Florida eye doctor linked to Sen. Robert Menendez indicted for healthcare fraud

The Florida ophthalmologist included in the public corruption charges against Senator Robert Menendez faces additional healthcare fraud charges for bilking the federal government out of $105 million between 2008 and 2013, according to a statement from the Department of Justice (DOJ). Salomon Melgen, M.D., remains in custody after a judge ruled he was a flight risk, according to the Miami Herald.

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The 76-count indictment alleges that Melgen falsely diagnosed patients with age-related macular degeneration (ARMD) and retinal disorders, for which he performed unnecessary tests and procedures, including laser surgeries and eye injections. Prosecutors also allege that Melgen split single-use vials of Lucentis--a medication used to treat ARMD--into multiple doses, but billed Medicare the reimbursement rate for each full dosage. Additionally, Melgen allegedly falsified patient records and prepared false reports in response to Medicare audits.

Melgen's practices, Vitreo Retinal Consultants Eye Center and The Melgen Retina Eye Center, included four office locations that often saw as many as 100 patients each day. Between January 2008 and December 20013, Melgen billed Medicare $190 million and received $105 million, according to the indictment. For years, federal investigators have targeted Melgen for $8.9 million in alleged overbilling dating back to 2011. In 2014, the Centers for Medicare & Medicaid Services released physician payment data showing that Melgen was one of the highest-paid physicians in the country, earning $20.8 million from Medicare in 2012.  

"Patients fearing blindness sought treatment from Dr. Melgen's office," Special Agent in Charge, Shimon Richmond, of the U.S. Department of Health and Human Services Office of the Inspector General's Miami Region (HHS-OIG), said in the DOJ statement. "Instead, they allegedly received medically unreasonable and unnecessary tests and procedures for which they and taxpayers paid millions of dollars."

On Thursday, a judge mandated that Melgen remain in prison after prosecutors argued that he was a flight risk due to his close ties to the Dominican Republic, according to the Herald. Melgen was released from prison earlier this month on a $1.5 million bail after he was charged in the corruption and bribery case alongside Menendez.

A portion of the corruption case revolves around a meeting that Menendez had with CMS authorities concerning the investigation into Melgen's billing practices, which he organized after Melgen made large campaign donations and paid for expensive gifts and trips to the Dominican Republic.

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As FierceHealthPayer: AntiFraud previously reported, the corruption case against Menendez and Melgen will hinge on their longstanding friendship, as well as the timing of donations and gifts in relation to favors provided by the senator.

For more:
- here's the indictment (.pdf)
- read the DOJ statement
- read the Miami Herald article

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