Jury Selection Begins in $190 Million Medicare Fraud Trial, Tied to Criminal Charges Against Democratic Sen. Menendez

Robert Menendez
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Jury selection began on Monday in a federal district court in West Palm Beach, Florida in the trial of Salmon Melgen, “where he faces 76 counts charging him with stealing up to $190 million from Medicare between 2004 and 2013,” the SunSentinel reported.

Melgen was indicted on April 15, 2015 in a “Medicare fraud scheme that prosecutors said attempted to bilk the health care program out of as much as $190 million,” as the Associated Press reported at the time.

Two weeks earlier, on April 1, 2015, Melgen and his friend and political ally, Sen. Bob Menendez (D-NJ) were indicted on charges of public corruption.

Menendez (pictured) “was accused of using his office to improperly benefit a Florida eye doctor and political donor who provided him with trips aboard his luxury jet,” Associated Press reported. The eye doctor is Melgen.

“The indictment from a federal grand jury in New Jersey charged the senator with 14 counts, including bribery and conspiracy, over his ties to Dr. Salomon Melgen, a wealthy doctor and the politician’s longtime friend [who] . . .also was charged in the case,” the Associated Press noted.

This fall, both men are expected to stand trial on the public corruption charges in a New Jersey federal district court. That is enough of a delay to conclude Melgen’s Medicare fraud trial, and Menendez’s bid to have the indictment thrown out by the Supreme Court, which is currently pending.

Menendez, first elected to the United States Senate from New Jersey in 2006, “is ramping up his political activity in anticipation of a 2018 reelection bid, even as he faces a September trial on multiple federal corruption charges. Menendez hosted a holiday party on Dec. 11 with an invite list that political adviser Michael Soliman called a “veritable who’s who of New Jersey elected officials, opinion-shapers, friends and supporters,’ ” Politico reported in late December:

Menendez is also planning fundraising trips to California, Florida and Texas in the first quarter of 2017, according to Soliman.

“He intends to run and run aggressively for reelection,” Soliman said in an email. “There is absolutely nothing that would indicate that this is a United States senator who is contemplating retirement.”

His friend and long-time political contributor, Melgen, faces a difficult legal road ahead.

“Prosecutors say he prescribed unneeded treatments, filed claims for procedures he never performed and charged for medicine he never purchased. If convicted, the 62-year-old doctor faces up to 610 years in prison,” according to the SunSentinel, which noted:

He is free on $18 million bond. . .

Prosecutors in the Florida case declined comment, but say in court documents that Melgen turned his practice into an assembly line, seeing up to 100 patients a day. In 2012, Melgen received more Medicare reimbursement than any doctor in the country, nearly $21 million.

Melgen’s attorneys also declined comment. Melgen has pleaded not guilty.

When Melgen was first indicted on the Medicare fraud charges April 15, 2015, “The indictment charge[d] that he operated the fraud scheme between 2004 and 2013, a time frame during which Melgen billed Medicare for more than $190 million and was paid more than $105 million. In 2012 alone, health official say he billed Medicare more than any other doctor in the nation at $21 million,” as the Associated Press reported at the time.

If convicted of all charges in the Medicare fraud case, Melgen could face up to 600 years in prison.

Should he be found innocent of all charges, Melgen and his co-indictee, Sen. Menendez, face serious charges in their public corruption case if the Supreme Court does not decide in Menendez’s favor.

In September, Breitbart News reported, “Sen. Robert Menendez (D-NJ) has lost his final opportunity for a federal appeals court to spare him from multiple corruption indictments, leaving him with only the hope of an intervention by the U.S. Supreme Court to avoid a trial on 22 felonies that could send him to prison for years.”

In February, the Associated Press reported that “Government attorneys are pushing back against New Jersey Sen. Bob Menendez’s attempts to have his corruption indictment thrown out.”

They filed a response this week to the Democratic senator’s filing seeking to have the U.S. Supreme Court hear his appeal.

