Salomon Melgen, an ophthalmologist in South Florida, is under criminal investigation because of earning $21 million yearly from Medicare. The earnings were allegedly from excessive Medicare billing used by health programs for seniors and disabled.
According to the most detailed data on physician's payments ever released in Medicare's five-decade history, which was released Wednesday, Melgen appeared to be their most highly paid doctor. He received $21 million in 2012 -- an amount greater than any other doctors who billed the taxpayer-funded program that same year.
According to the government data, more than 50 percent of the amount he requested for reimbursement was for an intravenous drug Lucentis-- a drug used to treat macular degeneration or the loss of vision in the center of the visual field due to retinal damage.
The U.S. Federal Bureau of Investigation and the Human Services agents were trying to establish the fact that he tricked Medicare into treating patients with Lucentis though unnecessary.
Melgen's attorney Kirk Ogrosky, a former federal prosecutor who for years fought Medicare fraud in South Florida and other places, released a statement Wednesday that his client is not guilty of Medicare fraud.
"At all times, Dr. Melgen billed in conformity with Medicare rules,'" said Ogrosky to Miami Herald.
"While the amounts in the CMS data release appear large, the vast majority reflects the cost of drugs," he added. "The amount billed by physicians is set by law, and drug companies set the price of drugs, not doctors."
Centers of Medicare and Medicaid Services principal deputy administrator Jonathan Blum argued that ophthalmologists and oncologists are paid higher than other doctors not just in Florida, but in other states, as well.
"Both of those professions are ones that use high-cost drugs as part of their practice, part of their treatments," Blum told Miami Herald. "Very expensive drug therapies tend to be the treatment of choice."
