This story is part of a partnership between MedPage Today and VICE News.
Dr. Thomas "Randy" Lombardo has been a well-regarded cardiologist in the Beaumont, Texas, area for decades, but a look at his entry in the Medicare provider database would make anyone do a double-take.
It says he graduated from Gate City Medical College in 1981, which is a problem because the school was shut down in 1911 after its dean was found to be selling phony diplomas for $50.
Though it's actually a data error, nonetheless it should have led Medicare to red-flag him for potential fraud, since that's why school information is collected by the Centers for Medicare and Medicaid Services (CMS) in the first place. If that occurred, CMS would have learned he was indeed a real doctor with a real medical degree and perhaps encouraged him to correct the misinformation.
But nobody is looking at the data.
The Medicare provider database currently lists thousands of doctors and other providers as graduates from medical schools that have been defunct for about a century, a VICE News/MedPage Todayanalysis found.
"Obviously, the credibility of doctors' education, especially as related to medical school attendance and graduation, is an important data point and a source for 'flags' as indicators that something is not quite right," said Seto Bagdoyan, who directs audit services at the U.S. Government Accountability Office (GAO). The GAO recently issued a report about bad addresses and license verification culled from the same dataset, but didn't look at defunct medical schools.
Without a medical degree from an accredited medical school, a doctor is ineligible to practice medicine, let alone bill Medicare.
Lombardo really graduated from his father's alma mater, the University of Texas Southwestern Medical School in 1981, according to the Texas state licensure board. And he has a medical license in good standing.
When Vice News/MedPage Today told his assistant about the defunct college in his federal record, she gasped and said they had no idea it was there. They bill Medicare all the time, she said, and haven't had a problem.
Indeed, Lombardo is one of the top billing cardiologists in Texas, according to Medicare records. He earned $882,000 from the program in 2013, the most recent data available.
Lombardo did not respond to multiple requests to be interviewed for this article.
What Went Wrong
Medicare providers like Lombardo enter their information into PECOS — Provider Enrollment, Chain and Ownership System — in order to get an identification number called an NPI to use when billing Medicare. Practitioners select their medical schools from a drop-down menu, and if it's not there, they select "other."
Medicare then "uses this information to verify that doctors and other providers have the proper education/certification for the specific provider type they are enrolling for in the Medicare program," CMS officials told VICE News/MedPage Today.
CMS officials said no one has flagged these providers because the system received its list of medical schools from "other sources," including the American Medical Association, and it never removes schools from the list to prevent licensed providers who graduated from obsolete schools from losing enrollment.
The VICE News/MedPage Today analysis found 70 long-defunct medical schools in the database attached to 6,312 current providers.
In some cases defunct schools had names similar to the names of active schools, but many were far off the mark. Since all but one of these schools closed between 1864 and 1923, no doctor who graduated from one of them would still be practicing — or alive — today. The outlier closed in 1939.
"We believe many of these defunct schools were selected in error from a drop down menu containing a long list of medical schools because the names appear similar to other medical schools," CMS officials explained.
In all, CMS paid these providers $654 million out of $89 billion paid out to providers overall in 2013. Provider payments only account for one fifth of Medicare payouts overall. The rest is used to pay hospitals, cover drugs, and go to other programs.
No Surprises Here
"It is no surprise with a system as large and complex as that administered by CMS that there are some data errors," said Matthew Shepard, a spokesman for the nonprofit Center for Medicare Advocacy, Inc., adding that the organization hasn't studied this particular issue. "We just hope that when found, these errors are remedied quickly and accurately, and cause no access issues for, or harm to, those who rely on the programs."
Health policy professor Jack Hoadley at Georgetown University has delved deep into the Medicare data, but he said he hasn't come across this issue, either. When VICE News/MedPage Todaytold him about the phantom medical schools, he chuckled.
"I'm not sure I've got enough specifics on how that system works to help you," he said. "But I know there've been a lot of issues over the years in terms of NPIs and various other kinds of things."
A GAO report by Bagdoyan and his team revealed that the problem also applies to addresses for Medicare providers. The report, which does not mention medical schools, notes that doctors in the PECOS system have listed invalid practice addresses, including a P.O. Box and a McDonald's.
The GAO report, which was released July 21, found that nearly a quarter of practice location addresses are "potentially ineligible." That coupled with the fact that CMS in 2014 reduced the amount of independent verification work its contractors perform could leave the program vulnerable to fraud.
Rising health care costs are a hot button issue for politicians, and health care fraud is a serious crime that costs taxpayers billions of dollars a year. The Department of Justice, the Office of the Inspector General, and the Department of Health and Human Services all have their own teams combating Medicare fraud.
Medicare paid out $554 billion in fiscal 2014, but CMS estimates that $60 billion of that was "paid improperly," according to the GAO report.
The recent report did not include school information, but Bagdoyan said, "The school issue underscores the imperative for CMS to have access to the most complete, accurate, and accessible data on doctors, including their addresses of actual business and historical insight into their licensure experience."
Doctors in the Dark
But physicians, for example Lombardo, appear to have no idea about the errors.
Dr. Matthew Churpek, a pulmonary specialist at University of Chicago Medicine, said through a hospital spokesman that he was "not aware of the phenomenon" that allowed for Dunham Medical College to appear on his federal database entry instead of Duke University Medical School, which is in Durham, North Carolina.
It's possible it was an easy mistake for him to make on the drop-down menu.
After learning that his record says he went to Dunham, which merged with Hering Medical College in 1902 and closed altogether in 1913, Churpek said through the spokesman that he was working to fix the error.
The Association of American Medical Colleges pointed to CMS's advice suggesting that doctors and other providers make sure their data is correct.
Fraud Is Not the Default
Although a long-defunct medical school in PECOS data should be a red flag for fraud, it is not.
VICE News/MedPage Today researched a small sample of doctors — fewer than 400 — from the most suspicious defunct schools (those with the fewest graduates in the database), and learned they are all licensed doctors in their states.
State medical boards do not use PECOS data during the licensure process, so the Federation of State Medical Boards said it could not comment on this issue.
Instead, state boards require proof of successful completion of a medical degree directly from the medical school, and only institutions accredited by the Association of American Medical Colleges or the American Association of Colleges of Osteopathic Medicine will do, according to FSMB spokesman Drew Carlson. AAMC represents 161 accredited medical schools, 400 teaching hospitals and health systems, and 90 academic and scientific societies. There are 31 accredited colleges of osteopathic medicine, according to AACOM.
Another doctor, Dr. Daniela Morato, is an emergency medicine physician and formerly a professor at the University of Pittsburgh, graduated from the University of Maryland Medical School, has a license to practice medicine, and has never even had a complaint lodged against her with her state medical board.
But the Medicare database lists her as graduating from the Maryland College of Eclectic Medicine and Surgery in 2006—a neat trick since the Maryland College of Eclectic Medicine and Surgery changed its title to Eastern University School of Medicine and closed in 1915 when word got around that its dean wasn't licensed to practice medicine in Maryland.
Morato did not respond to requests for comment.
CMS officials told VICE News/MedPage Today that the "Medicare enrollment process protects beneficiaries by preventing fraudulent or unqualified providers from enrolling in the Medicare program and removing existing unqualified providers" via regular screening and validation to ensure that providers are licensed.
Photo via Flickr