An Order of Chicken and Waffles with a Big Side of Illicit Prescription Drugs

Monday, April 14, 2014

The federal government's data dump last week of Medicare payouts to doctors—a first—offered a misleading snapshot of some of the recipients, but the big picture was pretty clear. A very small number of physicians nationally were getting a huge share of the billions being expended by government.

That included a Berkeley doctor who allegedly met her customers at restaurants in and around Oakland—including Burger King, House of Chicken and Waffles and Starbucks—to prescribe prescription drugs, including oxycodone. The Oakland Tribune said that Dr. Toni Daniels was indicted Friday by the U.S. Attorney's Office on charges of conspiracy to commit health care fraud, not paying her taxes and conspiracy to dispense controlled substances.

Daniels allegedly sold prescriptions for cash to patients she knew were reimbursed through Medicare or Medicaid. The indictment said Daniels picked up $64,000 that way between October 2010 and April 2011 and failed to file with the IRS after earning $144,000 in 2010.

Daniels’ method of extracting money from the federal government may prove to be among the more egregious reasons for being near the top of a list of 880,000 Medicare healthcare providers and how they divvied up $77 billion in 2012. At least a dozen made more than $10 million. The top 2% collected almost 25% of the payments.

An ophthalmologist from West Palm Beach, Florida, topped the list at $26 million by productively utilizing just 900 patients. A Newport Beach oncologist was California's sole doctor in the Top 10, checking in with $11 million in billings.

The list is a bit misleading, as a number of complaining physicians have pointed out. Sometimes a single doctor does the billing for a group of doctors, or the drugs they are prescribing are really expensive. In fact, prescription drugs accounted for a large percentage of billings, which is why  cancer doctors figure so prominently among the highest paid doctors.

That prompted Paul Waldman at the American Prospect to suggest that perhaps the government should pay doctors a flat fee of, say, $10 or $15 per prescription instead of the 6% fee they get to order the most expensive or in-demand drug on the menu.     

The Medicare data became available when a federal judge lifted a 33-year old injunction last May.

–Ken Broder


To Learn More:

Sliver of Medicare Doctors Get Big Share of Payouts (by Reed Abelson and Sarah Cohen, New York Times)

Medicare Millionaires Emerge in Data on Doctor Payments (by Shannon Pettypiece, Alex Wayne and Caroline Chen, Bloomberg Businessweek)

Doctors Make Millions Off of Medicare (by Tami Luhby, CNN)

Release of Medicare Doctor Payments Shows Some Huge Payouts (by Chad Terhune, Noam N. Levey and Doug Smith, Los Angeles Times)

Behind the Scenes on Those Enormous Medicare Billing Numbers (by Kevin Drum, Mother Jones)

Feds Say Berkeley Doctor Dispensed Illicit Prescriptions from Booth at Chicken And Waffles Restaurant (by Katie Nelson, Oakland Tribune)

Medicare Provider Utilization and Payment Data: Physician and Other Supplier (Centers for Medicare and Medicaid Services)

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