Medicare Data Release: Some Docs Make Millions

Dr. Minh Nguyen is an oncologist working in Newport Beach, California, a wealthy area of Orange County. This week Dr. Nguyen began getting calls from reporters after CMS released a list of Medicare payments showing he was paid $11 million in 2012, making him the #1 payee in California.

“I didn’t make $11 million in 2012. I’d be ecstatic if I made $11million. I’d be ecstatic if I made a million dollars in 2012, let alone$11 million. But it’s nowhere near the truth,” Nguyen told the Orange County Register.

The release Wednesday of Medicare payment data was framed by the Obama administration as an opportunity to identify fraud and inefficiency. “We want the public, press, and researchers to mine the data to help usfind outliers, and identify spending that doesn’t make sense or appearsto be wasteful or fraudulent,” CMS deputy administrator Jonathan Blum said on a conference call with reporters.

The payment data had not been released publicly since 1979 when the American Medical Association got a federal injunction against doing so. The AMA continued to express its opposition to the release this week saying, “We believe that the broad data dump by CMS has significantshort-comings regarding the accuracy and value of the medical servicesrendered by physicians.”

The initial media response focusing on the top payees in each state appeared to bear out the AMA’s concern. For instance, Dr. Nguyen works for a medical practice with four other doctors. All five of them make Medicare claims under his billing number, known as a National Provider Identifier or NPI. And some of the drugs he provides can cost as much as $100,000 for a single course of treatment.

Dr. Nguyen wasn’t the only doctor put in the media’s cross-hairs as a result of the data dump. Dr. Michael McGinnis in New Jersey wound up in third place on the list with total reimbursements in 2012 of $12.6 million. Dr. McGinnis tells CNBC his phone began ringing like crazy, “You name it: USA Today, Bloomberg, NBC…My head is spinning.” But Dr. McGinnis added that the numbers were misleading “Several ex-wives … they’d be ecstatic if I was making that kind of money.”

In reality, McGinnis runs three medical practices in the state, one of which, PLUS Diagnostics, is the largest independent pathology lab in the country. A total of 28 doctors have been using McGinnis’s NPI number to file for reimbursements.

Both Dr. Nguyen and Dr. McGinnis said they had no objection to the release of data, though both expressed concern that it created a misleading impression for some observers. McGinnis tells CNBC, “As far as I’m concerned, any and all data should be available for all people to see,” but he added, “Somebody is sitting in a cornfield in Nebraska and thinking that one doctor is making this kind of money.”