematologist who specializes in complicated cases of a rare blood disorder known as hemophilia. Of the $28 million she collected from Medicare, nearly all of it went to drugs to treat her patients.
Here are the Medicare doctors paid more than $10 million in 2013:
1. Anne Greist, Indianapolis hematologist, $28 million
2. Asad Qamar, Ocala, Fla., cardiologist, $16 million
3. Salomon Melgen, West Palm Beach, Fla., ophthalmologist, $14.4 million
4. Alexander Eaton, Fort Myers, Fla., ophthalmologist, $12 million
5. Vasso Godiali, Bay City, Md., vascular surgeon, $11 million
6. Franklin Cockerill, Rochester, Iowa, pathologist, $10.9 million
7. Minh Nguyen, Newport Beach, Calif., hematologist, $10.6 million
To mammogram or not to mammogram?
A group of scientists has been trying since November to shed more light on the question of when women should start getting mammograms. But after reviewing the existing medical evidence, their conclusions aren't likely to resolve the question.
The scientists said mammograms are significantly useful for screening breast cancer in women only between 50 and 70 years of age, in a review published Wednesday in the New England Journal of Medicine.
But the major dispute is over whether women should start getting mammograms even younger, at age 40. While the American Cancer Society says to start them then, the U.S. Preventive Services Task Forces says women can wait until age 50.
The researchers, organized by the World Health Organization's cancer agency, didn't entirely rule out screenings for women younger than age 50. But they said the procedure could have limited benefits from women between 40 and 50 and definitely isn't worth if for women younger than that.
"The evidence of efficacy for women in other age groups was considered inadequate," they wrote.
So why not get screened, just to be on the safe side? Because screening can result in false positive results causing psychological harm to women and raises the risk for radiation-induced cancer, the researchers wrote.
They also reconfirmed that breast self-exams — long the holy grail for breast cancer activists — aren't as useful a screening tool as once thought because they don't lower breast cancer mortality rates.
Storytime with Secretary Burwell
The Obama administration has been talking a lot lately about how to improve the way Americans get healthcare — and Health and Human Services Secretary Sylvia Mathews Burwell tried to inspire the troops Wednesday at the White House's Health Datapalooza conference.
She told the story of an older women with severe hip pain named "Pearl" to illustrate how the healthcare system could work better.
Under the current system, Burwell said, Pearl might get uncoordinated care from a primary care doctor, an orthopedic surgeon and a therapist who operate in completely separate worlds. But Pearl's situation could be totally different under a reformed system in which doctors are paid for quality and medical records are easily transferable, she said.
"All of these doctors and specialists would work together, exchanging information and seeing Pearl's big health picture. Rather than paying them for each X-ray or session, we would pay them to get Pearl back on her feet — and make sure she stays there," Burwell said.
"Instead of running duplicative tests, doctors run the right tests. They have the information they need to factor in chronic conditions and other medications. And a care coordinator follows up with her at home to minimize the risk of another fall and fracture.
"And with her medical history online, she can come to her next appointment ready to ask questions, or even email her doctor. And now that she is connected to her care in a personal way, she's more likely to get that blood pressure screening when it's time, or other preventive care that could keep her out of the emergency room."