Who are top docs getting Medicare money? Fees in the Godfrey case now top $500,000.

First of all, the disclaimer. Just because a doctor gets oodles of money from Medicare doesn’t mean he takes it all to the bank. Doctors have to buy medicines, pay staffs, buy equipment and pay the rent, among other things. Doctors would really, really want Cityview to tell you that before you look at this list.

Second of all, the overall figures. There are 531,209 Medicare beneficiaries in Iowa. In 2012, the average doctor in Iowa received $63,103.98 in reimbursements from Medicare.

Third of all, some doctors received a whole lot more.

Consider the ophthalmologists David Saggau and Jared Nielsen, who practice out of the Wolfe Clinic in West Des Moines. According to the Centers for Medicare and Medicaid Services, Saggau submitted bills to Medicare in 2012 of $15,886,073 for 1,852 patients, and Medicare paid him $7,855,327. That included nearly $6 million in reimbursements for various injections. Saggau billed for 12,489 injections of ranibizumab, a drug that treats macular degeneration, for instance, for which he was paid $319.77 a shot, or nearly $4 million, the data say.

Nielsen submitted bills for 1,330 patients for $13,347,375 and was reimbursed $6,544,844. He gave 12,318 shots of ranibizumab, getting about $3.9 million.

Those two were the top recipients of Medicare money in the state. The top eight recipients all are ophthalmologists.

Des Moines-area dermatologists also got big checks. Roger Ceilley submitted bills of $3,291,174 for 26,769 procedures on 2,890 patients and was reimbursed $1,490,252. His partner at Dermatology PC, Andrew Bean, submitted bills of $2,517,139 for 20,077 procedures on 3,360 patients and was reimbursed $1,139,778. A third partner, Joshua Wilson, submitted bills of $1,023,071 for 8,142 procedures on 947 patients; he was reimbursed $487,691.

Saggau, Nielsen and Ceilley were the top three recipients in the Des Moines area. Bean was fifth. Bob Shreck, an oncologist and hematologist, was fourth, with reimbursements of $1,150,502. He submitted bills of $2,449,175 for 42,739 procedures on 750 patients.

Here are figures for the next 10 highest recipients:

All told, 212 doctors in the Des Moines area received at least $150,000 in Medicare reimbursements in 2012. Among them, were 32 cardiologists and 19 ophthalmologists.

Doctors weren’t the only recipients. The city of West Des Moines got $705,656 for ambulance services. Fraser Transportation Services, an ambulance company in Des Moines, received $776,514 in Medicare payments in 2012, and Midwest Ambulance

Service got $714,038. An ambulance company in Dubuque got $908,068, and the Davenport Hospital Ambulance Corp. got $2,574,988. Portable X-Ray Inc. in Des Moines got $662,412.

Side note: Across the nation, that eye drug, ranibizumab, was given to 143,000 patients last year — and cost Medicare about $1 billion in reimbursements. The drug, which is sold under the brand name Lucentis, costs up to $50,000 per patient per year (without the insurance-negotiated discount), according to a researcher at Boston University. She says a similar drug, Avastin, which is used for cancer but not approved for macular degeneration, is widely — and legally — used for the eye disease and is equally effective. She says it has an annual cost of about $650, according to a Boston University publication. Avastin is made by the same company as Lucentis, which might explain why the company has not sought federal approval for use of the drug by eye patients. …

As long as we’re talking about money:

At the Executive Council meeting the other day, the Attorney General’s office recommended the state pay another $7,250.32 to LaMarca & Landry, the law firm representing Gov. Terry Branstad and others in the lawsuit brought by Chris Godfrey.

That brings the total paid the firm so far to $501,759.26, according to state records.

Godfrey, you’ll recall, is the head of workers’ compensation for the state. He has a fixed term that runs until next spring, but the governor wants him gone. Godfrey refused to resign, so Branstad whacked his pay by $30,000 or so, which prompted Godfrey to sue. Godfrey is a Democrat and is gay, two things that rankle some Republicans.

Though the bills now exceed $500,000, the suit is barely under way. …

No explanation was offered, but Supreme Court Justice Brent Appel was not on the bench last week when the court heard the fascinating case where Ned Chiodo is maintaining that Tony Bisignano shouldn’t be on the June Democratic primary ballot for the legislative seat being vacated by Jack Hatch. Chiodo thinks Bisignano’s recent conviction of second-offense drunk-driving makes him ineligible. (On Tuesday of this week, the court, in a three-way split decision, ruled for Bisignano.) Appel’s wife is involved in Democratic politics — she’s running for Congress this year — but justices don’t have to give a reason when they recuse themselves.

A score or more of court watchers showed up for the hearing. Chiodo was there, but Bisignano wasn’t, perhaps because he can drive only to and from work these days. …

“Don’t be surprised if the undisclosed site of that data project being proposed for West Des Moines turns out to be the south part of Willow Creek Golf Course along Highway 5,” Cityview wrote a couple of weeks ago. “And don’t be surprised if the company is Microsoft.” It turns out The Des Moines Register was so surprised it put a “Register Exclusive” and copyright line on its Sunday story saying “Microsoft apparently behind data center.” Oh, well. CV

COMMENT: VARNUM

Many nice things have been said and written in recent days in celebration of the fifth anniversary of the Iowa Supreme Court’s decision that the equal-opportunity clause of the Iowa Constitution means that persons of the same sex may marry one another.

The decision — Varnum v. Brien — is a great ruling for marriage equality.

But when it came down — and, again, recently — people overlooked the second great prong of the ruling: strong language about the danger of a government establishing any religion and equally strong language about everyone’s right to worship as he pleases.

Explaining that churches may define religious marriage any way they desire, the court said that “civil marriage must be judged under our constitutional standards of equal protection and not under religious doctrines or the religious views of individuals.”

“We are not permitted to do less,” Justice Mark Cady wrote for the unanimous court, “and would damage our constitution immeasurably by trying to do more.”

That’s worth noting every so often. CV

— Michael Gartner