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24 Utah providers billed Medicare $1M or more in 2012

Six businesses get a similar amount; Utah numbers still a tiny portion of a whopping $77 billion nationwide.



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While some physicians see the drugs as equivalent, others say Avastin is less safe. The cancer drug has not been approved by the Food and Drug Administration (FDA) for use in treating macular degeneration.

Most Utah eye doctors, including Goff’s partners at Rocky Mountain Retinal Consultants, favor Lucentis, Medicare data show.

At a glance

Find your doctor

To search Medicare’s 2012 billings by state, city, specialty and physician names, visit an interactive graphic at the Wall Street Journal.

Utah’s top Medicare billings

Eighteen Utah physicians and six businesses billed Medicare for $1 million or more in 2012, according to billing data released by the U.S. Centers for Medicare and Medicaid.

Hematology/oncology

$4.5 million, Carl R. Gray

$3.8 million, Vincent Hansen

$1.8 million, Joseph D. Te

$1.3 million, Jay C. Bott

$1.1 million, Steven L. Wallentine

$1.1 million, Wendy A. Breyer

Ophthalmology

$2.6 million, Mitchell J. Goff

$2.3 million, Peter R. Hurlbut-Miller

$2.2 million, David W. Faber

$2.1 million, Kirk E. Windward

$2.1 million, Robert C. Kwun

$1.5 million, Douglas S. Mehr

$1.3 million, John A. Carver

$1.2 million, Mano Swartz

$1.1 million, Sharon R. Richens

$1.1 million, James G. Howard

Rheumatology

$1.6 million, Jeffrey L. Matthews

Neurology

$1.1 million, John F. Foley

Laboratories

$54 million, Myriad Genetic Laboratories, Inc.

$2.3 million, Intermountain Health Services, Inc.

Ambulance service supplier

$2.6 million, Classic Air Care, Inc.

$2.6 million, Gold Cross Services, Inc.

Ambulatory surgical centers

$1.6 million, Central Utah Surgical Center, LLC

$1.3 million, Coral Desert Surgery Center

Sources: Wall Street Journal, U.S. Centers for Medicare and Medicaid

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Rocky Mountain administrator Kari Rasmussen said such decisions are based on years of FDA-approved research and clinical experience.

"Our physicians are motivated by what is in the best interest of our patients," she said in an emailed response to questions. "We do not receive incentives from pharma to use their drugs."

In reality, doctors don’t always get the 6 percent markup, she added. Avastin generally has a "considerably" higher margin than Lucentis, she added.

Though expensive, Rasmussen said, today’s drugs are "able to stave off debilitating vision loss," giving patients a higher quality of life and prolonged independence. "This also relieves the burden on their families, care givers, and the community at large," she said.

Rocky Mountain retina doctors draw patients from across Utah, Nevada, Montana and Wyoming.

"Our practice is very busy and the doctors work long hours," Rasmussen said, noting Medicare accounts for 75 to 80 percent of the practice’s revenue.

Others question the accuracy of the Medicare data.

The records say Salt Lake City neurologist John Foley performed 155,000 IV "natalizumab" injections for multiple sclerosis patients.


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"But we didn’t perform that many injections. The 155,000 number reflects grams per infusion, and there might be 300 grams per injection," said Foley’s office manager, Robert Allred.

Foley ranks high, Allred said, because "he’s one of the top MS docs in the western United States. We have people coming to him from outside Utah for treatment."

Tribune reporter Kristen Moulton contributed to this story.

Where Medicare’s money goes in Utah

In Utah, ophthalmologists and oncologists receive the highest total Medicare payments, because those payments include the costs of expensive drugs they administer to patients.

$19.9 million, ophthalmology

$14.6 million, hematology/oncology

$14.3 million, miscellaneous*

$6.3 million, cardiology

$5.9 million, dermatology

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