Rhode Island’s ‘Medicare Millionaires’
Thursday, April 10, 2014
More than 4,000 doctors and other providers of health care services in Rhode Island received nearly $260 million in Medicare reimbursements in 2012, according to new federal data released yesterday.
The data, the first of its kind available in decades, pinpoints where Medicare dollars are going and which doctors and other health care providers are the top recipients—including many so-called ‘Medicare millionaires’ who bill $1 million or more annually. Of $64 billion issued in individual reimbursements nationwide, a third went to under 3 percent of doctors, with nearly 4,000 physicians billing at rates of $1 million or more annually, according to Bloomberg.
In Rhode Island, seven doctors billed at $1 million or more and another three received just under seven figures in Medicare reimbursements, according to a GoLocalProv analysis of the federal data. Overall, a quarter of the nearly $260 million spent went to just 11 percent of doctors and other health care providers. (See the slides for the list of the top 20.)
GET THE LATEST BREAKING NEWS HERE -- SIGN UP FOR GOLOCAL FREE DAILY EBLASTTop doctor faces fraud investigation
The top doctor listed is Fathalla M. Mashali, an anesthesiologist who received $3.4 million for an estimated 727 patients in 2012. That’s still significantly less than the $13.5 million Mashali requested from Medicare, when he was eligible for no more than $3.6 million, federal records show.
Last month, federal authorities announced that a doctor identified as Fathalla Mashali, who was licensed in both Rhode Island and Massachusetts, had been charged with nine counts of Medicare fraud. Mashali, who ran New England Pain Institute, P.C., with multiple locations in both states, allegedly trained his employees “to overbill the Medicare program,” according to a new release issued by the U.S. Attorney for Massachusetts. Federal prosecutors allege that the doctor “overbooked patient appointments,” often spending less than 10 minutes with a patient and often neglecting to perform any physical examination.
Also, in 2010, the U.S. Department of Labor sued Mashali for failing to contribute more than $6 million to his business’ pension plan, which it described as a violation of the Employee Retirement Income Security Act. Federal authorities alleged that Mashali diverted the money to benefit himself and his business, which had filed for bankruptcy in 2008. (At the time his business was Northern Rhode Island Anesthesia Associates P.C.)
The Rhode Island Department of Health database of licensed doctors lists one Fathalla M. Mashali, whose license was actually suspended last year after state authorities concluded that he had not followed proper procedures in prescribing pain medication to six patients who later died.
Mashali had been practicing in Rhode Island since 1996, according to state records. Attempts to reach him at an office listed in federal records at East Providence were unsuccessful yesterday.
Reining in costs
The release of the data is an opportunity to track how Medicare dollars are being spent and identify ways to make health care more affordable, according to Tom Sgouros, a progressive policy analyst who has studied health care costs. “Now that we have a path to covering almost everybody, we need a path to adequate cost control,” Sgouros said.
Sgouros said those doctors who are overbilling are increasing costs for everyone else in the system, especially those who can least afford it.
“Behind every person who is making a zillion dollars from health care is a company that can’t afford to insure its employees or a city that can’t … make its health care payment,” Sgouros said. “The idea that somebody can become fabulously rich off health care is a burden on everybody else.”
But Steven DeToy, the spokesman and lobbyist for the Rhode Island Medical Society, said it’s unfortunate that the media has focused on those doctors who are abusing the system and facing allegations of fraud. “For every one of those, there’s probably thousands of doctors doing it the right way,” DeToy said.
DeToy cautioned against drawing too many conclusions from the data, noting that it is a glimpse of just one year’s worth of spending and does not identify trends or patterns over a period of time. “It’s like a public opinion survey. It’s a snapshot at that moment,” DeToy said.
The data may not be able to answer some questions, but at least it allows the public and analysts to ask the right kinds of questions, Sgouros added. “You can’t really tell from the list who’s a scammer and who’s not but you can use it as a hint,” he said.
While some praised the new database as a step forward in transparency and accountability, one local commentator says it is just another example of how dysfunctional health care spending becomes when the government is involved.
“It’s astonishing to think about what happens when government meddles. We should know what doctors are charging for services upfront, as part of the decision making process. Instead, it’s like we have to have government pay the bill, then pressure the administration for transparency, and then wade through a massive database,” said Justin Katz, the research director for the Rhode Island Center for Freedom and Prosperity and the managing editor for the Ocean State Current.
“And at the end of the day, we can only hope to catch obvious fraud or careless scammers,” Katz added. “When you add in the government requirements and price fixing that limit the supply of doctors, the incentive and opportunity increase to work the system.”
Cracking down on Medicare fraud
The Centers for Medicare and Medicaid Services said the new database would allow public to track $77 billion in Medicare payments to more than 880,000 health care providers nationwide, saying the release has given consumers “unprecedented transparency” on how the Medicare system work. In all spending for 6,000 different types of services is listed, according to a news release.
“Data transparency is a key aspect of transformation of the health care delivery system,” CMS Administrator Marilyn Tavenner said in a news release. “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 agency also already has in place programs that target fraud, abuse, waste, overpayments, and unusual billing patterns, according to information provided in response to a series of questions from GoLocalProv.
Estimates of Medicare fraud vary. A 2010 Government Accountability Office report pegged it at nearly 10 percent of the annul $500 billion in Medicare spending for the year while the U.S. Attorney General has said the amount could be nearly double that, according to a May 2012 Fobes.com report.
Stephen Beale can be reached at [email protected]. Follow him on Twitter @bealenews
Related Slideshow: Top 20 Medicare Payment Recipients in RI
Below are the top 20 highest recipients of Medicare reimbursements in 2012, listed in order from least to greatest. The list includes doctors, ambulance services, and health care businesses. Two municipal ambulance services are also listed. The data, the first of its kind available in decades, was released by federal authorities yesterday.
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