By Evan Levine, M.D.

On April 9th, 2014, the Center for Medicare and Medicaid Services (CMS) released billing and collection date, for the year 2012, for every physician practicing in the United States.  This treasure trove of information, while being imperfect by not showing payments from all the insurers or what each doctor’s payer mix is, clearly shows us the most important fact; CMS has clearly illustrated that it cannot manage physicians or itself. 

I began looking through payments of some of my trusted colleagues and comparing their payments to physicians I know to be poorly trained and who have a very well-known reputation of ripping off Medicare. 

It’s no secret to most doctors who the criminals are but just like the destitute neighborhoods that harbor gang leaders and whose citizens often stay quiet when confronted by law enforcement, doctors, fearing retribution or because of indifference, go about their lives without reporting the criminals amongst them as well.  Add an inept government agency and as you will see, Medicare is being ripped off, without fear of retribution by scores of Criminal MDs.

I decided to research this data base and see what these duplicitous doctors were billing and how much they were collecting compared to honest physicians.  There was one very clear trend: Doctors in private practice who trained at the better schools and hospitals were  more likely to bill far less, sometimes as much as 80% less, than doctors who graduated from some of worst schools and who trained at some of the poorest training programs. Thanks to Medicare and Medicaid the best and brightest physicians in private practice are suffering while the worst in medicine are getting rich!

For one doctor practicing in New York I found he was billing over $600,000 dollars more than I was, and he was just a general internist, not a cardiologist.  Somehow Medicare allowed him to get paid for a host of procedures that he was clearly never trained to perform and some that seemed so absurd to my colleagues that we never even heard of them and wondered who the heck really needed these studies.  

Here was this internist getting paid for cardiology studies that included echocardiograms, stress tests, ultrasound studies of the aorta and arteries in the neck and extremities.  And the amount of tests Medicare was paying this person, who likely had no formal training during his residency, included studies that left every one of my colleagues, cardiologists, internists, and gastroenterologists aghast: visualization with an instrument of the anus, complex urinary flow measurements, EMG studies of the muscles and the anus, sonogram studies of the bladder and even complex neurologic studies. 

I sat down with several neurologists, who too were billing Medicare hundreds of thousands of dollars less than this doctor as they read the types of neurologic studies being paid by Medicare with apparently no vetting process.  We all agreed that Medicare was allowing just about any doctor to do any test on any patient. If Medicare was a bank they had their doors wide open , the safe unlocked, and closed-circuit cameras recording every single thief!

The data from Medicare kept on coming with more bizarre payments that included CAT scans of just about every part of the human body being paid to a family physician and treatment of varicose veins, usually felt to be cosmetic, for as much as $1,700 dollars for every procedure or  more than Medicare pays my associate, a cardiac surgeon, for coronary artery bypass!

Looking at this data, that Medicare has known about for two years, made us all wonder what the heck they were doing?   They have these numbers, can clearly see outliers who are billing four or five –times more than the average physician and yet they do nothing!   And Medicare appears to allow device manufacturers to get approval for procedures that appear to have very limited use and yet are being performed by   duplicitous doctors on thousands of patients who likely don’t require any of these tests.  Billions of dollars are willingly be handed to the criminals.

A broken entity, Medicare, then seeks ways of curbing this runaway cash cow, not by preventing fraud but by cutting payments to all doctors.  In the end, the only physicians to suffer are the decent  physicians  who practice honest medicine.  Ten years ago, for example, Medicare payments for an echocardiogram were about double of what they are now.  But when every doctor was allowed to perform an echo, whether they had any training or not, or if their patient required that study, Medicare cut their reimbursement for the procedure.

By releasing the 2012 payments to physicians Medicare, and thus  our government, has illustrated its inability to run healthcare, to appropriately police the system and its physicians.  Medicare works to clearly reward any unscrupulous doctor without fear of retribution, while penalizing the honest doctors and encouraging many to perform expensive and inappropriate tests, whether they are qualified to perform them.

Many suggest that Medicare is an example of how government can run healthcare. Perhaps after reading this, we will all think that Medicare is an example of how government cannot run healthcare!

About the author: Evan S. Levine, MD FACC, is Director of the Cardiovascular Center at Saint Joseph’s Hospital and a Clinical Assistant Professor of Medicine at Montefiore Medical Center – Albert Einstein College of Medicine. He is also the author of the book “What Your Doctor Won’t (or can’t) Tell You”. He lives in Connecticut with his wife and children.