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Article from the Washington Post Exposes Medicare Earnings By Doctors

Data Uncovers Nation's Top Billers

By , and , Wednesday, April 9, 12:01 AM

The Medicare program is the source of a small fortune for many U.S. doctors, according to a trove of government records that reveal unprecedented details about physician billing practices nationwide.

The government insurance program for older people paid nearly 4,000 physicians in excess of $1 million each in 2012, according to the new data. Those figures do not include what the doctors billed private insurance firms.

The release of the information gives the public access for the first time to the billing practices of individual doctors nationwide. Consumer groups and news outlets have pressured Medicare to release the data for years. And in doing so Wednesday, Medicare officials said they hope the data will expose fraud, inform consumers and lead to improvements in care.

The American Medical Association and other physician groups have resisted the data release, arguing that the information violates doctor privacy and that the public may misconstrue details about individual doctors.

Among the highest billers were a cardiologist in Ocala, Fla., who took in $18.1 million, mainly putting in stents. A New Jersey pathologist who received $12.6 million performing tissue exams and other tests. And a Michigan vascular surgeon who got $10.1 million.

Some of the highest billing totals may simply reflect a physician who is extremely efficient or who has an unusually large number of Medicare patients.

The highest numbers also may reflect a physician who specializes in procedures that require costly overhead, and in those cases, a large portion of the money may wind up not with the doctor but with pharmaceutical companies or makers of medical devices.

But in some instances, the extremely high billing totals could signal fraudulent doctor behavior, as government inspectors have previously found.

Indeed, three of the top 10 earners already had drawn scrutiny from the federal government, and one of them is awaiting trial on federal fraud charges.

The greatest tallies also may signal that the Medicare payments for some procedures are to high for the amount of work involved or that perverse incentives lead doctors to overuse a procedure.

The specialties most common at the top ranks of the Medicare payments were ophthalmologists, oncologists and pathologists.

This information gives the public “unprecedented access to information about the number and type of health-care services” doctors provided during the year, Jonathan Blum, principal deputy administrator of the Centers for Medicare and Medicaid Services, said in a blog post.

The Medicare program is the nation’s largest medical insurer. By virtue of its breadth, the forthcoming billing data are expected to shed light on an array of questions that have arisen about health-care costs as the nation has confronted decades of rising medical bills.

Overall, the data cover $77 billion in billing involving 880,000 practitioners in 2012.

The AMA has warned that the data could contain errors, and in some cases, one doctor’s billing number may have been used by multiple support personnel for billing purposes.

In addition, the billing figures reflect what a doctor receives in payment but does not show the actual profit after paying for equipment, support personnel and malpractice insurance. For some procedures, the overhead can reach three-quarters or more of the payment amount.

Many of the highest billers, for example, were in fields with unusually high expenses, and that was likely to limit their personal share of the money. Using the assumptions that Medicare and the AMA make when setting payment rates, only 23 of the 4,000 biggest billers personally earned $1 million or more, according to a Washington Post analysis.

“The AMA is concerned that CMS’ 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 a statement. “We have witnessed these inaccuracies in the past.”

But consumer and public interest groups argued that the information will help consumers make better decisions.

“This data is important because it will make it possible for consumers to identify physicians that will best meet their needs,” said Robert Krughoff, president of Consumers’ Checkbook, a group that began seeking the release of this information in 2005 and eventually sued for it.

For example, it will allow consumers to know which doctors are most experienced in a given operation. Studies have shown that in several types of surgery, volume matters: Surgeries by doctors who have performed the procedure enough times are less likely to end with the patient’s death.

As for the potential that the data might misrepresent a physician’s practice, Krughoff said, “The consumer organizations that have pushed for release of this information have a strong obligation to make sure that the information is used properly. But I believe in the marketplace of ideas.”

Opting for expensive

The doctor at the top of the list of largest Medicare billers is Salomon Melgen, an ophthalmologist in West Palm Beach, Fla., who took in $20 million from Medicare in 2012, according to the data released Wednesday.

Most of Melgen’s take — about $11.8 million of it — came from injecting patients’ eyes with Lucentis, a drug used for macular degeneration, according to the data.

For each shot, Medicare and the patient pay a doctor about $2,000, but the drug is very expensive and the doctor must then pay most of that money to the drug’s manufacturer, Genentech.What may be most interesting about Melgen’s practice, however, is that he could have used a much cheaper drug than Lucentis — one called Avastin that many ophthalmologists consider an equivalent.

