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Photo credit: AP
International

Lengthy jail sentence for ophthalmologist’s multi-million dollar medicare fraud

13/04/2018
A Florida ophthalmologist has received a 17-year jail sentence for performing unnecessary eye procedures some witnesses compared to torture, in order to defraud Medicare out of at least US$73 million (AU$93.26 m).

Eye doctor Salomon Melgen, 63, was found guilty of 67 crimes, including submission of false medical claims, healthcare fraud, and falsification of patient records. According to AP, before the scheme was discovered, Melgen had become the highest-paid Medicare doctor in the country between 2008 and 2013 by subjecting elderly patients to unnecessary eye injection and retinal laser treatments.

In sentencing, presiding US District Judge Kenneth Marra ordered Melgen to repay US$42.6 million (AU$54.4 m) in restitution to Medicare, with the potential for future additional payments. The payment is only a fraction of the US$136 million (AU$173.7 m) prosecutors allege the Florida ophthalmologist stole, but substantially more than the US$64,000 (AU$81,730) his defence team argued had been proven during the trial.

"Melgen had become the highest-paid Medicare doctor in the country between 2008 and 2013"

However, Marra determined there was evidence Melgen had stolen at least US$73 million, which led him to also dismiss the defence team’s requests for an immediate release. Instead, the eventual sentence was closer to the 30 years prosecutors had requested, and means Melgen may not be released from prison until he is 80.

His legal team will appeal the sentence.

During the two-month trial, prosecutors accused Melgen of deliberately billing Medicare for procedures he knew to be unnecessary, such as ordering tests and treating the prosthetic eyes of one-eyed patients, and painful, but ultimately pointless laser treatments for patients with atrophic age-related macular degeneration.

Prosecutors also highlighted tests that should have taken at least five minutes that were performed in seconds, stripping them of their diagnostic purpose but allowing him to bill Medicare hundreds of dollars per patient, for as many as 100 patients per day.

Melgen was also found guilty of splitting expensive single-dose injectable eye treatments into four doses and then billing Medicare the full amount for each injection.

Melgen’s sentencing hearing had been delayed after he was also accused of bribing New Jersey Democratic Senator Mr Bob Menendez. Prosecutors in that case alleged Melgen had given the senator gifts, vacations and private flights in exchange for political favours, however the case was thrown out after the jury failed to reach a verdict.

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