By Charles Ornstein, Moneylife
A check of Medicare’s new database of payments to physicians confirms that at least $6 million in 2012 went to doctors who had been indicted or otherwise sanctioned. Photo from NPR.
In August 2011, federal agents swept across the Detroit area, arresting doctors, pharmacists and other health professionals accused of running a massive scheme to defraud Medicare.
The following month, several of those arrested —including psychiatrist Mark Greenbain and podiatrist Anmy Tran — were suspended from billing the state’s Medicaid program for the poor.
“Health care fraud steals funds from programs designed to benefit patients, and we all pay for it,” U.S. Attorney Barbara McQuade said in a press release at the time of the arrests. “We hope that the strength of our efforts will have a deterrent effect.”
But the indictment and Medicaid suspensions didn’t deter Medicare from continuing to allow the doctors to treat elderly and disabled patients — and billing taxpayers for their services.
In 2012, Medicare paid Greenbain more than $862,000, according to newly released data on Medicare payments to physicians. Tran received $155,000.
Greenbain and Tran were among dozens of doctors identified by ProPublica who Medicare kept paying after they were suspended or terminated from state Medicaid programs, indicted or charged with fraud, or had settled civil allegations of submitting false claims to Medicare.
Outlays to these doctors amounted to more than $6 million in 2012, ProPublica’s analysis shows. That’s a small fraction of the $77 billion Medicare has publicly reported paying that year for doctors’ visits and outpatient services in its Part B program, but it signifies a hole in regulators’ ability to protect the program — and patients — against fraud and abuse, said current and former government officials and fraud experts.
The total dollars paid to sanctioned doctors is likely much higher. Only a handful of states post online the names of doctors terminated from Medicaid programs in a way that can be accurately matched to Medicare Part B payments.
“If you’ve been suspended or terminated in one of the federal programs…I would think that you’d be suspended in the other programs, just as a basis of good practice,” said Louis Saccoccio, chief executive of the National Health Care Anti-Fraud Association.
Part B payments to doctors were released last week for the first time. A court injunction that had kept the information secret for 35 years was lifted last year as a result of a lawsuit by Dow Jones & Co., parent company of the Wall Street Journal.
But Medicare has long had access to the information. “They’re the ones doing the paying,” Saccoccio said.
Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services, said he could not discuss the status of individuals, such as Greenbain and Tran, both of whom were finally barred from billing Medicare this month.
By that time, Greenbain had pleaded guilty and been sentenced to four years in prison. Tran had been found guilty and trial and was sentenced to five years. She is appealing her conviction.
Albright said the Medicare payment data may not reflect money already recovered by his agency or held back from providers suspended from billing the program.
Preventing improper payments is a top priority for CMS, Albright said. The agency has employed new enrollment screening techniques to prevent high-risk providers from getting into the system and is using advanced data analytics to spot fraudulent billing before payments are made, he said. “Already, we have cracked down on tens of thousands health care providers suspected of Medicare fraud,” he said in an email.
Medicare’s fraud-fighting efforts have been criticized repeatedly in recent years. In an audit released last month, the inspector general of the U.S. Department of Health and Human Services found that about one-third of states hadn’t told CMS when they terminated providers from Medicaid and others had provided incomplete information, hobbling regulators’ ability to flag sanctioned professionals.
In December, the inspector general faulted Medicare for not systematically reviewing the billings of the program’s top-paid doctors and said it should be doing more to spot aberrant claims.
