Menendez crony got $21 million from Medicare in 2012

posted at 2:01 pm on April 9, 2014 by Ed Morrissey

Remember Salomon Melgen? Over a year ago, the FBI raided his opthalmologic practice offices shortly after his connection to Senator Robert Menendez’ travel and prostitution habits surfaced. The FBI later opened a probe of Menendez, which went to a grand jury a year ago, and charged Melgen with Medicare fraud last August. CMS released its figures on total compensation from 2012 on Medicare and Medicaid claims, and guess who topped the list?

Medicare paid a tiny group of doctors $3 million or more apiece in 2012. One got nearly $21 million.

Those are among the findings of an Associated Press analysis of physician data released Wednesday by the Obama administration, part of a move to open the books on health care financing.

Topping Medicare’s list was Florida ophthalmologist Salomon Melgen, whose relationship with Sen. Robert Menendez, D-N.J., made headlines last year after news broke that the lawmaker used the doctor’s personal jet for trips to the Dominican Republic. Medicare paid Melgen $20.8 million.

AP’s analysis found that a small sliver of the more than 825,000 individual physicians in Medicare’s claims data base — just 344 physicians — took in top dollar, at least $3 million apiece for a total of nearly $1.5 billion.

AP picked the $3 million threshold because that was the figure used by the Health and Human Services inspector general in an audit last year that recommended Medicare automatically scrutinize total billings above a set level. Medicare says it’s working on that recommendation.

Give AP credit for both mentioning Menendez and his political affiliation — and in the third paragraph, no less. Bloomberg never bothers to mention Melgen’s Beltway connections, which led a commenter to ask: “Why no mention that the florida $21 Million doctor is a benefactor to NJ Senator Menendez?” That’s a good question — as is the question of the status of the probe into Menendez.

The release of this data looks like a campaign to keep doctors from demanding more reimbursement for their services from CMS.  Medical providers have long opposed this kind of data dump, and their opponents can claim some victory in finally naming and shaming those billing the most from the government. However, the top-line figures don’t tell the whole story:

The release of the information gives the public access for the first time to the billing practices of individual doctors nationwide. Consumer groups and news outlets have pressured Medicare to release the data for years. And in doing so Wednesday, Medicare officials said they hope the data will expose fraud, inform consumers and lead to improvements in care.

The American Medical Association and other physician groups have resisted the data release, arguing that the information violates doctor privacy and that the public may misconstrue details about individual doctors. …

Some of the highest billing totals may simply reflect a physician who is extremely efficient or who has an unusually large number of Medicare patients.

The highest numbers also may reflect a physician who specializes in procedures that require costly overhead, and in those cases, a large portion of the money may wind up not with the doctor but with pharmaceutical companies or makers of medical devices.

But in some instances, the extremely high billing totals could signal fraudulent doctor behavior, as government inspectors have previously found.

That’s an argument for making the data available to investigators, not public, which it presumably always has been for CMS. The problem with making the top line figure available is that the providers spend most of that on their own services and equipment. As much as 75% or more goes to overhead, the AMA argues, and even under CMS assumptions only 23 of the 4,000 biggest billers earned $1 million for their own personal income from their businesses.

Besides, the concentration of reimbursements to a small number of providers may be an indication not of fraud but of narrowed provider markets precisely because Medicare/Medicaid practice only makes sense when handled on the broadest possible scale.  Less than half of all providers will take Medicaid patients any more according to a study released two months ago, and that gets worse in the specialties. Only 7% of cardiologists in my area will take Medicaid patients any longer, which means that they will get an enormous amount of reimbursements as those patients flood into their offices.

If CMS and Congress continue to make this market less attractive, fewer providers will remain in it, and those who do will get a larger and larger share of reimbursements. The figures from this report are hardly surprising, even if some in the media don’t want to dig too deep into the biggest figure of all.


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This is why we need term limits.

Politicians on both sides of the aisle go to D.C. and enrich themselves/their cronies and buddies at the expense of the taxpayer.

As long as politicians control the pursestrings they will funnel taxpayer dollars to themselves or special interests.

Republicans do the same thing with the Chamber of Commerce, or as Mark Levin likes to call it, the Chamber of Crony Capitalists.

Term Limits and a Balanced Budget Amendment will take a step forward to putting a stop to things like this.

tcufrog on April 9, 2014 at 2:05 PM

Democrats are proud of his achievement…

PatriotRider on April 9, 2014 at 2:07 PM

On an offtopic note: I was interested to check to see if HotAir suffered from the “heart bleed” attack on SSL certificates. Imagine my surprise when I found that as far as I can tell, Hotair doesn’t use any SSL at all–not even your login page.

That means all of our passwords are vulnerable to anyone who happens to be sniffing–like, say, an IRS agent.

Does Hotair not even use basic security or any security at all here?

Vanceone on April 9, 2014 at 2:08 PM

On an offtopic note: I was interested to check to see if HotAir suffered from the “heart bleed” attack on SSL certificates. Imagine my surprise when I found that as far as I can tell, Hotair doesn’t use any SSL at all–not even your login page.

