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Tyler Ophthalmologist Tops List of Texas' Top Medicare Billers

Opthalmology, apparently, is where the big Medicare money is.
Opthalmology, apparently, is where the big Medicare money is.
PFrankoZeitz

On Wednesday, the federal government released a massive trove of Medicare data showing how much some 880,000-plus U.S. healthcare providers were paid for their services in 2012. Fully mining the data will take months or years, but using the data to compile a list of the top Medicare billers took mere minutes.

Texas doesn't have any villains quite as convenient as Dr. Salomon Melgen, a West Palm Beach ophthalmologist who both received $21 million in Medicare payments and looks vaguely sinister in pictures, but it does have its fair share of doctors and lab that annually bill the federal government for millions of dollars.

The Wall Street Journal, among others, has put the data into a searchable database, which allows sorting by state and city.

Topping the list in Texas are clinical labs like Quest Diagnostics, whose Irving and Houston locations received a combined $80.2 million, and Laboratory Corporation of America, whose Dallas and Houston locations were paid a combined $74.9 million. Houston's Proton Therapy Center is the first non-lab on this list, coming in at No. 9 with $8.7 million in Medicare reimbursements. Rounding out the top 10 is the city of Houston's ambulance service, which gets $8.7 million. Here's the list:

Tyler Ophthalmologist Tops List of Texas' Top Medicare Billers

And what doctors and practices, outside of labs and ambulance services, are the most prolific? Hundreds received more than $1 million from Medicare. Here are Texas' top 25:

Tyler Ophthalmologist Tops List of Texas' Top Medicare Billers

None of this is to imply that any of these providers are doing anything wrong. There are plenty of reasons for a high Medicare reimbursement rate, like treating a lot of elderly patients. As the New York Times notes, this is highlighted by ophthalmologists, who comprise roughly half of the top 100 billers nationwide.

In ophthalmology, for example, a small number of doctors are able to perform high numbers of well-paid cataract surgeries or give numerous injections to patients with a serious eye disease known as macular degeneration, a condition that can, if left untreated, lead to blindness. They are also likely to treat a large share of Medicare patients in their practices.

"There are just these pockets of profitability within the system," said Dr. Lisa Bielamowicz, executive director and chief medical officer for research at the Advisory Board Company.

Ophthalmologists say that their high representation among the list of big recipients is misleading. Much of what Medicare pays them, they say, goes to the cost of the drugs they administer to patients in their offices and the bulk of that money ultimately goes to the drug companies.


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