Wall Street Journal pries loose Medicare payment data

“Small Group of Doctors Are Biggest Medicare Billers: Top 1% of billers of the federal insurance program in 2013 reaped 17.5% of all payments that year” is a June 1, 2015 Wall Street Journal piece whose most interesting angle, to me, is how tough it can be to get information on how tax dollars are spent:

That release [of data] followed a yearslong legal effort by The Wall Street Journal, which overturned a 1979 court ruling that such records must be kept secret. The American Medical Association obtained the injunction to block Medicare from releasing such records by arguing doctors’ right to privacy trumped the public interest in how the federal programs’ money was spent.

The Journal’s parent company, Dow Jones, intervened in that suit in 2011, arguing that the records should be releasable and, in May 2013, a judge reversed the injunction.

The data themselves are not very surprising. The doctors with the best connections to politicians are the ones who made the most money:

For instance, the No. 3 biller in 2013 was Salomon E. Melgen, a Florida eye doctor who had close ties to Sen. Robert Menendez and was indicted on health-fraud charges in April. He received $14.4 million in 2013 payments.

The second-biggest individual recipient of Medicare payments was Florida cardiologist Asad Qamar, who received $16 million in 2013, much of it for inserting stents. He was a top biller in 2012, too—and a major contributor to Democratic political campaigns in recent years, according to federal election data.

… The case of Dr. Melgen illustrates how politics can sometimes play a role in efforts to rein in waste and abuse in Medicare. After agency auditors identified about $9 million in overpayments in Dr. Melgen’s billings over the years, the doctor lavished his friend Sen. Menendez with nearly $1 million in gifts and campaign contributions to lobby CMS to resolve the issue, according to an indictment filed earlier in the spring.

[But of course when we want to find examples of corruption we must look to foreign countries and FIFA rather than at our own system…]

One little gem, though, is that Medicare doctors can make a lot of money testing the over-65-crowd for rave drugs such as Ecstasy (previous Journal article): “The program spent $14 million that year just on tests for angel dust, or PCP. Sue Brown, a laboratory director in Brunswick, Ga., said she has never seen someone over 65 test positive for angel dust, in 25 years in the business.” The cost of checking to see which retirement home dwellers are just back from Burning Man is $1,265 per patient at one successful lab.

People sometimes talk about the death of traditional media in favor of citizen journalists but what citizen journalist would have the budget or endurance to spend years in litigation with the American Medical Association and Federal government in order to get the information necessary for the story?

Related:

• American Economics Association convention report (paper on how “A payment from a pharmaceutical company [to a doctor] corresponds to, on average, an additional 29 Medicare prescriptions per year, and this number rises to nearly 100 prescriptions if the payment is at least $1,000.”)