Sponsored By: Two Men and a Truck
cloudy-day Created with Sketch.
Sct Thunderstorms
H 94° L 77°
  • cloudy-day Created with Sketch.
    Current Conditions
    Sct Thunderstorms. H 94° L 77°
  • partly-cloudy-tstorms-day Created with Sketch.
    Sct Thunderstorms. H 94° L 77°
  • partly-cloudy-tstorms-day Created with Sketch.
    Sct Thunderstorms. H 93° L 75°

The latest top stories

00:00 | 00:00


The latest traffic report

00:00 | 00:00


The latest forecast

00:00 | 00:00

Florida doctor was paid $21 million by Medicare; No. 1 in U.S.

Florida doctor was paid $21 million by Medicare; No. 1 in U.S.

Florida doctor was paid $21 million by Medicare; No. 1 in U.S.
Photo Credit: Richard Graulich
Dr. Salomón Melgen (2009 file photo)

Florida doctor was paid $21 million by Medicare; No. 1 in U.S.

A Florida ophthalmologist, whose records were seized last year by federal authorities, was paid nearly $21 million by Medicare in 2012, more than any doctor in the country.

Dr. Salomon Melgen, 59, of North Palm Beach, has been locked in a five-year dispute with the government, which made him repay $9 million he allegedly overbilled for his use of the drug Lucentis. The highly expensive medication is used to treat macular degeneration, the most frequent cause of blindness in the elderly. Melgen, whose practice is 70 percent Medicare patients, has sued to get the money back.

Wednesday, the Centers for Medicare and Medicaid Services (CMS) released nationwide figures on how much doctors had been paid by Medicare. Melgen ranked first, having received $20.8 million in 2012, the most recent year for which figures are available. The doctor, who runs four Florida clinics under the name Vitreo Retinal Consultants, billed mostly for Lucentis treatments.

Use of the drug is controversial because of its cost. Genentech, the pharmaceutical company which markets Lucentis at about $2,000 per dose, also markets the drug Avastin at about $50 for an equal dose. Medical trials, including a two-year study cited in 2012 in The Journal of American Academy of Ophthalmology, determined Avastin works just as well to treat most cases of “wet” macular degeneration in the elderly.

Avastin was originally developed as an anti-cancer drug. While the federal Food and Drug Administration has not approved it for treatment of macular degeneration, many doctors regularly use it for that purpose.

The drug company gets paid for the medication, but Medicare allows doctors to charge 6 percent of that amount for administering it. A doctor using Lucentis can bill Medicare 30 to 40 times as much for injecting it as he would for Avastin.

The Medicare statistics show Melgen treated 645 patients and gave them 37,075 doses of Lucentis. The cost of the drugs was $11.778 million. His total payment for 2012 also included $2.5 million for his work and overhead was listed at $6.1 million, all paid by Medicare.

According to a 2010 New York Times report, Genentech was also paying “secret rebates” to doctors who used Lucentis, which reached as much as tens of thousands of dollars every quarter. Only the biggest users were offered rebates and were not allowed to discuss the terms of the agreements, the Times said.

Melgen’s attorney, Kirk Ogrosky, based in Washington, told The Palm Beach Post he did not know whether Melgen had received “discounts or rebates” from the company, but said they would have been above board, not “under the table.”

Ogrosky said Melgen received large payments from Medicare because of the size of his practice, which includes 30 employees.

“At all times, Dr. Melgen billed in conformity with Medicare rules,” Ogrosky wrote in an email. “While the amounts in the CMS data release appear large, the vast majority reflects the cost of drugs. The facts are that doctors receive 6 percent 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.”

“Dr. Melgen treats his patients using both Lucentis and Avastin,” Ogrosky wrote. “Each patient’s course of treatment is determined on a case-by-case basis, entirely based upon what is in the best medical interests of that individual patient.”

When asked why the use of Avastin was not included in the breakdown of payments to Melgen published by CMS, the way his use of Lucentis is, Ogrosky said since Avastin is not FDA-approved for treatment of macular degeneration he assumed Melgen had included the cost of the drug in some other category in his charges to Medicare. Such use of drugs by doctors is not illegal and not prohibited by Medicare.

Ogrosky said using the raw data released by CMS to judge his client was “irresponsible” and said Melgen “stands by his record of improving the vision and quality of life of patients from around the world.”

CMS released the information for 880,000 health care providers who collectively received $77 billion in Medicare payments in 2012, under Medicare Part B. It measured spending on “6,000 different types of services and procedures provided, as well as payments received by individual health care providers.”

>> Read more trending stories 

Melgen battled Medicare over billing since at least 2009. Last year, FBI agents raided his West Palm Beach offices on Metro Centre Boulevard twice and removed boxes of documents. He was accused of overbilling Medicare when it was found that he was using one vial of Lucentis to treat several patients, when Medicare rules stipulate only one patient can be treated from that vial. He was forced to repay the government $9 million.

Melgen then sued the U.S. Department of Health and Human Services, which oversees Medicare, admitting he had treated more than one patient from a vial of medication but had not hidden that fact from Medicare and had not overbilled. In court pleadings, his attorneys contend the policy is not prohibited by the CMS and was upheld in a 1981 federal court decision and other rulings. His lawsuit is pending. HHS ordered a suspension of all Medicare payments to Melgen’s practice. That suspension was reversed and he is receiving Medicare payments today.

Melgen, a native of the Dominican Republic, lives in the gated Captain’s Landing community near North Palm Beach and owns a private jet. He has also come under federal investigation for his relationship with U.S. Sen. Robert Menendez, D-N.J. Melgen donated $700,000 to a political action committee, which in turn spent $600,000 to help Menendez. The senator also accepted free flights from Melgen to a resort in the Dominican Republic and stayed at Melgen’s home there. Menendez came under Senate ethics scrutiny and was forced to pay $58,000 in reimbursement.

