Billing for useless treatments

Prosecutors say Melgen scammed Medicare by lying about patients’ conditions, allowing him to perform useless tests and treatments and bill for procedures never done.

Many charges relate to patients Melgen said had age-related macular degeneration, one of the leading causes of severe vision loss in people 65 and older. Most ARMD patients have the “dry” variety, which is caused by retinal cells breaking down and cannot be treated. Fewer have the “wet” variety, which involves bleeding beneath the retina. It can be treated by injections.

Prosecutors say Melgen falsely diagnosed many patients with ARMD so he could run unneeded tests. They say he also falsely claimed patients with dry ARMD had wet ARMD, giving them multiple injections that had no benefit.

In the sampling of 30 patients prosecutors listed in Melgen’s indictment, he allegedly claimed reimbursement for multiple tests and treatments on both eyes of three patients who have one prosthetic. In another six cases listed, Melgen allegedly ordered useless treatments on an eye clearly damaged beyond recovery. Most other reimbursements listed center on ARMD treatments prosecutors say were fraudulent. that contain four times that amount — a sixteenth of a teaspoon. The manufacturer’s instructions say doctors should pull the vial’s entire contents into the syringe and then squeeze out and dispose of the excess — about a thirtieth of a teaspoon — before administering the injection. Medicare reimburses doctors their wholesale cost of $1,900 per vial plus a 6 percent surcharge, $114.

Prosecutors say that rather than throw away the excess, Melgen hired a lab that would fill three to four syringes from each vial. He still charged Medicare the full $1,900 per injection, however, meaning the extra two or three injections per vial were almost pure profit, prosecutors say. They say Melgen received a warning in 2008 to stop the practice but continued, even though it increased the risk patients could get an eye-destroying infection.

Melgen’s attorneys outlined a twopronged defense at a court hearing. First, they said dose splitting is common and that Lucentis’s manufacturer, in a wink to the practice, includes four labels per vial. Second, they said the practice cost the U.S. government nothing — if Melgen had drawn one dose per vial, Medicare would have paid for the additional two or three vials purchased.

The trial is expected to last several weeks.