Had he used the cheaper alternative, his bill to Medicare for the shots would have dropped from $11.8 million to less than $500,000.

But physicians have a financial incentive to use more expensive drugs. Medicare pays a doctor more for injecting the more expensive drug — the physician’s fee is based on the drug’s price — and Genentech offered doctors its own incentive to use the expensive drug: The company gave discounts to those who use high volumes.

Melgen’s name appeared in headlines in 2012 as result of his connection to Sen. Robert Menendez (D-N.J.), a friend who received campaign contributions from the ophthalmologist. Menendez has been accused of improperly raising concerns with federal health officials on his behalf.

Melgen’s attorney issued a statement before the data release to try to put his client’s billing in perspective.

“At all times, Dr. Melgen billed in conformity with Medicare rules,” Kirk Ogrosky said. “While the amounts in the CMS data release appear large, the vast majority reflects the cost of drugs. . . . Responsible analysis requires looking beyond the raw data to what was paid for pharmaceuticals and expenses.”

The use of the more expensive eye drug helps explain why so many of Medicare’s top billers are ophthalmologists.

Of the doctors who were paid at least $1 million by Medicare in 2012, 879 were ophthalmologists, who — like Melgen — relied on using the more expensive drug, Lucentis.

Some physicians have suggested that using Lucentis is wasteful because a much cheaper alternative exists.

“There is no advantage of using Lucentis over Avastin — as six randomized clinical trials have shown they’re equivalent,” said Philip Rosenfeld, a Miami ophthalmologist who has pioneered the use of the less-expensive drug.

Top billers

Melgen, like some other doctors among the top billers, already has drawn scrutiny from Medicare investigators. Indeed, government inspectors have noted that instances of billing disputes and potential Morefraudmay occur more frequently among the highest Medicare billers. A December report from the Department of Health and Human Services, for example, analyzed the records of 303 physicians who were paid more than $3 million by Medicare in a year. It found that 13 were responsible for overpayments totaling $34 million, six faced payment reviews, three had their licenses suspended and two were indicted.In releasing the data, Medicare officials forbade news outlets to share any of the data until 12:01 a.m. Wednesday.

This provision meant that reporters could not solicit responses from any doctors beforehand.Because of that restriction on reporting, this article names only physicians who previously have come under scrutiny and have had an opportunity to respond to questions about their billing.The second-highest biller in 2012 was Asad U. Qamar, a cardiologist in Ocala. Qamar made headlines last year after a Reuters report detailed large donations the doctor had made to the Obama administration’s agenda a detailed federal review of his billing practices.

He told Reuters that he had seen “tremendous harassment of the physician community.”

The seventh-highest biller is Farid Fata, a cancer doctor in the Detroit area. He received $10 million in Medicare payments in 2012. Fata was arrested in August and is awaiting trial in a Medicare fraud case, accused of intentionally misdiagnosing illnesses and ordering unnecessary treatments, including chemotherapy for patients who did not have cancer.

Federal authorities say that Fata, who owned and operated two health-care companies, fraudulently billed Medicare from August 2007 to July 2013. He also is accused of conspiracy to pay and receive kickbacks to providers of home health services and hospice services in return for referring patients.

He has denied any wrongdoing.

Not all of the highest billers have faced such scrutiny, however. The fourth-highest biller on the list is a department chairman at the Mayo Clinic in Rochester, Minn.

Answering questions

The data release is expected to answer a much broader array of questions than who billed the most.

One of the persistent mysteries of U.S. health care, for example, is why some surgeries are performed much more frequently in some areas of the country than in others, as researchers at Dartmouth College noted.

Why, for example, is the rate of bypass surgery more than five times as high around Hattiesburg , Miss., and Slidell, La., as it is in Grand Junction, Colo.? Why is the rate of heart-valve replacement in Paterson and Camden, N.J., more than twice that of New Orleans and Albuquerque?

The data may allow researchers to take a closer look at individual doctors to find answers.

Jonathan S. Skinner, a Dartmouth economist, acknowledged that some doctors “may feel that their privacy has been compromised” with the dissemination of their billing records.

But, he said, “as earlier reporting has shown, there are people who are operating in the gray area of health care who are causing Medicare to spend enormous amounts on health care that may be harmful to their patients.”

