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Wednesday, April 16,2014

Medicare money makers

Eight Lansing-area medical providers received more than $1 million each from feds in 2012

by Todd Heywood
Eight of Lansing’s top 10 Medicare billers raked in over $1 million each in 2012, according to a database released by the Center for Medicare and Medicaid Services to The Wall Street Journal. The other two brought in just under $1 million each.

The top biller is Pathology Services Org LLC. That lab billed the government health program over $1.8 million for various drug assays. Drug assays are used to monitor drug abuse, including abuse of prescription drugs. In fact, the second highest area of billing from Pathology was for drug assays for opiates. In 2012, 17,759 such tests were performed by the lab, at a cost of $27.51 per test, resulting in a payout of $488,550.09.

Mid-Michigan MRI logged in with the second highest billings, charging Medicare over $1.6 million for specialty diagnosis services using magnetic resonance.

Among those top billers are Mercy Ambulance Service and the city of Lansing’s ambulance service. Mercy was the fourth highest paid biller, taking in nearly $1.3 million, while the city of Lansing was fifth on the list, taking in over $1.26 million.

“Medicare (typically for seniors) is an important revenue source as are all of our revenue streams. They help to supplement the costs for providing EMS & fire services,” Randy Talifarro, chief of the Lansing Fire Department, said in an email. “The amount you indicated from 2012 ($1.2 million) represents nearly a third of our ambulance income. Medicare has remained essentially stable as a source of income. As a point of clarification, Medicaid (for poor & underinsured) has increased significantly over the last 2-years. This is a trend we are continuing to track.”

The five other top billers for 2012 were specialty physicians. Justus Fietchner, a specialist in rheumatology, billed the federal health care program over $1.6 million in 2012. Christopher Sweet, a diagnostic radiologist, billed over $1.1 million, while Mark Folts, a nurse practitioner working in pain management, billed the program over $1 million. Dermatologist Gregory Messenger also billed the program over $1 million.

Two other Lansing area health care agencies billed Medicare nearly $1 million in 2012. Genesis ASC Partners, an ambulatory surgical location, billed nearly $1 million. Over half — $560,556.40 — was billed for cataract surgeries. Meanwhile, Cap-Lab PLC billed over $936,000. Among the billing specifics, the laboratory billed for over 12,000 tissue examinations for a total cost to taxpayers of $690,019.29.

According to the searchable database, 200 physicians and medical clinical services businesses obtained Medicare reimbursements in 2012.

Among those is Dr. Shannon Wiggins, owner of East Michigan Family Care Clinic, 2310 E. Michigan Ave. She and her husband, who acted as office manager for the clinic, pleaded guilty in January to multiple federal charges related to health care fraud. The charges include receiving kickbacks for prescribing unnecessary diagnostic tests and billing Medicare and other programs. In 2012, Wiggins billed the health agency $160,178.46.

Despite the large price tags, medical societies warn the information could be misleading. On the Michigan State Medical Society website, the professional group representing 15,000 Michigan physicians warned the information would not provide a clear picture for patients about a physician’s work or quality of that work.

“The recent release of Medicare payment data by CMS provides patients and taxpayers with some level of transparency, and this is a good thing. It is important to realize, however, the data does not completely or accurately reflect the complexity of health care delivery and patient care,” the organization wrote. “The information released by CMS does not in any way inform patients whether or not a physician provides quality care, the level of integrity with which a physician operates his or her practice or explain whether a local practice handles reimbursement services for more than one physician.”

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