New Medicare Payment Data Expose Doctors And Hospital Reimbursement Patterns

The Wall Street Journal: Doctor-Pay Trove Shows Limits Of Medicare Billing Data
The trove of Medicare data released Wednesday shows a wide cast of characters in the top ranks of the highest-reimbursed doctors, and reveals as much about the limits of the newly public billing records as it does about medical practice. (Weaver, Beck and Winslow, 6/3)

The Wall Street Journal: New Medicare Data Offer A More Complete Picture
Newly disclosed Medicare data reveal $12.4 billion in 2012 payments to physicians and other medical providers that were redacted from an earlier version of the data release. The 16% increase in payments accounted for in the new data—which now total $90 billion—reflects bills Medicare paid for services doctors and other providers performed on very small numbers of patients, though some of those services include very-high-cost treatments. The federal agency had previously excluded the data, citing privacy concerns, because the number of Medicare beneficiaries for these providers was lower than 11. (Weaver and McGinty, 6/3)

The Wall Street Journal: Taxpayers Face Big Medicare Tab For Unusual Doctor Billings
Ronald S. Weaver isn't a cardiologist. Yet 98% of the $2.3 million that the Los Angeles doctor's practice received from Medicare in 2012 was for a cardiac procedure, according to recently released government data. The procedure is rarely used by the nation's heart doctors. Patients are strapped to a bed with three large cuffs that inflate and deflate rhythmically to increase blood flow through the arteries—a last resort to treat severe chest pain in people who can't have surgery. The government data show that out of the thousands of cardiology providers who treated Medicare patients in 2012, just 239 billed for the procedure, and they used it on fewer than 5% of their patients on average. ... Dr. Weaver's clinic administered it to 99.5% of his Medicare patients—615 in all—billing the federal health-insurance program for the elderly and disabled 16,619 times, according to the data. (Carreyrou, Stewart and Barry, 6/3)

The Wall Street Journal: Cancer Doctors Ring Up Big Medicare Bills For Tarnished Drug Procrit
Many cancer doctors now use a drug called Procrit sparingly. It was approved in 1989 for anemia and became a popular treatment for that side effect of chemotherapy. But regulators later learned Procrit can speed tumor growth and hasten death in cancer patients. Today, use of this class of drug—best known as EPO, a substance Lance Armstrong took illicitly to pedal faster and longer—is sharply restricted. One Florida oncology group stands out for how much it bills Medicare for the pricey drug. (Weaver, Wilde Mathews and McGinty, 6/3)

The Wall Street Journal: How Medicare ‘Self-Referral’ Thrives On Loophole
In a letter to a friend, the manager of a Florida urology practice worried in 2010 that her company would attract federal scrutiny for its frequent use of an expensive bladder-cancer test. The manager’s concern involved a program at 21st Century Oncology Holdings Inc.—a national chain of cancer practices—that gives its urologists a financial incentive to order the test from a central in-house lab. A federal law since the 1990s has prohibited “self-referral,” in which doctors can profit from Medicare-reimbursed procedures they order. But 21st Century Oncology and many physician groups around the country have found ways to do it anyway, exploiting an exception to the law in ways its writers didn’t anticipate. (Carreyrou and Adamy, 6/3)

The Wall Street Journal: A Fast-Growing Medical Lab Tests Anti-Kickback Law
A fast-growing Virginia laboratory has collected hundreds of millions of dollars from Medicare while using a strategy that is now under regulatory scrutiny: It paid doctors who sent it patients' blood for testing. Health Diagnostic Laboratory Inc. transformed itself from a startup incorporated in late 2008 into a major lab with $383 million in 2013 revenues, 41% of that from Medicare. (Carreyrou and McGinty, 6/3)

Bloomberg: Deadly Infections Drive Billions In Hospital Bills To Medicare
Life-threatening complications from bacterial infections are on the rise among hospital patients, increasing at a double-digit rate as the population ages and costing U.S. health-care programs billions of dollars a year. One form of the condition, severe sepsis with a major complication, was the second most frequently billed diagnosis submitted by hospitals to Medicare in 2013, with more than 398,000 cases, according to data released Monday from the Centers for Medicare & Medicaid Services. (Chen and Bloomfield, 6/4)