TAMPA – Two Tampa clinical labs received the highest Medicare payments in the state for 2012, according to long-awaited data on the government insurance program for older people, and three doctors from the same Spring Hill practice received the highest individual reimbursements in the Tampa Bay area.
The data is consistent with top users nationwide in that laboratories for Quest Diagnostics Clinical Laboratories Inc. and the Laboratory Corporation of America handle a high volume of tests for long lists of doctors and institutes in their regions. And oncology, the specialty of the Spring Hill doctors, is traditionally the most highly reimbursed field because of the high cost of cancer-fighting drugs, which they must buy up-front.
Quest Diagnostics was reimbursed $87.6 million in 2012, according to Centers for Medicare and Medicaid Services figures assembled into a database by the Wall Street Journal. That was the seventh-highest reimbursement level in the nation. LabCorp received $56.0 million.
A spokeswoman for Quest, the industry leader with $7.1 billion in worldwide revenues, said the company is very active in Florida. “That lab would be performing testing services for the state and potentially for patients outside the state as well,” said Wendy Bost.
The three local physicians are affiliated with Florida Cancer Specialists & Research Institute, a Fort Myers-based practice with 80 locations, including Spring Hill.
Vikas Malhotra received $8.4 million from Medicare; Mary M. Li received $6.1 million; and Huayang Tang received $5.8 million.
Experts cautioned about jumping to conclusions about high payouts, which do not imply fraud or improper billing.
“Most of our expenses, the number one, number two, number three, and number four expenses, are drugs,” said Bill Harwin, founder of Florida Cancer Specialists. “Drugs are extremely expensive. The cost of drugs is set by the pharmaceutical companies and is under no control of the oncologist.”
Harwin said institutes such as his serve as a “pass-through” for cancer drugs. New cancer treatments generally cost more than $100,000 a year.
Malhotra, who has been practicing in the area for 13 years, said other factors contributed to the high reimbursement rate.
The Spring Hill area has always been a high-need area for oncology practitioners, he said, keeping the specialists extremely busy. And before the 2012 billing period, at least three high-profile doctors retired or moved, with their case loads added to existing doctors’. Others, such as nurse practitioners, also bill on the doctors’ accounts.
Malhotra estimated that drug costs represent “the high-90-percent range” in a typical Medicare reimbursement.
“There is no impropriety,” he said. “Like every physician, we are audited by Medicare, and we have never had to pay a dime back to Medicare. Transparency is a good thing, but people need to know how to interpret the data.”
The release of the Medicare billing data was a victory for employers, insurers, consumer groups and news organizations such as the Wall Street Journal, which has been fighting to overturn a 1979 injunction prohibiting the release of the information. The newspaper began publishing articles highlighting fraud and abuse in the Medicare system in 2010, and in 2011, its parent company intervened in a lawsuit that eventually overturned the injunction.
The Obama administration this week released an accounting of $77 billion in Medicare payouts to more than 880,000 health care providers for 2012.
The American Medical Association and doctors’ groups objected to the release of the claims data.
“We believe that the broad data dump … has significant shortcomings regarding the accuracy and value of the medical services rendered by physicians,” AMA president Ardis Dee Hoven told the Associated Press.
“Releasing the data without context will likely lead to inaccuracies, misinterpretations, false conclusions and other unintended consequences.”
On Wednesday, the AP and other news organizations reported that two Florida doctors topped the list for individual reimbursements in 2012.
Ophthalmologist Salomon Melgen of West Palm Beach received more than $26 million to treat fewer than 900 patients. Cardiologist Asad Qamar of Ocala received $22.9 million.
The Centers for Medicare and Medicaid Services said the data would allow consumers to conduct a wide range of analyses that compare 6,000 different types of services and procedures, as well as payments received by individual health care providers.
The information also allows comparisons by physician, specialty, location, the types of medical service and procedures delivered, Medicare payment, and submitted charges.
“Data transparency is a key aspect of transformation of the health care delivery system,” said Marilyn Tavenner, administrator of the Centers for Medicare and Medicaid Services. “While there’s more work ahead, this data release will help beneficiaries and consumers better understand how care is delivered through the Medicare program.”
The data can also be used to weed out fraud, making it easier to spot unusual reimbursements.