Blog: Docs accused of fraud get more Medicare bucks (a lot more)

Most of the doctors swept up in last week's national Medicare fraud takedown collected a lot more from Medicare than others in the same specialty, according to Medicare physician payment data for 2013.

Of the 18 physicians identified so far in the sweep, more than half collected at least three times as much from Medicare as the average doctor in their specialty. Only four got less than the average payment.

While a physician pulling down more Medicare money than colleagues is not necessarily a red flag in itself, it could become an indicator of fraud when combined with other elements of physician payment data.

And a look at what the indicted doctors actually got from Medicare could yield some insight as to what investigators look for in ferreting out fraud.

Take Dr. Paul M. Robinson, who received just over $1 million from Medicare in 2013. That's nearly 18 times the average yearly Medicare payment of $58,000 for a general practitioner, Robinson's listed specialty.

But this relatively large Medicare payment wasn't the only red flag for Robinson.

The search form below breaks out different services provided by all 18 physicians. It shows Robinson was paid for thousands of ultrasound and other diagnostic tests, an unusually high number. He also filed claims for 39,000 skin allergy injection tests, for which Medicare paid $6 a pop.

A federal indictment unsealed last week charged Robinson with billing for numerous ultrasound and other diagnostic tests that were medically unnecessary or never performed. In fact, the indictment alleges, no allergy tests were ever performed at Robinson's El Centro, Calif., clinic.

While authorities did not not disclose what led them to bring charges against Robinson or the other doctors, it is likely investigators got some leads by crunching numbers.

Of course, the CMS has a lot more data than it makes public in its annual physician payments release. The agency says it now combs through real-time claims-filing data so that it can identify fraudulent patterns even before it writes checks to doctors.

In 2014 the agency reported it had identified or prevented more than $210 million in healthcare fraud the previous year using big data techniques.