Royal treatment: Nine Tar Heel doctors hit seven figures from royalties and speeches.

• Author: Williams, Allison
• Position: CASE STUDY

Drug and medical-device makers paid $2.56 billion to more than 600,000 U.S. doctors last year, according to the Centers for Medicare & Medicaid Services.

North Carolina docs pocketed more than $94 million during a 17-month period between August 2013 and December 2014, including nine physicians who took home at least $1 million each. Five of the nine work at Charlotte-based OrthoCarolina PA, including four at its Foot & Ankle Institute who benefit from ties to Memphis-based device maker Wright Medical Technology Inc. OrthoCarolina, a privately owned practice with more than 100 doctors in Charlotte and across North Carolina, accounted for at least $9.65 million in payments.

CMS gave physicians an opportunity to explain the payments; Kimberly Livingston, a Raleigh neurosurgeon who received the most money among North Carolina doctors, and urologist Robert Lippitt of Smithfield were the only ones among the nine who responded. (See their explanations in the chart below.)

Most of the money on this list comes from royalties--when physicians help a medical-device company make an improvement, they receive money based on device sales. Typically, they do not receive payment on devices used in their practices.

Blair Primis, a spokesman for OrthoCarolina, said the practice is proud that inventions created by its doctors, including a popular system used in hip transplants, are being used by other surgeons. "We're not just doing the surgery," he says, "we're the ones creating the technique."

Money was also paid to doctors for promotional speaking, meals and travel expenses. Meeting with other doctors offers an opportunity to learn from each other, Primis says.

Payment methods vary, according to ProPublica, a nonprofit news organization that studied compensation. Doctors sometimes receive payments directly, while other times money goes to their practices or separate companies they create.

Medical moolah

More than $2 million

Kimberly Livingston On leave of absence, WakeMed, Raleigh

$2.16 million from Covidien LP for "transfer of value related to company acquisition"

Edwin Bartlett

Emeritus, Orthopaedics East &amp...