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WASHINGTON (AP) -- Medicare paid a tiny group of doctors $3 million or more apiece in 2012. One got nearly $21 million.
Those are among the findings of an Associated Press analysis of physician data released Wednesday by the Obama administration, part of a move to open the books on health care financing.
Topping Medicare's list was Florida ophthalmologist Salomon Melgen, whose relationship with Sen. Robert Menendez, D-N.J., made headlines last year after news broke that the lawmaker used the doctor's personal jet for trips to the Dominican Republic.
Medicare paid Melgen $20.8 million. His lawyer said the doctor's billing conformed with Medicare rules and is a reflection of high drug costs.
AP's analysis found that a small sliver of the more than 825,000 individual physicians in Medicare's claims data base - just 344 physicians - took in top dollar, at least $3 million apiece for a total of nearly $1.5 billion.
AP picked the $3 million threshold because that was the figure used by the Health and Human Services inspector general in an audit last year that recommended Medicare automatically scrutinize total billings above a set level. Medicare says it's working on that recommendation.
About 1 in 4 of the top-paid doctors - 87 of them - practice in Florida, a state known both for high Medicare spending and widespread fraud. Rounding out the top five states were California with 38 doctors in the top group, New Jersey with 27, Texas with 23, and New York with 18.
In the $3 million-plus club, 151 ophthalmologists - eye specialists - accounted for nearly $658 million in Medicare payments, leading other disciplines. Cancer doctors rounded out the top four specialty groups, accounting for a combined total of more than $477 million in payments.
The high number of ophthalmologists in the top tier may reflect the doctors' choice of medications to treat patients with eye problems. Studies have shown that Lucentis, a pricey drug specially formulated for treating macular degeneration, works no better than a much cheaper one, Avastin. But lower-cost Avastin must be specially prepared for use in the eye, and problems with sterility have led many doctors to stick with Lucentis.
Overall, Medicare paid individual physicians nearly $64 billion in 2012.
The median payment - the point at which half the amounts are higher and half are lower - was $30,265.
AP's analysis focused on individual physicians, excluding about 55,000 organizations that also appear in the database, such as ambulance services. None of those entities was paid $3 million or more.
The Medicare claims database is considered the richest trove of information on doctors, surpassing what major insurance companies have in their files. Although Medicare is financed by taxpayers, the data have been off limits to the public for decades. Physician organizations went to court to block its release, arguing it would amount to an invasion of doctors' privacy.
Employers, insurers, consumer groups and media organizations pressed for release. Together with other sources of information, they argued that the data could help guide patients to doctors who provide quality, cost-effective care. A federal judge last year lifted the main legal obstacle to release, and the Obama administration recently informed the American Medical Association it would open up the claims data.
"It will allow us to start putting the pieces together," said Dianne Munevar, a top researcher at the health care data firm Avalare Health. "That is the basis of what payment delivery reform is about."
Doctors' decision-making patterns are of intense interest to researchers who study what drives the nation's $2.8-trillion-a-year health care system. Within the system, physicians act as the main representatives of patients, and their decisions about how to treat determine spending.
"Currently, consumers have limited information about how physicians and other health care professionals practice medicine," said HHS secretary Kathleen Sebelius. "This data will help fill that gap."
The American Medical Association, which has long opposed release of the Medicare database, is warning it will do more harm than good.
The AMA says the files may contain inaccurate information. And even if the payment amounts are correct, the AMA says they do not provide meaningful insights into the quality of care.
"We believe that the broad data dump ... has significant shortcomings regarding the accuracy and value of the medical services rendered by physicians," AMA president Ardis Dee Hoven said. "Releasing the data without context will likely lead to inaccuracies, misinterpretations, false conclusions and other unintended consequences."
The AMA had asked the government to allow individual doctors to review their information prior to its release.
Over time, as researchers learn to mine the Medicare data, it could change the way medicine is practiced in the U.S. Doctor ratings, often based on the opinions of other physicians, would be driven by hard data, like statistics on baseball players. Consumers could become better educated about the doctors in their communities.
For example, if your father is about to undergo heart bypass, you could find out how many operations his surgeon has done in the last year. Research shows that for many procedures, patients are better off going to a surgeon who performs them frequently.
The data could also be used to spot fraud, such as doctors billing for seeing more patients in a day than their office could reasonably be expected to care for.
Medical practice would have to change to accommodate big data. Acting as intermediaries for employers and government programs, insurers could use the Medicare numbers to demand that low-performing doctors measure up. If the data indicated a particular doctor's diabetic patients were having unusually high rates of complications, that doctor might face questions.
Such oversight would probably accelerate trends toward large medical groups and doctors working as employees instead of in small practices.
Melgen, the top-paid physician in 2012, has already come under scrutiny. In addition to allowing the use of his jet, the eye specialist was the top political donor for Menendez as the New Jersey Democrat sought re-election to the Senate that year.
Menendez's relationship with Melgen prompted Senate Ethics and Justice Department investigations. Menendez reimbursed Melgen more than $70,000 for plane trips.
The issue exploded in late January 2013, after the FBI conducted a search of Melgen's West Palm Beach offices. Agents carted away evidence, but law enforcement officials have refused to say why. Authorities declined to comment on the open investigation.
Associated Press writer Kelli Kennedy in Miami and Marilynn Marchione contributed to this report.