That means all of our passwords are vulnerable to anyone who happens to be sniffing–like, say, an IRS agent.

Does Hotair not even use basic security or any security at all here?

Vanceone on April 9, 2014 at 2:08 PM

The comment section of an unrelated issue isn’t really the place to be asking that – email the site admin or any other contact.

Good Lt on April 9, 2014 at 2:10 PM

But, but, but, the Koch Brothers!!!

Resist We Much on April 9, 2014 at 2:10 PM

They don’t mention the biggest Medicare scammers, Sen. Feinstein and her husband.

NO one has defrauded the Medicare system more than they have, under RAC, recovery audit consulting, under two different business names. For a time, in btw. the names, she was under ethical scrutiny in the senate. Then the rats forgot all about it and her husband is at it, in full swing.

Schadenfreude on April 9, 2014 at 2:12 PM

Yeah Mendez is rotten, but he doesn’t like Iran therefore its a wash. Right?

coolrepublica on April 9, 2014 at 2:14 PM

Gee, more cronyism from the most Crony-ist Regime ever. Shocking.

Since we have no opposition party in this country any more, the uncovering of any abuse, misdeeds or law breaking is pretty much meaningless at this point, isn’t it?

Meople on April 9, 2014 at 2:15 PM

Looks like the war on Medicare fraud is moving forward, full speed ahead.

rjoco1 on April 9, 2014 at 2:15 PM

The states that didn’t expand Medicaid are the real villains,right?

docflash on April 9, 2014 at 2:20 PM

But, but, but, the Koch Brothers!!!

Resist We Much on April 9, 2014 at 2:10 PM

I don’t think they’re Medicare providers. Medicare enrollees maybe. ;0

Happy Nomad on April 9, 2014 at 2:22 PM

The American Medical Association and other physician groups have resisted the data release, arguing that the information violates doctor privacy and that the public may misconstrue details about individual doctors. …

So how about this ,
we should get to see how much each medicare doctor gets paid
and how much the doctor launders this taxpayer money for
which politician and what causes.
I think the public is intelligent enough to understand that much , right ?

burrata on April 9, 2014 at 2:24 PM

The states that didn’t expand Medicaid are the real villains,right?

docflash on April 9, 2014 at 2:20 PM

You had to go there! Virginia’s budget and a bunch of unrelated bills are being held hostage by Terry McAuliffe and the Dems. They’re refusing to do anything until the GOP agrees to expand Medicaid. The funny thing is that they really think they have more leverage than they actually do, bless their little evil hearts.

Happy Nomad on April 9, 2014 at 2:24 PM

Happy Nomad on April 9, 2014 at 2:22 PM

They use their own money. Menendez insures that his buddy, an eye doctor, can rake in $21 million in Medicare tax dollars in a year.

Resist We Much on April 9, 2014 at 2:25 PM

Don’t forget the Koch Brothers

Schadenfreude on April 9, 2014 at 2:26 PM

But, but, but, the Koch Brothers!!!

Resist We Much on April 9, 2014 at 2:10 PM

Heh, just saw your comment.

Schadenfreude on April 9, 2014 at 2:27 PM

They don’t mention the biggest Medicare scammers, Sen. Feinstein and her husband.

NO one has defrauded the Medicare system more than they have, under RAC, recovery audit consulting, under two different business names. For a time, in btw. the names, she was under ethical scrutiny in the senate. Then the rats forgot all about it and her husband is at it, in full swing.

Schadenfreude on April 9, 2014 at 2:12 PM

DiFi also got an exclusive deal for CBRE’s Richard Blum for dealing foreclosed homes during the housing crisis. They made millions off her position then ,
and now , they will make billions
” building” the CA high speed rail ,
but she supports killing babies so it’s all fine.

burrata on April 9, 2014 at 2:33 PM

The free flow of information is a prerequisite to an informed society, which is also necessary for an efficient natural market.

Anyone should be able to see any company’s books online. Why? You might then decide not to frequent inefficient establishments. You may then use that information to invest, (or not), in the company.

This data dump doesn’t go far enough. There should be further breakdown of all the financials involved.

It might upset people’s applecarts, but the free market has ALWAYS been disruptive to established cartels.

antisense on April 9, 2014 at 2:35 PM

Yeah but did he close some lanes on a bridge?

bsinc1962 on April 9, 2014 at 2:37 PM

Alert – the US of Thuggery

Drudge:

200 Armed Federal Agents Surround Farm…
Forcibly Removing Cattle…
Governor Calls Roundup ‘Intimidation’…
Blasts ‘First Amendment Area’…
Family: ‘Wake up America…they are taking everything from us’…

STANDOFF AT NEVADA RANCH

Schadenfreude on April 9, 2014 at 2:38 PM

OT- I hope everybody saw that IRS Report about partisan activity. One example:

The report, further fueling allegations of bias at the agency, claimed that several accusations were made against the Dallas office claiming pro-Obama gear was “commonplace” there. Employees allegedly wore Obama shirts, buttons and stickers to work and had Obama screensavers on their IRS computers.

