Doctor tied to Menendez indicted on Medicare fraud charges

2015-04-15 17:19


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Miami - The Florida doctor charged in a political corruption case along with US Senator Robert Menendez was indicted on Tuesday in a 76-count Medicare fraud scheme that prosecutors said attempted to bilk the government-funded health care program out of as much as $190m.

Miami US Attorney Wifredo Ferrer said Dr Salomon Melgen, 60, a native of the Dominican Republic, was charged with 46 counts of health care fraud as well as additional charges of filing false claims and making false statements. Melgen is an ophthalmologist with offices in Palm Beach and St Lucie counties.

The indictment charges that he operated the fraud scheme between 2004 and 2013, a time frame during which Melgen billed Medicare for more than $190m and was paid more than $105m. In 2012 alone, health official say he billed Medicare more than any other doctor in the US at $21m.

"Medical professionals who violate their oath by failing to attend to the health of their patients and who submit falsified billing statements for their own personal gain jeopardise the viability of government benefit programmes," Ferrer said in a statement.

"People who defraud Medicare indirectly increase the cost of health care for everyone," added George L Piro, FBI special agent in charge of the Miami field office.

False diagnosis

Melgen has already pleaded not guilty in the New Jersey corruption case, in which he is accused of funnelling nearly $1m in gifts and campaign donations to Menendez in exchange for political favours. Menendez, a New Jersey Democrat, has also pleaded not guilty, and he is not implicated in the Medicare fraud case.

Melgen attorney Annie Lyons declined comment on Tuesday on the Medicare fraud charges, but has previously said the charges are "highly defensible." Melgen is scheduled to make his first appearance in the case Wednesday in West Palm Beach federal court.

The total maximum prison time for all 76 counts – if Melgen is convicted in the health fraud case and the sentences are imposed consecutively – comes to a staggering 610 years.

According to the indictment, Melgen falsely diagnosed many patients with serious eye conditions, such as macular degeneration and retinal disorders, which allowed him to then perform unnecessary and costly procedures such as laser surgery and eye injections for which he would bill Medicare.

In addition, the indictment claims that Melgen made exorbitant profits from a costly macular degeneration drug, Lucentis, by splitting vials intended for single use into multiple-use vials and then billing Medicare as if each were for a single use. Melgen is also accused of falsifying patient and billing files and filing claims for unperformed diagnostic tests.

Melgen graduated from medical school in his native Dominican Republic and has lived in the US since at least 1980, holding posts across the country while building a reputation as a top eye surgeon, records show. He was licensed in Florida in 1987.

Melgen and Menendez have been friends for decades. The senator has said they celebrated holidays and weddings together, mourned together at funerals and exchanged gifts on birthdays.

The corruption indictment unsealed earlier this month against the men claimed Menendez intervened on his friend's behalf to gain visas for Melgen's foreign girlfriends, press Dominican officials to honour a lucrative port contract for one of the doctor's businesses and influence CMS officials on the billing dispute. In exchange, authorities say, Melgen showered the senator with flights, vacations and contributions.

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