PERTH, Australia (AP) -- The frustrating monthlong search for the Malaysian jetliner received a tremendous boost when a navy ship detected two more signals that most likely emanated from the aircraft's black boxes. The Australian official coordinating the search expressed hope Wednesday that the wreckage will soon be found.
Angus Houston, head of a joint agency coordinating the search for the missing plane in the southern Indian Ocean, said that the Australian naval vessel Ocean Shield picked up the two signals on Tuesday, and that an analysis of two sounds detected in the same area on Saturday showed they were consistent with a plane's black boxes.
"I'm now optimistic that we will find the aircraft, or what is left of the aircraft, in the not-too-distant future. But we haven't found it yet, because this is a very challenging business," Houston said at a news conference in Perth, the hub for the search operation.
The signals detected 1,645 kilometers (1,020 miles) northwest of Perth are the strongest indication yet that the plane crashed and is now lying at the bottom of the ocean in the area where the search is now focused. Still, Houston warned he could not yet conclude that searchers had pinpointed Flight 370's crash site.
"I think that we're looking in the right area, but I'm not prepared to say, to confirm, anything until such time as somebody lays eyes on the wreckage," he said.
Finding the black boxes quickly is a matter of urgency because their locator beacons have a battery life of only about a month, and Tuesday marked exactly one month since the plane vanished on March 8 with 239 people on board.
If the beacons blink off before the black boxes' location can be determined, finding them in such deep water - about 4,500 meters, or 15,000 feet - would be an immensely difficult, if not impossible, task.
The Ocean Shield first detected underwater sounds on Saturday before losing them, but managed to pick them up again on Tuesday, Houston said. The ship is equipped with a U.S. Navy towed pinger locator that is designed to detect signals from a plane's two black boxes - the flight data recorder and cockpit voice recorder.
A data analysis of the signals heard Saturday determined they were distinct, man-made and pulsed consistently, Houston said, indicating they were coming from a plane's black box.
"They believe the signals to be consistent with the specification and description of a flight data recorder," he said.
To assist the Ocean Shield, the Australian navy on Wednesday began using parachutes to drop a series of buoys in a pattern near where the signals were last heard.
Royal Australian Navy Commodore Peter Leavy said each buoy will dangle an underwater listening device called a hydrophone about 300 meters (1,000 feet) below the surface. The hope, he said, is the buoys will help better pinpoint the location of the signals.
Houston acknowledged searchers were running out of time, and noted that the signals picked up on Tuesday were weaker and briefer than the ones heard over the weekend, suggesting that the batteries might be dying. The two signals detected on Saturday lasted two hours and 20 minutes and 13 minutes, respectively; the sounds heard Tuesday lasted just 5 and a half minutes and 7 minutes.
"So we need to, as we say in Australia, `make hay while the sun shines,'" Houston said.
Picking up the sound again is crucial to narrowing the search area so a small, unmanned submarine can be deployed to create a sonar map of a potential debris field on the seafloor. The sub, dubbed Bluefin 21, takes six times longer to cover the same area as the pinger locator, which is pulled behind the boat at a depth of 3,000 meters.
U.S. Navy Capt. Mark Matthews said the detections indicate the device emitting the pings is somewhere within about a 20-kilometer (12-mile) radius. Still, he said, that equates to a 1,300-square-kilometer (500-square-mile) chunk of the ocean floor.
That amounts to trying to find a desktop computer in a city the size of Los Angeles, and would take the sub about six weeks to two months to canvass. So it makes more sense to continue using the towed pinger locator to zero in on a more precise location, Matthews said.
"It's certainly a man-made device emitting that signal," he said. "And I have no explanation for what other component could be there."
The disappearance of Malaysia Airlines Flight 370 on a trip from Kuala Lumpur to Beijing has sparked one of aviation's biggest mysteries. The search has shifted from waters off of Vietnam, to the Strait of Malacca and then to waters in the southern Indian Ocean as data from radar and satellites was further analyzed.
The weakening of the signals could indicate that the batteries were reaching the end of their life, or that the device was farther away, Matthews said. Temperature, water pressure or the saltiness of the sea could also be factors.
Houston said a decision had not yet been made on how long searchers would wait after the final sound was heard before the sub was deployed, saying only that time was "not far away."
"Hopefully in a matter of days, we will be able to find something on the bottom that might confirm that this is the last resting place of MH370," he said.
The Bluefin sub's sonar can scan only about 100 meters and it can "see" with lights and cameras only a few meters. The maximum depth it can dive is 4,500 meters, and some areas of the search zone are deeper.
Search crews are also contending with a thick layer of silt on the seafloor that can both hide any possible wreckage and distort the sounds emanating from the black boxes that may be resting there, said Leavy, who is helping to lead the search.
Meanwhile, the search for debris on the ocean surface picked up intensity on Wednesday, with 15 planes and 14 ships scouring a 75,400 square kilometer area that extends from 2,250 kilometers northwest of Perth.
Despite the challenges still facing search crews, those involved in the hunt were buoyed by the Ocean Shield's findings.
"I'm an engineer so I don't talk emotions too much," Matthews said. "But certainly when I received word that they had another detection, you feel elated. You're hopeful that you can locate the final resting place of the aircraft and bring closure to all the families involved."
Gelineau reported from Sydney. Associated Press Writer Rod McGuirk in Canberra, Australia, contributed to this report.