How Much Does Your Doctor Bill Medicare? Now You Can Find Out

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Federal data show that a tiny sliver of medical providers accounts for a hefty share of Medicare costs.

Some doctors are getting rich off of Medicare. And others look like they are, when they’re actually sharing a billing code with other doctors or performing necessary but pricey medical procedures.

A new study shows that the top 1 percent of doctors and other medical providers accounted for 14 percent of the nearly $77 billion in Medicare billing recorded for 2012. Medicare is the government health insurance program for those 65 and older.

One Florida ophthalmologist reportedly billed Medicare for nearly $21 million in 2012, 64 times the average in the ophthalmology field. You can read more about him here.

The Centers for Medicare and Medicaid Services made the Medicare billing information public this week for the first time. Some of the statistics were startling. For instance, “Some top earners were paid as much as 100 times the average for their respective fields,” Bloomberg News said.

Is your doctor on the Medicare billing list? You can check by clicking on the CMS website here.

But don’t be quick to assume that the top earners on the Medicare list are scamming the system. Sure, some probably are, but that’s not always the case. But it’s hard to tell what’s what just looking at the information that was released. According to The Wall Street Journal:

Medical groups and policymakers have asserted that the figures lack context needed to show which doctors may be abusing the system and which are simply hard workers and overseers of complicated medical practices, or those whose specialties involve high overhead costs, such as radiation oncology, that lead to bigger bills.

For instance, a family practice physician in Michigan shows up on the list as one of the highest reimbursed doctors in her field. But it fails to show that she oversees a statewide, Medicare-funded project, and the majority of the Medicare money billed in her name is used to reimburse other doctors for their services, not pad her pockets.

Medicare billing information has been kept under lock and seal since 1979. Last year, a federal judge overturned a previous injunction, and presto – now we know where Medicare compensation is going. I think this is a great step in providing transparency for a government-funded program.

What do you think of the new Medicare billing information? Share your comments below or on our Facebook page.

Stacy Johnson

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