Living in DC, I know a couple of people who work for the government. The pro-Obama gear is questionable if these critters have any contact with the public but partisan screensavers….. Supervisors should be fired for letting this kind of crap happen.

Happy Nomad on April 9, 2014 at 2:41 PM

Schadenfreude on April 9, 2014 at 2:38 PM

Nevada ranch, eh?

I guess Harry Reid’s got a big BBQ coming up.

Happy Nomad on April 9, 2014 at 2:42 PM

Political cronies ripping off gubmint programs?
Shocked, I say, shocked I am….

dentarthurdent on April 9, 2014 at 2:47 PM

Anyone should be able to see any company’s books online. Why? You might then decide not to frequent inefficient establishments. You may then use that information to invest, (or not), in the company.

This data dump doesn’t go far enough. There should be further breakdown of all the financials involved.

It might upset people’s applecarts, but the free market has ALWAYS been disruptive to established cartels.

antisense on April 9, 2014 at 2:35 PM

If a company is publicly-traded, it already does. If a company sells fractional shares, but isn’t publicly traded, it must provide financial information to potential investors under most states’ Blue Sky laws.

While I agree with you on the free market, I would remind you of what happen to Eich last week or any number of people that have been driven out by lynch mobs. Do you really want to subject every business and its owners, management, and employees to that? Do you remember what happened to El Coyote Cafe and its manager, Marjorie “Margie” Christoffersen?

Putting ‘any’ company’s financials online or even on file at the courthouse will only invite retaliation and oppression. Do you really want to make the corner petrol station or convenience store post its financials online? Why do you need that information?

Resist We Much on April 9, 2014 at 2:48 PM

Happy Nomad on April 9, 2014 at 2:41 PM

Every level of “supervisor” from the peon right up the chain to Lerner are all doing the same thing.

The IRS needs to be dissolved, ended.

I say we pull up and nuke it from orbit. It’s the only way to be sure.

Meople on April 9, 2014 at 2:51 PM

It’s not like Bishop will ever see this.

Lanceman on April 9, 2014 at 2:54 PM

Hmmm $21 million, they be some damn expensive under age hookers.

ouldbollix on April 9, 2014 at 2:55 PM

Resist We Much on April 9, 2014 at 2:48 PM

You argue with one of the most perfect noms on HA.

Schadenfreude on April 9, 2014 at 2:57 PM

Putting ‘any’ company’s financials online or even on file at the courthouse will only invite retaliation and oppression. Do you really want to make the corner petrol station or convenience store post its financials online? Why do you need that information?

Resist We Much on April 9, 2014 at 2:48 PM

Forgive me for butting in,
but it would be a good idea if the government departments do that for the government contractors, vendors and suppliers.
Those who do not profit off the government need to be left alone,
but those who profit off the taxpayers and then launder taxpayer money to politicians should have no right to privacy of anything .

burrata on April 9, 2014 at 3:06 PM

I would like them to be online because I like learning about financials and think it could be fantastic information. Not necessarily saying it needs to be *mandated*, but if consumers reward companies who do so I could see it catching on.

I would love to learn the overhead on certain restaurants for instance. I could glean useful bits of info and basically decide their prices are inflated because they have too much overhead.

Also, competitors could try to reduce prices by lowering overhead, which is almost like business evolution. That would be helpful to everyone. Better profits, better products, better service in the long run.

antisense on April 9, 2014 at 3:35 PM

Also imagine this: a company’s books are published online. Someone in another company who might possibly be a vendor of the first company sees their overhead is a little high.

Email is sent out to the first company “Do you know that we can reduce your overhead and boost your bottom line by hiring us as a vendor/using our products?”

Gold Jerry, gold!

antisense on April 9, 2014 at 3:40 PM

And he gave 700,000 to Harry Reid’s Majority PAC. Oh what a tangled web of influence congress dinosaurs curry.

jake49 on April 9, 2014 at 3:52 PM

And he gave 700,000 to Harry Reid’s Majority PAC. Oh what a tangled web of influence congress dinosaurs curry.

jake49 on April 9, 2014 at 3:52 PM

Yeah, I was listening to Rush on my lunch and he did not mention that aspect. He only mentioned the push to demonize Medicare doctors… as if they represent free market capitalism! Did he later bring this aspect up?

antisense on April 9, 2014 at 4:05 PM

What LIV’s don’t understand is that these figures are NOT ‘income’ in the personal sense, it’s ‘revenue’ that a business takes in. From that figure, even in the case of Melgen’s $21 million, the doctor’s business pays expenses. Expenses are the salaries for nurses, payments for the rent on the office, mortgages on expensive equipment, benefits including healthcare for all employees, consumables including some drugs, etc.

If you want to know how much the doctor herself actually takes home, you have to ask them their personal taxable income, a far different figure from these being quoted.

slickwillie2001 on April 9, 2014 at 4:21 PM

slickwillie2001 on April 9, 2014 at 4:21 PM

Melgen’s medical expenses aren’t anywhere near $21 million, but I understand the difference between revenue and profit.

Resist We Much on April 9, 2014 at 5:59 PM

The 7% solution.

HEY…!

Seven Percent Solution on April 9, 2014 at 6:07 PM