Data Stream
2013 Medicare Recipients
2013 Medicare Payments
100
Meet the 1 Percent
A small group of doctors and individual
medical providers are the biggest recipients
of Medicare dollars, according to payment
data recently released by Medicare. Of the
950,000 recipients in 2013, the top 1% took
in 17.5% of Medicare’s annual payments –
totaling $13.1 billion. This continues a trend
from 2012, the first year that Medicare
made this type of data publicly available,
when, again, 1% of doctors received 16.6%
of the program’s payments.
900
= 1,000 doctors
= 1,000 doctors, top 1%
90
= 1% of $13.1 billion
= 1% of $13.1 billion,
top 1%
800
80
The majority of those payments were for
drug prescriptions – not surprising given
the rising cost of drugs, and cancer drugs in
particular. Here’s how the rest of that billing
data broke down:
Other:
8%
600
60
Surgeries and
procedures: 14%
Drugs: 51%
Exams and
evaluations:
20%
50
400
40
300
Other: 1,329
(14.8%)
Internal
medicine:
385 (4.3%)
30
Hematology/
oncology:
2,237 (25%)
Dermatology:
534 (5.9%)
Ophthalmology:
1,663 (18.5%)
200
20
62
national average of 23.
468
had a high percentage of billing for
commonly abused opioid prescriptions:
comprising at least
17%
of Part D billing, nearly three times the
national average of 6%.
Rheumatology:
546 (6%)
Radiation
oncology:
611 (6.8)
Cardiology:
613 (6.8%)
Source: The Wall Street Journal and Health and Centers for Medicare and Medicaid Services, “Physician
and Other Supplier Data CY 2013.”
34
billed for an extremely high number of
prescriptions per beneficiary: at least
PHARMACIES
Nephrology:
180 (2%)
Diagnostic
radiology:
240 (2.7%)
403
PRESCRIPTIONS
per beneficiary, nearly three times the
500
Hematologists and oncologists were overrepresented among the top 1% of Medicare
billers:
Fraud and abuse continue to plague Medicare’s prescription drug program, according
to a new report from the inspector general
of Health and Human Services.
In 2014, 1,432 retail pharmacies had
questionable billing for Part D drugs –
together billing $2.3 billion.
PHARMACIES
700
70
Labs and
imaging
tests: 7%
Fraud Alert
ASH Clinical News
Medical oncology:
645 (7.2%)
100
10
These pharmacies were more likely to be
independently owned and to be located
in the New York, Miami, Los Angeles,
and Detroit areas.
The good news? Those 1,432
pharmacies represent only 2% of retail
pharmacies nationwide.
Source: U.S. Department of Health and Human
Services Office of Inspector General, Data Brief, June
2015.
July 2015