According to a New York Times investigation, Menendez spoke to HHS on Melgen’s behalf in the billing dispute at least twice, starting in 2009, and also helped plead Melgen’s case in other business interests. Menendez has said he did nothing improper on those occasions.

About the doctor

Dr. Salomon Melgen had two offices raided last year by the federal government. He’s in a dispute after the feds he was overpaid $9 million for his use of the macular degeneration drug Lucentis. He sued in federal court. He has offices in West Palm Beach, Wellington, Port St. Lucie and west of Delray Beach.

Read More

There are no comments yet. Be the first to post your thoughts. or Register.

The Latest News Headlines

  • Police in Georgia are hoping surveillance video that captured a violent attack will help them find the people responsible. Video shows a restaurant owner and her teenage daughter being beaten by two customers Thursday afternoon in Baxley, Georgia. >> Read more trending news The victims told police the suspects were unhappy with their order. The verbal argument turned violent when one of the suspects began punching the restaurant owner repeatedly. When the victim’s teenage daughter came out of the car to break up the fight, the male suspect punched her in the face. WJCL reported that Baxley police have issued warrants for the suspects, Nathaniel Smith and Latasha Smith. The pair could be charged with aggravated battery and cruelty to children. The suspects drove away from the restaurant in a cream or tan Cadillac Escalade with tag number REU8495. Officials said they headed north on Highway 144. Anyone with any information about the assault is asked to call the Baxley Police Department at 912-367-8305 or the 911 call center at 912-367-8111.
  • The Federal Aviation Administration is investigating a small plane crash that occurred Saturday morning near Fort Meyers, the Lee County Sheriff’s Office said. Deputies said the plane crashed into an unoccupied day care building. >> Read more trending news One person died in the crash while another was taken to the hospital. The survivor’s condition has not been released.
  • A Transportation Security Administration agent has been arrested after he was accused of stealing money from a passenger at Orlando International Airport in Florida, Orlando police said. >> Read more trending news Alexander Shae Johnson, 22, was arrested Thursday night. Passenger Kathleen Duddleston entered the TSA checkpoint and was stopped for additional screening, police said. While she was patted down, Duddleston told TSA security officer Michelle Metz that she couldn’t see her luggage, so Metz moved her closer. Duddleston complained again that she couldn’t see her bag, and Johnson moved slightly. After the pat down, Duddleston reached for her bag and could not find her money, police said. She said she noticed a bulge in Johnson’s left front shirt pocket. Duddleston asked Johnson if that was her money, and he said he got the money from the bank, police said. The woman complained to Metz that she believed Johnson stole money from her. Metz contacted her supervisor. Duddleston has been charged with third-degree grand theft. TSA said in a statement to WFTV: TSA has a zero tolerance for misconduct in the workplace. The TSA immediately reported the allegation to OPD and we aggressively investigated the incident with our law enforcement partner. TSA officers represent a professional and honorable workforce that is trained to treat passengers and their personal belongings with care and respect. No exceptions will be tolerated. We immediately ended the federal career of this individual.
  • A scare happened at a Leominster, Massachusetts, supermarket after a 4-day-old newborn was left locked inside of a hot car while her mother was inside shopping. >> Read more trending news Mother Sharma Murphy said that on her way to Market Basket supermarket on Friday, she stopped by the fire house to make sure her baby’s car seat was properly installed. Less than an hour later, those firefighters helped rescue her 4-day-old baby, who was locked in her hot car. A shopper called Leominster police after spotting a newborn alone inside a car. It was Sharma Murphy's silver Chevy Malibu. >> A reminder of hot car dangers as temperatures climb Murphy said she was out for the first time with her newborn daughter, 4-day-old Katherine, and was nervous. “I went, I bought it. Came right out and this lady just starts screaming at me. Screaming at me,” said Murphy. Murphy said she brought her newborn inside with her to Market Basket and then returned to the car when Katherine fell asleep. She said that she ran back inside for two or three minutes to buy some baby formula. “I went (in and) I bought it,” Murphy said. “(I) came right out and this lady just starts screaming at me.” Related: Two toddlers dead after 15 hours in hot car, police say Police said the windows were rolled up. “I believe she locked her keys in the car because they had to use the jimmy to get the baby out,” witness John Casey told WFXT. According to WFXT meteorologists, the outside temperature was 84 degrees at the time. Murphy said she didn’t want to wake her newborn. “I thought, ‘OK, if I run in and run out...’ It was one of those things where she's gotta eat because I have nothing left for her and that's when everything happened and I'm like, oh my God,” Murphy said. Katherine was taken to the hospital to be checked out. Her mother said he is fine. The baby is currently in custody of DCF. No charges have been filed.
  • UPDATE: JSO says Waverly was found under a motel stairway by a maintenance worker on Sunday. ---------- The Jacksonville Sheriff's Office is asking you to keep an eye out for a missing elderly man, diagnosed with Alzheimer's disease.   JSO tells us Waverly Northington Jr., 66, left his home in the 8200 block of Halls Hammock Court on Friday morning, between the hours of 12:00 am and 2:45 am.   Police say they've conducted an extensive search, but haven't been able to find him.  We're told Northington doesn't have a vehicle, so he's believed to be on foot.   Northington is described as a black male, 5'9'', 130 pounds, with gray hair and brown eyes. He was last seen wearing all white clothing with white shoes.   If you know where he is, or even if you've spotted him somewhere today, you're urged to contact the Sheriff's Office at (904) 630-0500.

The Latest News Videos