Medicare fraud trial to begin for local doctor
Salomon Melgen is charged with stealing up to $190M.
WEST PALM BEACH — Many of the Medicare fraud charges against prominent Florida eye doctor Salomon Melgen are complicated, but one is simple — federal prosecutors say he claimed reimbursement for treating both eyes of patients who have one prosthetic.
Melgen is scheduled to go on trial today in West Palm B e a c h , f a c i n g 76 c o u n t s charging h i m w i t h stealing up to $190 mill i o n f r o m Medicare between 2 0 0 4 a n d 2013. Prosecutors say he presc ribed unneeded treatments, filed claims for procedures he never performed and charged for medicine he never purchased. If convicted, the 62-yearold doctor faces up to 610 years in prison. He is free on $18 million bond. He faces a bribery trial this fall in New Jersey with Democratic Sen. Bob Menendez.
Prosecutors in the Florida case declined comment, but say in court documents that Melgen turned his practice into an assembly line, seeing up to 100 patients a day. In 2012, Melgen received more Medicare reimbursement than any doctor in the country, nearly $21 million.
Melgen’s attorneys also declined comment. Melgen has pleaded not guilty.
In 1997, he treated Florida Democratic Gov. Lawton Chiles, who appointed him to a state board. He was soon hosting Democratic fundraisers at his 6,500 square-foot North Palm Beach home and meeting party congressional leaders. That led to his friendship with Menendez, which included Melgen-purchased trips with the senator to France and the doctor’s home at a Dominican resort. Menendez reimbursed Melgen $58,500 after the trips became public knowledge.
Federal prosecutors in New Jersey say Melgen’s gifts to Menendez were actually bribes. In return, they say, the senator got visas for the married Melgen’s foreign mistresses, interceded with Medicare officials when they began investigating Melgen’s practice and pressured the State Department to help Melgen with a business dispute he had with the Dominican government. Menendez has denied wrongdoing.
Many Medicare 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 “dr y ” var iet y, which i s c aused 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 f a l s e l y d i a g n o s e d many patients with ARMD so he could run unneeded tests. T h e y s ay h e a l s o f a l s e l y claimed patients with dry ARMD had wet ARMD, giv- ing them multiple injections that had no benefit.
Prosecutors allege Melgen charged the government three or four times for single-dose vials of Lucentis, a drug used to treat wet ARMD.
Lucentis is administered in tiny doses — 0.5 milliliters per injection or a sixty-fourth of a teaspoon. It comes in single-use vials that contain four times that amount — a sixteenth of a teaspoon.
T h e m a n u f a c t u r e r ’ s i ns t r uc t i ons s ay doc t or s 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. The trial is expected to last several weeks.