Florida Ophthalmologist Involved in Senate Bribery Case Defends Medicare Billings

Friday, February 19, 2016
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On February 12, 2016, a Florida ophthalmologist accused of bribing his friend, U.S. Sen. Robert Menendez, said that separate allegations against him for Medicare fraud should be dismissed. Dr. Salomen Melgen was accused of using one single-dose vial of the wet macular degeneration drug Lucentis on multiple patients at his clinic called Vitreo-Retinal Consultants. He then allegedly billed Medicare as if he used one vial per patient resulting in charges that he was defrauding the government of about $105 million. Dr. Melgen claims this practice was legal stating:  “By suggesting that multi-dosing is improper, the indictment is completely at odds with eminently defensible and extensively litigated interpretations of multi-dosing Medicare policy.”

To read more on Dr. Melgen’s case, click here.


Multi-Dosing Allegations.


Dr. Melgen is accused of improperly muli-dosing with the drug Lucentis and then submitting false claims to the government. The Medicare administrative contractor (MAC) for Florida, First Coast Service Options, Inc.(First Coast), alleges that Dr. Melgen’s actions were improper stating: “As approved by the FDA, and as required in the First Coast LCD [local coverage determination] for Lucentis, each vial is to be used for the treatment of a single eye only. Any excess fluid or overfill is to be discarded.”

However, First Coast later made a statement in a clarification to its LCD for Lucentis which said, “that physicians may choose to multi-dose Lucentis by administering a ‘single-use vial’ of Lucentis for three patients,” the motion states.


Medicare Charges “At Cost”.

According to the motion, the indictment in April makes multiple legally incorrect assertions about how Dr. Melgen administered and billed for the use of Lucentis. Physicians are allowed to charge Medicare as much as they want, not necessarily just “at-cost.” However, Medicare does not have to reimburse that full amount. To read more about his indictment, click here.

To read a prior blog I wrote on a similar case, click here.


Denying the Allegations.

Dr. Melgen has pled not guilty and rejects the government's claims. In his motion to dismiss it states, “the Centers for Medicare & Medicaid Services (CMS) was obliged to pay Dr. Melgen for each unit of Lucentis that he administered, regardless of exactly what it cost him. Therefore, contrary to the indictment’s allegations, Dr. Melgen did not and could not defraud Medicare by submitting fraudulent Lucentis invoices for amounts that substantially exceeded his actual cost.”

This actually could be a good argument and he may have a good defense for any claims he submitted before First Coast published its clarifications.

Dr. Melgen reached an $18 million bond agreement in July over the charges.

To read the motion for dismissal, click here.


Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare Issues Now.

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S.  They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620.


Sources:

Kass, Dani. “Doctor Tied To Sen. Bribery Case Defends Medicare Billing.” Law360. (February 17, 2016). Web.

Iannelli, Jerry. “INFAMOUS EYE DOCTOR SALOMON MELGEN LEFT PATIENTS BLIND, LAWSUIT SAYS.” New Times Broward Palm Beach. (January 24, 2016). Web.


About the Author:  George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm.  The Health Law Firm has a national practice.  Visit our website at:  www.TheHealthLawFirm.com .  The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, FL 32714, Telephone: (407) 331-6620.


KeyWords: Medicare billing, Medicare fraud, improper billing, submitting false claims, False Claims Act (FCA), Centers for Medicare & Medicaid Services (CMS), multi-dosing, multi-dosing Medicare policy, Medicare reimbursements, motion for dismissal, Medicare investigations, Medicare audits, compliance, Medicare defense lawyer, false claims defense lawyer, fraud defense lawyer, health care attorney, health law attorney, Florida health law attorney, health law, The Health Law Firm

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2/19/2016

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