The story of a wealthy doctor, a powerful senator and a friendship put to the test

Friendships are a special, sacred bond, built on a foundation of mutual respect and admiration and nurtured over the course of years, even decades.

At least, that's what the Hallmark cards tell you. If you're New Jersey Sen. Robert Menendez (D) or Salomon Melgen, M.D., for example, your friendship might serve less altruistic purposes.

That's what we discovered last week when CNN reported the Department of Justice (DOJ) would file criminal corruption charges against Menendez based on his relationship with Melgen, a well-compensated ophthalmologist in Florida who has a history of run-ins with federal investigators concerning billing practices.

On the scale of "how they met" stories, Melgen and Menendez skew toward the non-traditional side. In 1993, Melgen attended a fundraiser for Menendez's re-election campaign, according to NJ.com. As the state's first Hispanic congressman, Menendez was a hot ticket in New Jersey. There were 49 other supporters at the fundraiser, but the doctor and the rising congressman connected. Their eyes locked; Melgen promptly wrote Menendez a check for $500.

That would kick off a friendship that would span more than two decades and approximately $750,000, including a $700,000 donation in 2012 to Majority PAC linked to Sen. Harry Reid (D-Nev.), which spent $582,000 on Menendez's re-election campaign. Sounds like the usual boring, run-of-the mill comradery.

Melgen, as you might already know, comes with an armful of baggage, most notably a long, complicated relationship with the Centers for Medicare & Medicaid Services over billing procedures. In 2009, a Medicare audit determined that he overbilled the program $8.9 million in 2007 and 2008 for Lucentis injections. Melgen appealed that ruling, virtually to death; it now stands pending at the U.S. Court of Appeals for the 11th Circuit.

The investigation and subsequent appeals didn't appear to have any negative impact on Melgen's business. CMS physician payment data showed that Melgen earned nearly $21 million from Medicare in 2012, more than any other physician in the country. FBI agents have raided his offices multiple occasions.

Menendez, always the loyal friend, appears happy to have carried some of the baggage presumably getting heavier by the day. In August 2012, he and Reid met with then-Secretary for the Department of Health and Human Services Kathleen Sebelius. What was discussed in that meeting will be crucial to the case against Menendez. Sebelius told Politico that the private meeting discussed the $8.9 million billing dispute against Melgen; through his spokesperson, Menendez has denied any foul play. He was simply concerned about CMS multi-dose billing practices and never mentioned Melgen by name. Melgen? Who's Melgen?

These circumstances, taken at face value, have the unmistakably strong odor of corruption and bribery. But that won't be enough for the corruption charges to stick. The intricacies of this friendship between the senator and the doctor appear to be central to the corruption charges. Menendez has already depicted the two as longstanding buddies, palling around for the holidays and at weddings--exchanging gifts on special occasions "just as friends do," Menendez said in a statement. To build their case, prosecutors will have to prove that Menendez was doing more than just looking out for his friend, according to the Washington Post.

"Was he doing things on behalf of Melgen because he was receiving campaign contributions, or was he doing it because he likes Melgen, which is not criminal?" Richard Briffault, a Columbia Law School professor, told the Post.

Sebelius told Politico that these kinds of meetings with members of Congress are "not at all unusual;" lawmakers may bring concerns to CMS if they believe their constituents have been treated unfairly. One has to wonder: Why was a New Jersey senator so concerned about a Florida constituent more than 1,000 miles away?

That's one of the many questions federal prosecutors will seek to answer in what is expected to be a contentious legal battle. Already, Menendez's aides have refused to testify for a grand jury probe investigating the relationship between the senator and Melgen, NJ.com reported. On the other hand, the DOJ does not bring criminal charges against Congressional leaders without a strong case and a truckload of evidence. Frivolous charges might fly against your everyday citizen, but a case against a powerful senator requires a surgical approach.

Ultimately, the charges aim to unveil what guts of this friendship really were: A poetic, Hallmark-inspired bond or mutually beneficial corruption. Only time will tell. - Evan (@HealthPayer)

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