My eye doc is worth over $3 million a year

By Dian Vujovich

My eye doc is an ophthalmologist. One of the guys who billed Medicare over $3 million in 2012. I know there is a lot of fraud in Medicare billing, and a large amount of it in this particular medical specialty, but  in my doc’s case I just don’t see it.

As a diabetic who has not successfully controlled the disease,   I have macular edema retinopathy in both eyes. In an effort to keep me from going blind, I’ve been getting a shot in each eye once a month for quite a while. My doc originally started treating me with Avastin injections and when no positive results were had from it, he changed to Lucentis—a far costlier  drug.

According to a recent story in The Palm Beach Post, one dose of Avastin costs about $50 and one injection of Lucentis, $1800. While docs bill for the total cost of whatever drugs are used, they are paid only of fraction of that  cost. According to that same source, Medicare pays 6 percent.

That’s one heck of a spread in drug costs that  translates to a huge difference in the amount of money docs who use one, both or either of those meds earn in a year. As well as, bill Medicare.

There’s plenty of room to argue about Medicare reimbursements or why some drugs are so expensive and others not. But when you’re a patient and insurance— be it Medicare or any insurance company—is covering the cost of the meds, what matters most  is whether the treatment is working. Not the cost of the drug.

When I tell people that I get a shot in my eye each month, they cringe. It is one of those OMG gasping things when you first hear about it. And, yes it was scary to learn I had to endure the treatment. And double-yes, it’s still stressful.

But my doc is hugely proficient at this shot-in-the-eye task and clearly has the steadiest hands in the universe.

He also doesn’t seem to be in the biz just for the money: Since the beginning of the year, the swelling of the retina in my right eye has improved so much that I’ve not had to have any monthly injections of the  costly Lucentis.  That’s good for me, less billing to Medicare and less income for him