Yesterday, opening statements took place in the trial of Florida doctor Salomon Melgen, who stands accused of defrauding Medicare of tens of millions of dollars. Melgen has also made headlines for his suspect financial relationship with U.S. Senator Robert Menendez, and is expected to face a separate trial on bribery charges in New Jersey later this year.
According to Florida prosecutors, Melgen stole millions from Medicare between 2008 and 2013 by falsely diagnosing patients and by administering unnecessary tests and treatments. Melgen, an eye doctor, allegedly treated as many as 100 patients a day in assembly line fashion and routinely misdiagnosed them as having age-related macular degeneration (ARMD). Prosecutors contend that Melgen’s staff would pre-fill the ARMD diagnosis into almost every patient chart before Melgen had seen the patient—even when patients were blind in one eye or had a prosthetic eye. Misdiagnosing patients with ARMD allowed Melgen to perform—and bill to Medicare—unnecessary tests and treatments, prosecutors alleged.
Prosecutors also accuse Melgen of violating complex regulations on multiple dosing from single vials of the eye medicine Lucentis. According to the indictment, Melgen would purchase Lucentis from Genentech, arrange to have the “single-use” vials split into multiple doses and administered to multiple patients, and then separately bill Medicare at the reimbursement rate for each full dosage. Medicare reimburses doctors for their wholesale cost of $1,900 per vial of Lucentis, plus a 6 percent surcharge of $114.
Melgen’s defense attorneys have argued that the doctor’s actions are just examples of aggressive medicine, legitimate differences of opinions between doctors, and honest mistakes. They assert that other doctors who have observed Melgen’s diagnoses and treatments don’t always agree with Melgen, but understand what he was attempting to achieve. According to the defense, other eye doctors often sent Melgen their most desperate patients, because they had heard that Melgen’s “cutting edge” treatments sometimes worked.
Melgen immigrated to the United States from the Dominican Republic almost forty years ago and built a reputation as one of the nation’s top ophthalmologists. He was once one of the top physician billers in the U.S.
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