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May 2, 2017

Jury finds Fla. doc tied to senator's corruption case guilty of defrauding Medicare

Daily Briefing

A Florida jury on Friday convicted a Florida-based ophthalmologist connected to separate corruption charges brought against Sen. Robert Menendez (D-N.J.) on 67 counts of Medicare fraud.

The Palm Beach County, Florida, jury found ophthalmologist, Salomon Melgen, guilty for improperly billing Medicare for more than $100 million of services from 2004 to 2013 that were never performed or were unnecessary. Melgen faces a minimum of 15 years in prison for the convictions.

According to the New York Times, the Medicare fraud convictions could increase pressure on Melgen to cooperate with federal authorities in a separate corruption case against Menendez as a way to seek a reduced sentence.

Ophthalmologist, Menendez face federal corruption charges

Menendez in 2015 pleaded not guilty to charges that he accepted about $1 million in gifts and campaign contributions from Melgen in exchange for influencing the outcome of millions of dollars' worth of Medicare billing disputes, among other actions. Menendez faced various federal charges, including for conspiracy, bribery, and false statements.

The corruption charges followed a multi-year investigation by the Department of Justice (DOJ) probing Menendez's involvement with Melgen. Federal investigators in 2013 announced that Menendez had made two unsuccessful attempts to intervene with federal health officials on behalf of Melgen, who had been under investigation for Medicare fraud.

DOJ claimed that Melgen administered multiple doses of a macular degeneration drug from single-dose vials. According to investigators, Melgen used the technique to inappropriately file extra reimbursement claims with Medicare. CMS accused Melgen of overbilling Medicare by almost $9 million, which Melgen eventually repaid.

Hospital executives, doctors indicted over alleged $200 million kickback scheme

The investigators in 2013 revealed that Menendez had attempted to intervene on Melgen's behalf in 2009 with then-senior CMS official Jonathan Blum and in 2012 with then-acting CMS Administrator Marilyn Tavenner. An indictment filed in 2015 also stated that Menendez met with then-HHS Secretary Kathleen Sebelius on Melgen's behalf.

Despite Menendez's efforts, Melgen in 2015 was indicted on charges involving more than $190 million in Medicare claims. The indictment claimed that Melgen defrauded Medicare over a six-year period, receiving $105 million in improper payments. Melgen pleaded not guilty to the charges.

According to the Times, a trial in the case involving federal corruption charges against Menendez and Melgen is scheduled to begin in September.


Robert Mintz, a former federal prosecutor, said, "It would only make sense for [Melgen] to assist prosecutors" in the corruption case "if he was also going to get the benefit of that cooperation at his sentencing in Florida."

However, Kirk Ogrosky, a lawyer for Melgen, said the doctor views the two cases as separate. Ogrosky said Melgen's convictions "will have no impact on what will happen" in the corruption case, adding that Melgen "intends to go to trial … in September."

A lawyer for Menendez said Melgen's convictions would have "no bearing" on the corruption case, the Times reports (Haag, New York Times, 4/28; Bresnahan/Gerstein, Politico, 4/28; Nesmith/Voreacos, Bloomberg, 4/28).

How your hospital board can become the first line of defense against fraud

A host of market forces and regulatory mandates are redefining the role of the hospital board of trustees. The federal government is significantly increasing its efforts to examine the operations and business practices of hospitals. This means increased scrutiny of hospital boards of trustees and possible legal liability associated with their organization’s compliance with requirements embedded in health care laws and regulations.

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