NEW: Melgen’s pay for procedures outpaced other doctors by millions


While a federal jury is still weeks away from deciding whether Palm Beach County retinal specialist Dr. Salomon Melgen bilked Medicare out of as much as $105 million, they learned on Monday that his far-flung practice was immensely lucrative.

Diagnosing and treating thousands of elderly patients for wet macular degeneration at four clinics from Delray Beach to Port St. Lucie, Melgen raked in millions more from Medicare for various tests and procedures than any other eye specialist in the nation, according to figures compiled by an FBI intelligence analyst.

For instance, while his closest competitor nationwide made $33.6 million over six years for a particular procedure, he made $57.3 million. While the median, or typical, amount a retinal specialist made for a certain test was $3,678, he collected a staggering $16.8 million.

Further, analyst Jennifer Minton testified, it wasn’tbecause Melgen saw more Medicare patients than other eye doctors. While he treated roughly 2,300 Medicare patients over the six years she reviewed, other doctors treated two or three times as many, she said.

In some cases, the wealthy, politically connected 62-year-old physician, who also had offices in West Palm Beach and Wellington, earned millions for tests most retinal specialists no longer use, she said.

Melgen, who faces 76 charges of health care fraud, made $8.4 million from the federal insurance program from 2008 to 2013 by using lasers to stem the progression of the disease that slowly robs the elderly of their sight. The second top biller nationwide took in $660,000 during the same years.

The reason was obvious. While Melgen submitted 12,500 claims to Medicare for laser eye treatments, the median number of claims submitted by his counterparts in Florida and across the nation hovered at around 10. Medical experts previously testified that most doctors curtailed the use of potentially damaging lasers to treat wet macular degeneration in 2005 when far more effective drugs came on the market.

Calling Melgen’s methods “abusive,” “unconscionable” and “horrifying,” Dr. Julia Haller, ophthalmologist-in-chief at Wills Eye Hospital in Philadelphia, last month gasped when she read patient charts that showed Melgen repeatedly zapped patients’ eyes with painful lasers. She bristled when records showed Melgen billed Medicare for treating patients with prosthetic and sightless eyes.

Minton, who is to be the last prosecution witness, is to be grilled by Melgen’s attorneys today. They tried to block her from showing her comparisons to the jury, which has been inundated with complex medical terminology since the trial began four weeks ago. Once this trial is over, Melgen faces corruption charges in New Jersey with his longtime friend, U.S. Sen. Robert Menendez, D-N.J.

In arguments that were rejected by U.S. District Judge Kenneth Marra, Melgen attorneys Matthew Menchel and Kirk Ogrosky argued that Minton’s analysis was unfair because it includes doctors who aren’t retinal specialists. Even top eye doctors like Haller and Dr. Stuart Fine, another acclaimed ophthalmologist who testified last month, don’t agree on what criteria should be used, they argued.

Minton’s analysis will leave the jury with the unsupported impression that Melgen was running a fraud factory, they argued in court papers. “There has been no evidence or testimony showing that every service billed and paid for every patient was fraudulent,” they claimed.

Instead, they have said that prosecutors cherry-picked patient records to come up with nearly three dozen cases to support their unfounded allegations of fraud. Describing Melgen as an innovative doctor, they claim he is the victim of poor record-keeping.

But, Minton said, she took steps to make sure she was comparing Melgen’s billings with those submitted by eye specialists who did the same kind of work. To make the list, she said, during the six years, all had to have seen more than 2,000 patients, billed Medicare for more than 500 injections of a drug to treat wet macular degeneration and submitted bills each year. Nationally, 899 doctors made the list. In Florida, 101 did.

While criticized by Haller and Fine for his use of lasers and outdated tests, Melgen also embraced the break-through drugs that both experts agreed had revolutionized treatment of the sight-robbing disease. It was the most lucrative part of his practice.

He received a whopping $57.3 million from Medicare for injecting the drug Lucentis into his patients’ eyes. The only doctor to come close received $33.6 million in reimbursements.



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