The doctor who was paid the most by Medicare last year is well-known to many in the political world. His office was raided twice last year by the FBI, and his relationship with New Jersey Democratic Sen. Bob Menendez has drawn scrutiny from federal investigators.
Data released Wednesday by the Centres for Medicare and Medicaid Services showed Dr. Salomon Melgen, a South Florida optometrist, received nearly $US21 million in Medicare reimbursements in 2012. He was part of a tiny group of nearly 350 doctors that were paid almost $US1.5 billion in 2012, according to the new data.
The new data revealed an unprecedented trove of information on the billing practices of doctors under the Medicare program. Officials said they hoped the data would expose fraud and ultimately lead to better, more cost-effective care.
Twice last year, the FBI raided Melgen’s offices in South Florida. A federal audit showed he overbilled the federal government by nearly $US9 million in Medicare and Medicaid payments. After he was forced to pay back that amount, he filed a lawsuit against the federal government to recoup the money.
In a statement, Melgen’s lawyer said he complied with Medicare rules, while conceding that, on its face, the “amounts in the CMS data release appear large.”
“At all times, Dr. Melgen billed in conformity with Medicare rules,” said attorney Kirk Ogrosky. “Dr. Melgen strongly supports transparency in government, but engaging in speculation based on raw data is irresponsible. Dr. Melgen and his employees provide a substantial amount of free services and drugs to patients who cannot afford to pay. The data is merely a reflection of Medicare’s spending for pharmaceuticals that are improving the lives of countless Medicare patients.”
The new data shows Melgen’s most common billing of the federal government for Medicare payments came from Lucentis, or Ranbizumab, a medication that treats macular degeneration. According to the data, Melgen billed for more than 37,000 doses of the medication that were given to 645 patients. The average reimbursement for the medication was $US318.
“While the amounts in the CMS data release appear large, the vast majority reflects the cost of drugs,” Orgrosky said. “The facts are that doctors receive six per cent above what they pay for drugs, the amount billed by physicians is set by law, and drug companies set the price of drugs, not doctors. Responsible analysis requires looking beyond the raw data to what was paid for pharmaceuticals and expenses. Dr. Melgen stands by his record of improving the vision and quality of life of patients from around the world.”
The controversy involving Melgen engulfed Menendez last year, as Melgen had a generous history of political contribution to the Democratic senator. According to Open Secrets, Melgen has given $US33,700 to Menendez since 1992. Overall, he has shelled out $US426,000 in political contributions since 1992, much of which has gone to Menendez or Democratic campaign groups.
Questions were first raised about the relationship in late 2012, when it was revealed Menendez received free rides on Melgen’s private jet and resided at his home in the Dominican Republic. Menendez eventually reimbursed Melgen more than $US58,000 for two trips that were for private purposes.
According to The Miami Herald, as of December, a federal grand jury had not filed any charges against Menendez or Melgen. However, the grand jury continues to look into evidence of Menendez intervening with U.S. officials on Melgen’s behalf in his billing dispute with Medicare and in relation to a port-security contract in the Dominican Republic tied to the doctor’s business interests. Menendez has denied the allegations.
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