A doctor affiliated with Tri-City Medical Center in Oceanside has been spotlighted as one of America’s worst — as far as billing Medicare.
The investigative news site notes that Medicare pays for more than 200 million office visits a year, “often to deal with routine problems like colds or high blood pressure. Most require relatively modest amounts of a doctor’s time or medical know-how.”
ProPublica reviewed newly released Medicare data, which found that doctors and other health providers nationwide charged the top rate in 2012 for just 4 percent of office visits for patients they had seen before.
A searchable database allows anyone to see how their own doctors fare as far as Medicare billing. See the Treatment Tracker here.
The listing for Farhoomand shows that Medicare paid him an average of $879 a patient — or nearly three times the average of $309 paid for patients in California.
According to a Tri-City hospital profile and video, Kaveh Sean Farhoomand joined the staff in July 2003, speaks French and graduated from UC San Diego before doing his medical training at Western University of Health Sciences in Pomona.
A Vista resident, he also has a private practice.
Farhoomand was one of more than 1,800 health professionals nationwide who billed Medicare for the most expensive type of office visits at least 90 percent of the time in 2012, ProPublica said.
Farhoomand told ProPublica why his patient visits were predominantly coded at the top level — billing Medicare for more than 2,100 level 5 visits, one of the highest tallies in the nation.
“I have a predominantly geriatric population, and I do mostly chronic critical illness, so all of my patients have, like, multi-organ failure, heart failure, diabetes with multiple complications, etc. etc.,” he was quoted as saying. “I’m savvy enough that I handle most of their issues myself, and I use specialists only for procedures and such things.”
ProPublica said Farhoomand is facing a 2013 accusation by the California medical board of gross negligence in his prescribing of controlled substances, a charge he denies.
“No good deed goes unpunished,” he said. “I wind up managing most of their chronic pain.”
ProPublica said Farhoomand is in talks with the board to settle the accusation.
Comment is being sought from Tri-City Medical Center.
In 2009, Farhoomand was noted by U-T San Diego as a sports dog trainer.
Dr. Robert Berenson, a former senior Medicare official who now works at the Urban Institute in Washington, was quoted as saying: “I think this is a smoking gun. Who’s asleep at the switch here?”
Farhoomand and others “insist that they treat older, sicker or more difficult patients than their peers,” said ProPublica, which looked at the 329,500 physicians and other providers who charged for at least 100 office visits for established patients.
Medicare paid out more than $12 billion for office visits in 2012, the site said.
“That’s real money coming out of the Treasury,” Berenson said. “Some doctors are robbing the commons for themselves.”
Cyndee Weston, executive director of the American Medical Billing Association, told ProPublica: “I can’t see a situation where every visit would be a level 5 [the most expensive], especially on an established patient. I was trying to talk myself into it, but I just can’t see it.”
She said such providers “would be ripe for audit,” because they are outliers, she said.
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