Federal health care officials released an unprecedented trove of data on physician Medicare billing Wednesday, enlisting the public’s help to root out fraud but also warning against jumping to conclusions based on raw data alone.
A Florida eye doctor, Salomon Melgen, whose practice was raided twice by federal authorities last year, topped the list.
A friend of Sen. Robert Menendez, New Jersey Democrat, Dr. Melgen billed the federal Medicare program for more than $20 million in 2012, records show, while just 2 percent of participating doctors accounted for nearly a quarter of all billings.
Through a lawyer, Dr. Melgen denied any wrongdoing or questionable billing.
“While the amounts in the CMS data release appear large, the vast majority reflects the cost of drugs,” Melgen lawyer Kirk Ogrosky wrote in an email. “The facts are that doctors receive 6 percent above what they pay for drugs, the amount billed by physicians is set by law, and drug companies set the price of drugs, not doctors.”
One lucrative source of income for Dr. Melgen: 37,075 injections of a macular degeneration drug he billed Medicare to treat 645 different patients, according to the data. The government paid him back at an average reimbursement of nearly $320 for each procedure, according to the records.
The name-brand drug reportedly has a cheaper alternative, but it’s not illegal for physicians to prescribe whichever treatment they believe works best, Medicare officials told reporters on a conference call Wednesday. They did not specifically discuss Dr. Melgen by name.
“The data released today afford researchers, policymakers and the public a new window into health care spending and physician practice patterns,” HHS Secretary Kathleen Sebelius said in announcing the release Wednesday.
Overall, CMS data contained information on nearly 900,000 providers paid about $64 billion. The billing information has long been kept secret, but it was made public after a lawsuit by Dow Jones & Co.
The American Medical Association fought the release, warning the information could contain errors and lead to misinterpretation.
“The manner in which CMS is broadly releasing physician claims data, without context, can lead to inaccuracies, misinterpretations and false conclusions,” the AMA said in a statement Tuesday.
While health care researchers and reporters scoured through the data Wednesday, top earners came under immediate scrutiny, and Dr. Melgen’s name returned to the headlines almost immediately.
Early last year, the FBI raided Dr. Melgen’s Palm Beach office. The highly-publicized raid drew attention to his relationship with Mr. Menendez. Dr. Melgen and his family members have donated more than $400,000 to Mr. Menendez’ campaigns or political causes since 1992.
Only when Dr. Melgen came under scrutiny last year did Mr. Menendez reimburse the doctor for two flights he took to the Dominican Republic on Dr. Melgen’s jet back in 2010.
“Dr. Melgen strongly supports transparency in government, but engaging in speculation based on raw data is irresponsible,” Mr. Ogrosky said. “Dr. Melgen and his employees provide a substantial amount of free services and drugs to patients who cannot afford to pay.”
Mr. Menendez and his office had no comment on the Medicare numbers Wednesday.
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