Florida Doctor with Senatorial Ties Charged with Fraud and Corruption
Florida doctor Salomon Melgen has been indicted on fraud and corruption charges tied to his medical practice and his connections with Senator Robert Menendez (D-New Jersey). Federal prosecutors in the Southern District of Florida recently hit Dr. Melgen with an indictment charging 46 counts of health care fraud associated with his ophthalmology practice. Nineteen of these counts alleged fraudulent claims and 11 counts alleged the making of false statements. Furthermore, Dr. Melgen is also charged by separate indictment in an alleged political corruption conspiracy—the same one that has ensnared Senator Menendez. Federal prosecutors allege that the senator accepted up to $1 million worth of campaign contributions and gifts from Dr. Melgen in exchange for political favors. The gifts included private jets, luxury hotel stays, and illicit sexual liaisons.
Medicare Fraud Scheme
While Dr. Melgen was released on $1.5 million bail and has pled not guilty to the corruption charges, his alleged participation in a Medicare fraud scheme is another black mark against the South Florida medical community. Investigators have determined that between January 2004 and December 2013, Dr. Melgen billed Medicare for more than $190 million and was reimbursed for more than $105 million. Prosecutors believe he falsely diagnosed patients with serious conditions such as age-related macular degeneration, created false patient files that would include fake drawings and diagrams that inaccurately represented the patients’ eyes, and billed for bogus tests. Dr. Melgen would then prescribe the patients a very expensive drug that is used to treat the claimed condition. Afterwards, he would allegedly have the treatment (which comes in single-use vials) divided into multiple doses and administered to the various patients. Dr. Melgen would then separately bill Medicare the full cost for each divided treatment
Dr. Melgen was identified last year as one of Medicare’s top billers nationwide, and continued to receive payments from Medicare even after his office was raided by the FBI in 2013. These payments occurred even after the agency temporarily stopped them, due to suspicions surrounding his billing practices, and other investigations into those practices. (Even when fraudulent practices by providers are suspected, Medicare is required to pay those providers within 30 days of receiving their claims. Any investigation of possible fraud commences only after payment is made.)
Fraud accounts for roughly 10 percent of Medicare’s annual spending, and the government is making a concerted effort to put a stop to it. This is due in part to the fact that the agency is unable to recover most of that money back. In 2013 Medicare only recovered $2.86 billion out of $58 billion in defrauded payments.
If Dr. Melgen is found to be guilty, this case will be yet another example of a high profile medical professional’s hubris, the level of fraud the healthcare system faces, and the scrutiny Florida doctors are currently facing by federal investigators for even more wide-ranging claims such as political corruption and bribery.
If You Think You Need a Lawyer, YOU DO. Call Now!
If you find yourself under investigation for health care fraud or political corruption, please contact Attorney Tony Moss at the Tony Moss Firm, L.L.C. to discuss these issues, or any other white collar defense matters. He has offices located in Miami and Fort Lauderdale, and is prepared to put his 27 years of experience to work for you.