Top-billing South Florida doctor charged with Medicare fraud held in jail

West Palm Beach eye doctor Salomon Melgen, shown in this 2013 file photo, was arrested late Tuesday, April 14, 2015, on new Medicare fraud offenses involving more than $190 million in billing to the taxpayer-funded program.
West Palm Beach eye doctor Salomon Melgen, shown in this 2013 file photo, was arrested late Tuesday, April 14, 2015, on new Medicare fraud offenses involving more than $190 million in billing to the taxpayer-funded program. Bloomberg

A top-billing South Florida eye doctor — charged just weeks ago in a political corruption case with a U.S. senator — will remain behind bars on a newly filed Medicare fraud indictment because prosecutors asserted Wednesday that he is a flight risk.

Salomon Melgen, 61, who was arrested late Tuesday at his medical office in West Palm Beach on charges involving $190 million in Medicare claims, will continue to be held at a county jail while his defense attorneys try to negotiate a bond for him by Thursday. If that fails, a detention hearing would be held in federal court.

Melgen, recognized as one of Medicare’s top-billing physicians in the nation, collected more than $105 million in reimbursements based on substantial “fraudulent” claims to the taxpayer-funded program for eye injections and other treatments between 2008 and 2013, according to an indictment.

Melgen plans to enter a not guilty plea at his arraignment Thursday before Magistrate Judge James Hopkins, according to his attorneys, Anne Lyons and Maria Dominguez.

“We have reviewed the indictment and can say we are convinced of the doctor’s innocence,” they told the Miami Herald.

His attorneys argued that the physician, a native of the Dominican Republic, should be allowed bail while he awaits trial. They also noted that he was granted a $1.5 million bond in the separate New Jersey corruption case involving his close friend, Sen. Robert Menendez, and that the doctor is scheduled to undergo a biopsy on Friday because of serious health issues.

Melgen was thrust into the national spotlight earlier this month when he was charged along with Menendez, the Democratic lawmaker, in an alleged graft scheme entailing close to $1 million in gifts and donations in return for official favors. Among them: the senator’s intervening on Melgen’s behalf to resolve a longstanding Medicare billing dispute.

Melgen, charged in the new 76-count indictment with healthcare fraud, filing false claims and making false statements, was arrested by Health and Human Services and FBI agents following a two-year investigation.

Melgen is a longtime ophthalmologist who has owned and operated Vitreo-Retinal Consultants of the Palm Beaches since 1990. His high-volume business, with four offices in Palm Beach and St. Lucie counties, has provided clinical and surgical services to as many as 100 patients in a single day, according to the indictment.

The indictment accuses Melgen of submitting false claims by fabricating entries on patients’ medical charts and diagnosing them with serious eye conditions, notably age-related macular degeneration and retinal disorders. He has specialized in treating “wet” macular degeneration, a disease that causes vision loss, mainly in older people.

In wet macular degeneration, abnormal vessels leak blood and fluid into the macula, causing scarring and rapid loss of vision. Based upon the false diagnoses, Melgen performed and billed for “medically unreasonable and unnecessary tests and procedures,” according to the U.S. attorney’s office. Among them: costly eye injections and laser surgeries.

Melgen is also accused of making “exorbitant and improper profits” from the purchase and use of the drug Lucentis, which is used to treat wet macular degeneration, according to prosecutors Roger H. Stefin, Carolyn Bell and Alexandra Chase.

Melgen purchased the drug from the manufacturer, Genentech, at $2,000 per vial and improperly split the “single-use” vials into multiple doses to treat four patients. Melgen then billed Medicare at the full reimbursement rate for each treatment, collecting $8,000 in payments for one vial of Lucentis, according to the indictment.

The indictment also accuses Melgen of putting false information in patients’ files, including fictitious drawings and diagrams that misrepresented the condition of the patients’ eyes. The indictment also claims he prepared fictitious reports to substantiate his “abnormal” billing practices in response to Medicare audits.

“Medical professionals who violate their oath by failing to attend to the health of their patients and who submit falsified billing statements for their own personal gain jeopardize the viability of government benefit programs,” U.S. Attorney Wifredo Ferrer said in a statement.

Added FBI special agent in charge George Piro: “People who defraud Medicare indirectly increase the cost of health care for everyone.”

After being charged with two federal indictments in the same month, Melgen now finds himself in an extremely vulnerable position that could cost him his lucrative medical career.

In early April, he and his close political pal, Menendez, were charged with conspiring to commit fraud, bribery and other offenses. Both pleaded not guilty in federal court in Newark.

Menendez is accused of illegally peddling his political influence to help Melgen with both business and personal concerns — in exchange for nearly $1 million in gifts and donations.

Among the charges: The senator tried to resolve the physician’s multimillion-dollar billing dispute with the Medicare program; he helped Melgen launch a port security business in his native Dominican Republic; and he supported visa applications for the doctor’s girlfriends from the Dominican Republic, Brazil and Ukraine.

As the senator sought to help the doctor between 2009 and 2012, Menendez went on several trips with Melgen to the Dominican Republic on the physician’s private plane and stayed at his Casa de Campo resort villa — all without reporting the gifts, according to the indictment.

Melgen also foot the bill for Menendez’s weekend trip to Paris with a female friend in 2010, using his American Express rewards points to cover the tab for a luxury hotel.

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