Menendez is accused of using his influence in exchange for gifts and political donations from a wealthy Florida eye doctor. Menendez has argued his actions were covered under the Constitution’s “speech or debate” clause that protects lawmakers when they are performing legislative duties.

In its brief this week, the government wrote that the clause is limited to acts that are “integral to the legislative process” and not to attempts to influence government agencies. If the Supreme Court declines to hear the case, a trial could take place this fall.

Menendez and Melgen have separate representation in the public corruption case, and if the Supreme Court throws out the corruption indictment against Menendez, Melgen would likely remain as a defendant in the case.

In 2013, Breitbart News reported on the FBI raid of Melgen’s medical offices during its investigations of Melgen’s Medicare practices:

Earlier this year, the FBI raided the medical offices of Dr. Salomon Melgen, seizing documents to investigate suspicions that he was overbilling Medicare. The Miami Herald reported, earlier this month, that one of the red flags that launched the Department of Health and Human Services Center for Medicare and Medicaid Services (“CMS”) investigation was Melgen’s alleged practice of dividing a single vial of the expensive liquid drug Lucentis into four doses and billing Medicare for each dose. A vial is intended by the manufacturer to generate a single dose in the treatment of macular degeneration. A medical expert told Breitbart News that Melgen’s alleged practice is highly unusual.

Dr. Michael Repka, Medical Director of Governmental Affairs of the American Academy of Opthalmology, told Breitbart News in an exclusive interview “it doesn’t seem possible you could get four doses [of Lucentis] out of a single vial. I would think that is hard to understand.” Repka noted that he was not commenting on the Melgen investigation, but was providing general information about standard practices among opthalmologists for the use of Lucentis in the treatment of macular degeneration.

Melgen’s friendship with and substantial political donations to Senator Robert Menendez (D-NJ) are at the center of an ever expanding political scandal that has prompted the New York Times to call for Menendez’s removal from the Chairmanship of the Senate Foreign Relations Committee.

As Breitbart News reported in 2013, Melgen’s attorneys  at the time claimed he “[simply] differed with the program over its reimbursement policy for Lucentis.”

“But the CMS reimbursement policy for the use of Lucentis is straightforward and not especially prone to misunderstanding on the part of opthalmologists, who use two drugs for the treatment of macular degeneration. Lucentis, which costs doctors $2,000 per vial, is FDA approved for use in treatment of macular degeneration. Avastin, which costs doctors a mere $50 per vial, is FDA approved, but not yet for the treatment of macular degeneration. Both drugs are manufactured by biotech giant Genentech,” Breitbart News noted then:

CMS has established the billing protocol for opthalmologists who purchase either Avastin or Lucentis for use in the treatment of patients with macular degeneration. Doctors are allowed to bill Medicare the “average selling price” of the medicine plus 6 per cent. In the case of a patient treated with a single vial of Lucentis, the opthalmologist would bill Medicare $2,000 plus 6%, or $2,120 for the medicine. When the doctor uses Avastin instead of Lucentis, the bill submitted to Medicare would be $50 plus 6%, or $53.

The Herald reported that Dr. Melgen uses Lucentis to treat macular degeneration patients “more than any other ophthalmologist in Florida and possibly the country. His high patient volume also raised red flags for investigators. ” That high usage prompted the formal investigation focused on potential Medicare overbilling. Specifically, the Herald reported that “Melgen is suspected of using one vial for as many as four patients, while submitting claims of up to $8,000, as if he had used separate vials for each, according to sources familiar with the billing dispute.”

“Instead of billing Medicare at a rate equal to the “average sale price” plus 6% for the approved use of a single vial (which would have generated a reimbursement of $2,120), Melgen is suspected of squeezing four doses out of a single vial, and billing Medicare $8,000 plus 6%, or $8,480. Doctors who play by the straightforward CMS billing policy make a $120 profit on each vial of Lucentis they purchase. A doctor who violates the CMS billing policy and charges $8,480 would make a $6,480 profit on each vial of Lucentis they purchase,” Breitbart News reported in that 2013 article.