Florida doctor paid $21M by Medicare, government says

WASHINGTON -- A doctor who treats a degenerative eye disease in seniors was paid $21 million by Medicare in 2012, twice the amount received by the next ophthalmologist on a list of more than 800,000 medical providers released Wednesday by the government.

The data on the payments were given to the public for the first time by the Centers for Medicare and Medicaid Services.

Topping Medicare's list was Florida ophthalmologist Salomon Melgen, whose relationship with Sen. Robert Menendez (D-N.J.) made headlines last year after news broke that the lawmaker used the doctor's personal jet for trips to the Dominican Republic. Melgen also was the top donor for Menendez's 2012 re-election campaign.

Medicare paid Melgen $20.8 million. His lawyer, Kirk Ogrosky, said the doctor's billing conformed with Medicare rules and is a reflection of the high cost of drugs used in treatments.

An Associated Press analysis of physician data released yesterday found that a sliver of the more than 825,000 individual physicians in Medicare's claims database -- just 344 physicians -- took in top dollar, at least $3 million apiece for a total of nearly $1.5 billion.

The Health and Human Services inspector general last year recommended Medicare automatically scrutinize total billings above the $3 million mark.

On Long Island, eight doctors each received more than $3 million in Medicare payments, with three all getting paid more than $4 million.

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. New York had 18.

In the $3 million-plus club, 151 ophthalmologists -- eye specialists -- accounted for nearly $658 million in Medicare payments, leading other disciplines.

The high number of ophthalmologists in the top tier may reflect the doctors' choice of medications to treat patients with eye problems. Studies have shown that Lucentis, a pricey drug specially formulated for treating macular degeneration, works no better than a much cheaper one, Avastin. But lower-cost Avastin must be specially prepared for use in the eye, and problems with sterility have led many doctors to stick with Lucentis.

Overall, Medicare paid individual physicians nearly $64 billion in 2012. On LI, Medicare paid $1.27 billion to local doctors.

The Medicare claims database is considered the richest trove of information on doctors, surpassing what major insurance companies have in their files.

"It will allow us to start putting the pieces together," said Dianne Munevar, a top researcher at the health care data firm Avalare Health. "That is the basis of what payment delivery reform is about."

The American Medical Association, which has long opposed release of the Medicare database, 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."

In addition, providers in a large practice group could bill all their services under one name, said a spokesman for the Centers for Medicare and Medicaid Services, which released the information Wednesday.