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Friday, December 9, 2016

After being sued by The Wall Street Journal, the government finally released its Medicare reimbursement data last week. It included the less-than-stunning revelation that 28 of the 100 doctors who received the largest payments in 2012 were from Florida.

No other state came close. And no physician in the country billed Medicare for bigger bucks than Dr. Salomon E. Melgen, a West Palm Beach ophthalmologist who operates several clinics and is tight with a powerful Democratic senator.

Melgen got almost $21 million from Medicare in 2012. (No, you don’t need your vision checked — $20,827,341 is the actual number, for one year.)

Records show Melgen filed claims for 894 patients and 92,000 procedures, meaning Medicare paid him approximately $11,700 for every eyeball that was eyeballed by him and his staff.

Even in Florida, the mecca for Medicare tricksters, Melgen’s billing habits drew notice. The government had already forced him to give back $8.9 million from 2007 and 2008, alleging he overbilled for injectable Lucentis, an expensive medication that combats macular degeneration.

The disorder is common in the elderly, and nationwide the treatment costs Medicare $1 billion a year. In 2012, Melgen reported administering more than 37,000 doses of Lucentis in South Florida.

Currently he’s under investigation for possible fraud, and twice FBI agents have swarmed his offices in search of evidence. His attorney says he’s done nothing wrong, and has taken action to recover the nearly $9 million that Melgen repaid the agency in charge of Medicare and Medicaid.

The doctor has an important ally in Senator Robert Menendez, the New Jersey Democrat, who has traveled on Melgen’s private jet and hung out at his posh spread in the Dominican Republican.

When Melgen first got in trouble, Menendez called the U.S. Department of Health and Human Services to defend his pal’s prolific billing. Another time the senator argued in favor of a company owned by Melgen in a dispute over a seaport contract in the Dominican Republic.

For his part, the doctor donated $700,000 to a Democratic political action committee that gave $582,000 to Menendez’s re-election efforts. So far, Melgen’s friendship with Menendez has failed to deflect the FBI’s interest.

Second on the national scoreboard of Medicare’s top billers is Dr. Asad Qamar, an Ocala cardiologist who was paid $18.2 million in 2012. He told the New York Times that his charges are fair, and that the sum is so large partly because he works in an outpatient facility for which the government pays added fees.

Like Melgen, Qamar is an enthusiastic donor to Democrats, including President Obama. He gave more than $100,000 to the Democratic National Committee, and distributed other contributions to congressional candidates in five states, including Florida.

12 Responses to First, Do No Harm — To Your Bank Account

  1. An argument for both drastic campaign finance reform and severe penalties for these thieves and their political allies.

    • That would be wonderful, but with Gov. Scott in Tallahassee, the likelihood of reform is slim to none. Scott is the former founder and CEO of Columbia HCA, the company that got the largest fine for fraud in history…and not only was he elected by a comfortable margin, he is likely to be re-elected.

  2. Kind of puts a kink in the doctors’ arguments that Medicare reimbursement is so poor. Fraud and abuse!!!! Cut programs for the poor people! Those working poor in FL don’t deserve healthcare. It may cut into the eye doctor’s millions. I doubt he takes Medicaid anyway.

    • Oh he takes Medicaid – they all do. Doctors like him work on volume and “upselling.” They also know have to code thing and get past any approval process. Like all good thieves, they have little concern for their victims (patients in this case) or regard for morality.

  3. The penalty for the docs should cost them their licenses to practice and the lawmakers should be censured and subjected to public humiliation in newspapers and on local television. They should find it virtually impossible to win re-election after their support of fraudsters.

    My recommendations here are simply common sense but what is likely to occur is each of the guilty will find some loop in the law or some leniency that allows them to reconstitute their practices and the lawmakers will use the Madison Ave solution

  4. I really do not care what party these criminal contribute to, they have got to be stopped. They are taking advantage of the elderly pushing procedures on them that they really do not need with little regard to any damage they might do. This writer is only talking about two doctors who are sneaky enough to have scammed millions – but it is also going on a smaller scale in far too many doctors’ offices.
    Here’s my story, I am old enough to be on Medicare, but until I moved to my current home I had the same eye doctor for decades. I am at high risk for eye condition called narrow-angle glaucoma so I see the ophthalmologist annually, my former doctor never once suggested that I needed the preventive procedure for the condition. In fact, I even had asked about having the preventive procedure and he said quite clearly that felt that the risks of it were high enough not to take a chance with such healthy eyes. When I moved here I, the eye doctor approved by my insurance was insistent that I should get the procedure, even through he said I had very healthy eyes and normal eye pressure. He even had his office call me twice about getting it done. I changed doctors and low and behold, the new doctor response when I asked about the procedure was the same as my old doctor’s. The moral is do not trust one doctors opinion about any procedure, always get a second opinion – maybe a third.

    • Good story; I also believe that many, many of the procedures that were billed for never happened. The doctor would have to be injecting eyes for 12 hours a day, every day of the year. I imagine he does other things as well in checking patients eyes. They are scum, to rip off the patients and the Medicare program. Medicare could do a better job of monitoring if the congress would allow them more hires to do so. Fraud is the big problem throughout our government stream of spending.

      • Actually, I work in health care in both the private and public sectors of it for several decades. I can tell you right now from personal experience – it is happening through out the system. I have seen what they do from the inside. It is all about learning to code and figuring out ways to get around the check and balances that are put in place in both the private and public systems. It too simple to blame it on the Government because our public and private health care system is so interwoven. I caught several of my doctors billing for stuff they did not do well before I turn old enough to get Medicare. I once had a eye doctor code me with a cataract, that way he could bill 150 dollars for my exam rather than 90 dollars. I was forty years old, a second doctor confirmed that I did not have a cataract, so I turned the doctor in. This has been a problem for decade, it is one of reasons our health care is so expensive and no matter what is done, the crooked doctor soon figure out how to get around it. BTW, if I had not corrected that little bit of coding, I just might have been one those people who for so many years have not been able to get coverage because that cataract would have been considered a pre-existing condition.

  5. I am ashamed of Menendez for his belonging to my party. Ideally, he should be replaced by another Democrat who is honest. More likely, if he is voted out in November, it will be by a Tea Party Republican who wants to cut the funding for HONESTLY NEEDY patients even more, using this scumbag of a doctor, and his Congressman friend, as an excuse.

    Voters in that district of New Jersey should ask, did Menendez do any favors SPECIFICALLY for this doctor, to allow him to get away with such fraud? Or did the doctor just “drop a name” when questioned by authorities? Would the public good be served by defunding a program that does so much good, because a few people like this doctor abuse it?

    Is there still time for the New Jersey Democratic Party to get an honest challenger on the primary ballot and promote the challenger?

    And remember, the biggest perpetrator of Medicare fraud a few years back was a chain of for-profit hospitals owned and managed by … Florida’s current Republican Governor, Rick Scott, who escaped legal accountability by pretending that, despite being CEO, he knew nothing about it. And his Tea Party ideology won him votes despite being so “incompetent” as a CEO that he didn’t know his company was committing so much fraud, to make him the CEO of their state.

  6. Over 20 years ago when I was being treated for BC, the radiologist, a Dr. Wang, not only billed through the hospital, but he also billed through his own business. When I called him up about it, he said quite flippantly, “What’s your problem? You have insurance.” It’s a racket.
    And the pharmaceutical companies along with the cancer industry, we all know it is going on. There are opportunists all over the place. And these guys really just prey on the elderly and the American taxpayers.

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