Before he found himself in hot water with state and federal watchdogs, Dr. Rakesh Jagetia was paid almost $20,000 for each Medicare patient he saw in 2012, for a total of nearly $5.3 million — the most, by far, paid to any Illinois doctor by Medicare.
That was revealed this past week when the federal government for the first time released data on services provided by — and money paid to — 880,000 health professionals in 2012 who took care of patients under the Medicare Part B program.
In 2012, the data show, about $77.4 billion was paid out nationwide.
The American Medical Association and other groups had fought Wednesday’s release, arguing it violated doctors’ privacy and could be inaccurate.
The Chicago Sun-Times used the data to determine which providers in Illinois were paid the most per patient in 2012 by Medicare, the federally administered health-insurance program for people 65 and older.
Jagetia was paid almost $5.3 million for the year by Medicare — making him one of the top-paid Illinois doctors under the program in 2012.
A year later, the Glenview physician was accused by state medical authorities of improper prescribing. He was placed on probation until at least 2018 and has had his license for prescribing controlled substances suspended, according to the Illinois Department of Financial and Professional Regulation.
None of the other doctors in the Top 10 Medicare payments-per-patient in Illinois is listed as having been disciplined by the state.
Jagetia, in an interview, disputed the government data, saying the practice where he worked at the time as an salaried employee received the money.
The physician ranked second in payments was Dr. Vera Petras of Joliet, at $9,616 per Medicaid patient seen in 2012. Yet Petras — who, like Jagetia, is a radiation oncologist — was paid far less overall than Jagetia, getting about $1.8 million for the services she provided to Medicare patients in 2012.
All but two of the top 10 highest paid per patient were radiation oncologists. Two were clinical psychologists.
Petras did not respond to calls to her office and home seeking comment.
The Sun-Times also found that most providers — more than 50 percent — are paid $180 or less per individual Medicare patient.
Combined with previously released data on hospital bills, the Medicare data will help people see where taxpayer dollars are going, said Cristina Boccuti, a senior associate of the Program on Medicare Policy at The Henry J. Kaiser Family Foundation. “But it’s difficult to talk about conclusions from this data when there are pieces that we don’t know.”
Those pieces include details on services each doctor performs. That could vary even among doctors in the same specialty, so it would take a more in-depth analysis to know what it means that Medicare paid some doctors more than others.
An especially high billing total could be a sign of fraud or abuse. But a high per-patient amount could just mean a physician specializes in costlier procedures. These doctors, who tend to be in oncology, ophthalmology and certain other fields, may not receive all the money listed as being paid to them by Medicare, because they also must pay for special drugs, medical devices or other expenses.
Nor does the data include what doctors may have gotten from patients in Medicare Advantage or private insurance. And it excludes doctors who provided services to 10 or fewer patients.
Nationally, the federal government paid 100 doctors a total of $610 million, the Associated Press found, using data from Centers for Medicare & Medicaid Services.
A Florida ophthalmologist now under criminal investigation for alleged excessive Medicare billing was paid the most of any doctor — almost $21 million.
Dr. David Dodwell of Springfield was paid the most Medicare money in Illinois — $5.8 million in 2012. He has never been disciplined for his work as a retina specialist.
Dodwell said the numbers should be analyzed based on doctor specialties. He said he routinely uses a drug for macular degeneration — an injection to the eye — which costs $2,000. So while Medicare might pay him $2,104 for a patient visit in that case, he would have been able to keep only $104.
He noted that a more inexpensive drug to treat macular degeneration caused a health scare in 2011; several patients were blinded, and some had their eyes removed.
Dodwell said simple math shows how much he really made from his Medicare patients: “If you took the number and then divide by 2,000 and multiply by 104, then you will see what Medicare paid us,” Dodwell said.
That equation produces this number: $301,600.
The American Medical Association maintains that the information had significant shortcomings.
“Thoughtful observers concluded long ago that payments or costs were not the only metric to evaluate medical care. Quality, value and outcomes are critical yardsticks for patients,” the AMA said in a statement Wednesday. “The information released by CMS will not allow patients or payers to draw meaningful conclusions about the value or quality of care.”
CMS said they agree people shouldn’t draw conclusions solely on the payment data, but they also argued that giving the public this data is a step toward making our health care system more transparent and accountable.
“The new data provides a better picture of how physicians practice in the Medicare program, and the payments they receive,” Jonathan Blum, principal deputy administrator of the Centers for Medicare & Medicaid Services, said in a blog post.
Contributing: Art Golab