Dumars Tenure AS GM For The Detroit Pistons Is Over

Joe Dumars run as Detroit Pistons GM is over. Dumar did not have total cooperation from his front office during his tenure in Detroit, this tarnished his record. The Pistons did win a Championship. The Pistons won the NBA Championship in 2004 and and returned to the finals in 2005. Under Dumars leadership the Pistons made the playoff every year until 2009. It was struggle for Dumars, primarily because of lack of support from his front office. The direction of the Detroit Pistons is clouded at best. Although Dumars made mistakes, primarilly because of a front office that spent little money, the Piston will have to rebuild. The new GM will have His work cut out for him.


LeBron James Believes Shabazz Napier Could Help

Seeing Shabazz Napier play last night for UConn for the National Championship you realize the potential of Napier and how he could help a team in need. LeBron James believes he can make a difference in the NBA at the point. Most mock drafts have him going late and may be not even getting drafted. I beg to differ. he makes good decisions at the point. He can get in the lane and distribute or score and he has a reliable shot when shooting the three, all good skills for an NBA point guard.

How to Ward Off Disease

2 Grown-Up Beverages That Keep Your Mind Young

These two adult beverages — one that wakes people up in the morning and another that relaxes them in the evening — may help keep the mind young: coffee and red wine.

According to research, these two beverages — if enjoyed in moderation — might help prevent the onset of Alzheimer's disease.

Staying SharpThe recent news is no reason to start a coffee or wine habit. But if they're already part of your beverage repertoire, you might be interested to know that both seem to contain ingredients that could help ward off dementia. Animal studies show that something in coffee may help trigger the release of a special growth factor — granulocyte colony-stimulating factor (GCSF) — that recruits cells from bone marrow to help sweep out beta-amyloid deposits. (Those are the pesky plaques that cause Alzheimer's symptoms.) And the polyphenols in red wine may have similar benefits, reducing levels of peptides that contribute to Alzheimer's plaques.

Very StimulatingThe substances in coffee and wine may also help strengthen the brain, either by helping it forge new connections or protecting it from the neurotoxic effects of Alzheimer's plaques. Ready for a younger, sharper mind? Try these rules for the road if you're a coffee or red wine drinker:

  • Make it fully leaded. In studies, decaf coffee didn't provide the same benefits. Of course, if you're caffeine sensitive, coffee probably isn't for you at all.
  • Enjoy responsibly. Heavy or binge drinking — even with polyphenol-rich red wine — is linked to worse cognitive performance. Limit yourself to one drink a day if you're a woman, or one to two drinks a day if you're a man.


Comments On Piston’s Peyton Siva – Leads Team To Victory

Pistons coach John Loyer

“If you don’t go home with a better appreciation for Peyton Siva, you really didn’t watch the game,” Loyer said. “He guarded the ball, he hustled, he got on the floor for loose balls, played with confidence. He was very, very good. You expect good things from Peyton just because he prepares so hard. If he’s not the first guy in the gym, I guarantee he’s the last to leave. He’s just been an incredible worker for us all year.His energy in the fourth quarter was tremendous,”

Andre Drummond

“He came out, ran the show, played great defense, made smart plays on offense and passed the ball to guys who were open.”


The Deal- What Will You Giveback?

You know we feel obligated from time to time. I need to do this, I need to do that. We feel an obligation to give back to the world. There certainly is nothing bad or wrong about this. It is all part of our human condition, it allows us to grow as Christians, to be more Christ like. In a larger since it is part of God's perfect plan for us which is ultimately to spread the 'Word” to everyone about the wonderful blessings and love of Almigthy God. God is real. He real in our soul and in our minds if we are willing to let Him in.


In order to give back you need to let The Lord into your life through the practice of folllowing His Word in the Holy Bible. Everthing in the universe and beyond in Centered in and around God's Word. With God's Word you are armed, locked, and loaded to talk about the Good News of God's Son, Jesus Christ. In order to Giveback, you must be willing to Seek and Discern. At first it will be difficult, however as you emerge yourself in the Word, a miraculous gift is given to you from The Lord. It is called discernment. It is important that you are armed with God “Word”, so that you are equipped to handled the dark resistance that you will encounter when you give back.


Our World is ruled by the enemy and his darkness. If you are attentive you can see it all around you. This world is not your friend, only The Lord can offer you protection through His Armour to withstand the evil and wiles of the devil (the enemy).


No One made Big Money on Warren Buffets and Quicken Loans Brackets

FORTUNE — The last few holdouts in the Quicken Loans bracket contest saw their billion-dollar dreams crumble Friday night.

