WASHINGTON — In 2012, seven physicians in the country received more than $10 million in reimbursements for services billed to Medicare, according to newly released federal data. They range from ophthalmologists who submitted claims for specialized, high-cost drug treatments to pathologists who billed the program for thousands of clinical tests performed by their labs.
Some built large, successful practices; others face investigations for fraudulent billing. The doctor with the highest reimbursement total is enmeshed in a criminal inquiry involving a U.S. senator.
It’s the first time since the 1970s that Medicare, the public insurance program for seniors, has provided claims and payment figures for individual providers. Among the 880,644 health care practitioners who billed Medicare for services in 2012, the average reimbursement for the year was $87,883. Yet more than 2,000 of those providers broke $2 million in Medicare receipts.
Last fall, Congress’ Government Accountability Office raised concerns that Medicare providers with exceptionally high reimbursement rates may be defrauding the program or billing it incorrectly. The investigators recommended that Medicare officials mandate automatic claims reviews for providers whose reimbursements exceed a set threshold, but they did not suggest a specific amount.
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