clear
Monday December 11th, 2017 12:19PM

Defense: Doc's $100 million Medicare fraud cost just $64,000

By The Associated Press
Related Articles
  Contact Editor

WEST PALM BEACH, Fla. (AP) — A politically connected Florida eye doctor convicted of a $100 million Medicare fraud actually cost the government just $64,000 in illegitimate payments, his defenders argued Thursday in an effort to drastically reduce his potential sentence.

Dr. Salomon Melgen's lawyers portrayed him as ahead of his time, injecting patients with then-experimental drugs that are now approved. Medicare does not pay for experimental treatments, so attorney Josh Sheptow suggested that Melgen may have falsified billing statements to get around those restrictions.

That would still be fraud, but Sheptow said the treatments were legitimate, so the government didn't lose anything with many of his patients. He also argued that Melgen's practice of splitting single-dose vials of an expensive medicine into four vials cost Medicare nothing, since reimbursements would not have changed had Melgen followed the rules.

His colleague, Kirk Ogrosky, conceded that $64,000 "sounds ridiculously low," but he told U.S. District Judge Kenneth A. Marra that it's what prosecutors can prove by a majority of the evidence. The rest, he and Sheptow argued, is based on faulty suppositions and gross exaggerations that cannot be proven.

Prosecutors will make their arguments later Thursday.

They said Melgen subjected elderly patients to painful tests and treatments they didn't need, for diseases they didn't have, to support a vacation home in his native Dominican Republic, lavish trips to Europe and outside business interests.

The amount of loss is important. Melgen could get a life sentence for a $100 million loss, but a minor loss could result in a short sentence. Melgen was found guilty of 67 counts, including health care fraud, submitting false claims and falsifying records in patients' files.

Melgen is charged separately with bribing New Jersey Democratic Sen. Bob Menendez in exchange for favors including an effort to interceded with Medicare officials investigating his practice. A federal jury in New Jersey hung on that case last month, and prosecutors there have not said whether they will retry them.

Melgen's attorneys rested much of their case for a short sentence on the doctor's use of the drug Lucentis between 2008 and 2013. At the time, Medicare approved its use only for wet age-related macular degeneration or ARMD, a retinal disease that can cause blindness.

Lucentis is injected in tiny doses — 0.5 milliliters, or a sixty-fourth of a teaspoon. It comes in single-use vials that contain four times that amount — a sixteenth of a teaspoon. The manufacturer's instructions say doctors should pull the vial's entire contents into the syringe and then squeeze out and dispose of the excess — about a thirtieth of a teaspoon — before administering the injection. Medicare reimburses doctors their wholesale cost of $1,900 per vial plus a 6 percent surcharge, $114.

Melgen used each vial for four injections, charging Medicare $2,014 each time. Prosecutors say the three extra injections were theft. Melgen's attorneys argue that he cost the Medicare program no extra money by avoiding what he would have spent buying more vials.

Melgen also administered the drug to patients who did not have wet ARMD, even as he told Medicare they did. Sheptow suggested Thursday that the patients had diabetic-related sight loss, types of which Lucentis is now authorized for. He said Melgen and other eye doctors knew then that Lucentis worked on the disease and suggested that Melgen gave a false diagnosis to Medicare to be reimbursed for a treatment he knew was effective, even if it wasn't yet approved. That might be fraud, he said, but Medicare lost no money because its mission of providing medical care to the elderly was met.

The judge said he would not issue a sentence on Thursday because of the case's complexity. Testimony during the three-day sentencing hearing -- and the two-month trial -- has centered around complicated and often contradictory medical and statistical evidence. Just Thursday, prosecutors dropped on Marra two six-inch thick binders filled with evidence they say counters the arguments made by Melgen's attorneys.