The competition, put on by Quicken Loans and Yahoo Sports and backed by Warren Buffett's Berkshire Hathaway, would have given away $1 billion to any contestant who correctly predicted every winner in this year's NCAA men's basketball tournament. The odds of that happening were never good — about 9.2 quintillion to one. But a few big upsets knocked out most brackets surprisingly early. After Dayton beat Ohio State and Mercer beat Duke, 99% of all entries were out of the running.

By the time Stanford bested New Mexico Friday afternoon, only 16 brackets remained perfect. One game later, after Arizona beat Weber, there were just six brackets left, according to unofficial tallies on the Yahoo Sports website. The number dwindled to three when Gonzaga prevailed over Oklahoma State.

But those proud survivors had all picked George Washington to win against Memphis. Memphis defeated GW by five points.

And just like that, by the end of the round of 64, Quicken Loans' billion-dollar contest was over. Buffett, whose Berkshire Hathaway insured Quicken Loans against the losses of a potential payout, is now officially off the hook.

As for the rest of us, we're not all losers. Twenty contestants who entered the bracket competition will bring home $100,000 each. And Quicken Loans will donate $1 million to programs for inner-city children.

Those hoping for the billion-dollar payout will have to wait until next year. Or maybe just do what Buffett and Quicken Loans founder Dan Gilbert did — spend decades building strong businesses based on prescient vision and keen business acumen. You still might not make a billion, but your odds are a lot better.


Business Update- Boston Boot Company

CTP has been tapped to help launch Boston Boot Company and introduce its line of all-season leather boots for men. The agency will provide branding, website development, broadcast production and PR duties. “Boston Boot has an interesting story and we're excited to help share it in a way that drives sales and fosters a meaningful, lasting relationship with the consumer,” said Fred Conover, founder and president of CTP. Boston Boot makes boots in small batches with designs inspired by their hometown. Launched via a Kickstarter campaign last November, Boston Boot's spring line includes the Commonwealth, Newbury and Cambridge boots. Additional CTP clients include the Boston Red Sox, Eastern Bank, Red Hat and Microsoft.


The Deal- A Prayer For Our Enemies

To often we hate and we continue to hate those who do us wrong. We hold grudges and you know what, none of us can deny that we have exhibited this behavior. We are all a work in progress and we all have fell short of the glory of the Lord. This is a prayer for my enemies, yes those that have done me wrong. I've read it will make us all more Christ like. If you like read it aloud and if you have not prayed for those who have done you wrong. Do so today and ask Jesus to come into your life as your personal Savior, by asking for forgiveness of your sins.

Father, I come to You today to thank You for the gift of salvation that You have given to us all through our Lord and Savior Jesus Christ. Thank You Jesus for showing all of us how we should forgive. Jesus when I think of the awful things that they did to You before and during Your work on Calvary, I realize the tremendous sacrifice that You made for me on Calvary. And the beautiful thing is that I do not have to do anything except ask for Your forgiveness and for You to be The Lord and Savior of my life. I ask You today to forgive me of all the sinful things I have done in my life and I thank You for giving me the gift of Salvation through Your work on Calvary. Please come into my life today! Thank You Father God for giving Your only Son Jesus and the sacrifice Jesus made for our redemption and salvation on Calvary. I give my life to You today and forever.

I pray this day for my enemies, those who I have held grudges against for the wrong they did to me. I ask that You bless and keep them. I pray that You strengthen them, so that they will come to know the Love and sacrifice that Jesus made on Calvary for them. I pray that they will know You and ask You into their lives Jesus. Please bless and keep all of my enemies.

I pray this prayer, so that I will take the step to be more like You Father and Your Son Jesus Christ. Strengthen everyone who reads this prayer, open their eyes and their Hearts that they will let Jesus into their lives by simply asking Him for forgiveness of sin and for His eternal Salvation. In this I ask it in Jesus Name I pray Amen!


God Answers Prayers In His Own Time

There are things on our mind. Somehow we feel that the things we hope for, the things we pray for are far away. Sometimes we feel that our prayers will not be answered. But we soon find that those thoughts are merely fleeting and they are thoughts that pass away because you answer our prayers. You know what we need and you deliver it at the perfect time, in Your own time. Know that the Father is there for you!! Know that He loves you. Know that you can turn to Him at anytime through His Son Jesus Christ. That my friend is a beautiful thing.

Father I'm here to testify of your goodness. I'm here to shout out all the miraculous things you've done and will do for us. We only need to seek and ask and we will find happiness through Christ Jesus. Father, we give all the glory to you and we know, more importantly that all things work together for good, for those that Love The Lord and are called according to His Purpose…….Romans 8:28