A doctor in the North Palm Beach area was hit with a 76-count indictment today for his participation in a Medicare fraud scheme worth over $100 million. Dr. Salomon E. Melgen, a 61-year-old ophthalmologist and retina specialist, was charged today with 46 counts of health care fraud, 19 counts of making false and fraudulent claims, and 11 counts of making false statements relating to health care.
According to a Justice Department press release, Melgen owned and operated Vitreo-Retinal Consultants (VRC), a medical clinic with four offices in South Florida that conducted business as Vitreo Retinal Consultants Eye Center and The Melgen Retina Eye Center. Melgen’s practice typically provided services to 100 or more patients per day—many of which were Medicare beneficiaries.
The indictment states that between 2004 and 2013, Melgen submitted false claims and made fraudulent changes to patients’ charts in a scheme designed to bilk money from federal health care programs. The 61-year-old ophthalmologist allegedly diagnosed his patients with serious eye conditions like age-related macular degeneration (ARMD or AMD) and other retinal disorders so he could perform and bill for medically unreasonable and unnecessary tests and procedures, including unnecessary eye injections and laser surgeries.
He was able to make these fake diagnoses by allegedly making fictitious diagrams and drawings that misrepresented the condition of his patients’ eyes. When faced with government audits into his business, Melgen allegedly prepared fictitious reports that justified his abnormal billing practices.
It is also alleged that Melgen profited from the purchase and administration of Lucentis, a Genentech drug used to treat symptoms related to vision loss in elderly patients. According to the indictment, Melgen purchased the drug from Genentech and then had the single-use dose split up into multiple doses before administering it to multiple patients. Once this process was completed, he allegedly billed Medicare and other health care providers separately at the full dosage reimbursement rate.
The defendant also submitted for claims for reimbursement based on services that were either never performed or not medically necessary, including angiographic studies on prosthetic eyes and blind eyes.
All told, Melgen billed Medicare for over $190 million and was paid more than $105 million. According to the Justice Department, a substantial portion of the payments Melgen received were obtained through fraudulent billing practices.