Health reports from NBC4's Dr. Bruce Hensel

New Report Lists Doctors Who Have Charged Medicare the Most for Office Visits

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    NEWSLETTERS

    4 the First Time: In an investigation into what doctors were billing Medicare for patient office visits, NBC4 discovered that a group of local physicians billed Medicare for the most expensive type of office visits -- 100 percent of the time. Dr. Bruce Hensel and the NBC4 I-Team investigate for the NBC4 News at 6 p.m. on Thursday, May 22, 2014.

    How much should a doctor charge for your office visit? The cost depends on the amount of time the doctor spends face to face and the tests and treatments which are done, according to Medicare.

    The highest rate typically is supposed to be charged for a visit that lasts at least 40 minutes, and evaluates and treats a moderate to severe problem. These are the longest and most expensive office visits and accounted for less than 5 percent of all Medicare office visits in 2012.

    But some doctors are billing Medicare for the most expensive visits 100 percent of the time.

    In partnership with ProPublica, NBC4 looked that the billing records of more than 16,000 doctors who saw Medicare patients in 2012, the most recent data available.

    About 337 of these physicians -- about 2 percent -- billed Medicare for the most expensive office visits for every Medicare patient they saw.

    Medicare consultant Jim Frogue says this pattern raises questions about how these doctors are billing.

    "Is it possible they’re legitimate? It’s possible," Frogue said. "It’s possible but it’s unusual and needs more scrutiny."

    The doctors NBC4 identified only billed for the highest and most expensive level.

    So how do you check your doctor’s billing and background? ProPublica has developed an online tool called called Treatment Tracker that allows consumers to compare their doctors, physical therapists and other health providers to others based on newly released data on the services they provide in Medicare’s Part B program.

    Here is what Dr. Bruce suggests you look for and ask about:

    • Does your doctor perform more services and order more tests per patient than others in his or her specialty and state?
    • Is your doctor’s cost per patient higher than peers? If your doctor is above average, it may be worth asking questions to ensure you are not being over-treated or over-charged. More health care does not always equate to better health care.
    • Are the most common services and treatments chosen by your doctor similar to others in the same specialty and state? Some doctors may be relying on unconventional or even questionable therapies that their peers do not. You may want to look for large gaps between where a service ranks for your doctor and where it ranks among similar providers.

    The Treatment Tracker tool can also help you identify:

    • If your physician accepted payments from pharmaceutical companies for promotional work
    • How your doctor’s drug prescribing patterns compare to peers
    • And if the California Medical Board has disciplined the doctor.

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