A South Florida eye surgeon who's a friend of a U.S. senator is under federal criminal investigation for billing Medicare millions of dollars to treat elderly patients for services they may not have needed, The Miami Herald has learned.
Federal agents began investigating Dr. Salomon Melgen last year, sources say, after investigators suspected he overbilled the taxpayer-funded health program by overprescribing a high-priced drug called Lucentis, which is injected into patients' eyes.
Several sources familiar with the doctor's practice said he used the drug, which costs $2,000 a vial, to treat patients with macular degeneration more than any other ophthalmologist in Florida and possibly the country. His high patient volume also raised red flags for investigators, the sources said.
Under Medicare policies, a doctor may only prescribe treatment that is "reasonable" and "necessary." To make a case, federal prosecutors would have to prove that Melgen needlessly treated patients simply to run up sky-high Medicare bills.
Melgen, whose lawyers have denied any wrongdoing, finds himself in the middle of two federal investigations: His Vitreo-Retinal eye clinics in West Palm Beach and two other South Florida sites were raided last week by agents with the FBI and the Department of Health and Human Services, who are investigating possible Medicare fraud.
A separate FBI investigation revolves around the doctor's relationship with U.S. Sen. Robert Menendez, D-N.J., and the trips they took on his private plane to Melgen's villa at a resort in the Dominican Republic.
Melgen donated more than $750,000 last year to Menendez's reelection campaign and other political committees and candidates.
Menendez has insisted that he only took two personal trips on the doctor's plane and recently reimbursed him $58,500 for the travel expense -- but only after an ethics complaint was filed against him in New Jersey last year.
Of late, Menendez also has drawn media coverage for contacting Medicare officials to help resolve Melgen's nearly $9 million billing dispute stemming from a 2008 audit. The dispute revolves around claims filed by Melgen's patients who received Lucentis.
Menendez also advocated on his friend's behalf to the U.S. State Department and at a Senate hearing, where he pushed for enforcement of a $500 million port security contract in the Dominican Republic that would directly benefit Melgen. The doctor owns half of a company that won the contract from the Dominican government a decade ago, but is now stalled.
On Thursday, Menendez acknowledged that his office contacted Medicare officials to help Melgen, but the senator denied he sought to intervene improperly in billing disputes between the doctor and the government.
Menendez said he contacted the U.S. Centers for Medicare & Medicaid Services to ask generally about billing practices and policies. "The bottom line is, we raised concerns with CMS over policy and over ambiguities that are difficult for medical providers to understand and to seek a clarification," Menendez told The Associated Press.
The senator called federal health officials in 2009 and met with them again in 2012, each time urging them to change what he called an unfair payment policy. Medicare ordered Melgen to repay the government program $8.9 million, and he complied, but he is appealing the decision.
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