  • Associated Categories: Associated Press (AP), AP Health, AP Business, AP Health - Senior Health, AP Business - Personal Finance
© Copyright 2017 AccessWDUN.com
All rights reserved. This material may not be published, broadcast, rewritten, or redistributed without permission.
A Medicaid challenge: Poor health, but a drive to improve
People on Medicaid have worse health, but a new survey finds they're invested in improving
1:46PM ( 8 minutes ago )
White ex-cop gets 20 years in prison for fatal shooting
A white former South Carolina police officer has been sentenced to 20 years in prison for shooting an unarmed black motorist to death in 2015. A federal judge handed down the sentence for Michael Slager on Thursday
1:45PM ( 8 minutes ago )
Defense: Doc's $100 million Medicare fraud cost just $64,000
Attorneys for a politically connected Florida eye doctor convicted of a $100 million Medicare fraud argue that the government's loss was significantly less.
1:41PM ( 13 minutes ago )
Associated Press (AP)
AP Exclusive: Poor health and high expectations for Medicaid
AP Exclusive: People on Medicaid have worse health, but a new survey finds they're invested in improving
3:29AM ( 10 hours ago )
Gene therapy shows promise against blood-clotting disease
A study fuels hope that gene therapy can give long-lasting help and perhaps even cure the blood clotting disease called hemophilia
7:13PM ( 18 hours ago )
Shulkin urges emergency aid for VA private health care soon
In a fresh warning, Veterans Affairs Secretary David Shulkin is urging Congress to pass billions in emergency funding for its ailing private-sector Choice health care program by year's end
5:20PM ( 20 hours ago )
AP Health
Largest wildfire eyes communities northwest of Los Angeles
Flames from the largest and most destructive Southern California wildfire churned toward communities northwest of Los Angeles on Thursday, disrupting travel on a major highway and triggering more evacuations
1:11PM ( 43 minutes ago )
Bitcoin soars then falls back; banks raise risk concerns
Bitcoin surges but then falls sharply; banks raise concern about risk ahead of the debut of bitcoin futures next week
1:07PM ( 46 minutes ago )
GOP leaves little doubt they'll prevent government shutdown
Top Republicans are all but guaranteeing that the House will approve legislation preventing a weekend partial government shutdown
1:00PM ( 53 minutes ago )
AP Business
Study to look at long-term health risks of playing soccer
A major study into whether soccer players are at risk of degenerative brain disease has been commissioned amid concerns that the sport's authorities in England haven't done enough to tackle the issue
2:50PM ( 1 week ago )
Bill Gates gives $50 million to combat Alzheimer's
Bill Gates says he's giving $50 million to help fight Alzheimer's disease
2:07PM ( 3 weeks ago )
Is your own MD best in the hospital? Study eyes hospitalists
Study suggests old-fashioned family doctor style of medicine could be lifesaving for elderly hospital patients
1:28PM ( 3 weeks ago )
AP Health - Senior Health
US mortgage rates rise, though remain historically low
US mortgage rates rise, though remain at historically low levels
11:14AM ( 2 hours ago )
Senate Republicans barrel toward sweeping tax overhaul
The Senate is barreling toward the most sweeping rewrite of the tax code in more than three decades
3:53PM ( 22 hours ago )
The Latest: Senate barrel ahead on tax overhaul
The Senate's narrow GOP majority prevailed in a 51-47 vote to begin talks with House lawmakers on reconciling the two bills
3:39PM ( 22 hours ago )
AP Business - Personal Finance
A Medicaid challenge: Poor health, but a drive to improve
People on Medicaid have worse health, but a new survey finds they're invested in improving
1:46PM ( 8 minutes ago )
White ex-cop gets 20 years in prison for fatal shooting
A white former South Carolina police officer has been sentenced to 20 years in prison for shooting an unarmed black motorist to death in 2015. A federal judge handed down the sentence for Michael Slager on Thursday
1:45PM ( 9 minutes ago )
New Mexico school shooting leaves 2 students, suspect dead
Authorities say a shooting at a high school in a small New Mexico town left two students and the suspect dead
1:36PM ( 17 minutes ago )
Tillerson says Ukraine key sticking point in US-Russia ties
Secretary of State Rex Tillerson says Ukraine is the sole sticking point keeping the U.S. and Russia from forging a closer relationship
1:33PM ( 21 minutes ago )
Argentine judge seeks arrest of ex-President Fernandez
A federal judge is asking Argentina's Senate to allow the arrest and trial of former President Cristina Fernandez for allegedly covering up the role of Iranians in a terror attack on a Jewish center
1:27PM ( 27 minutes ago )