(Florida) Doctor With Big Medicare Billings Is No Stranger to Scrutiny (NJ Sen Menendez' donor/pal)

NY TIMES ^

[Uncle Chip]

Melgen’s lawyers assert he did not bill Medicare fraudulently. They contend the doctor differed with the program over its reimbursement policy for Lucentis.

Medicare reimburses $2,000 for each vial of the drug used to treat macular degeneration. The policy is that one vial is used for each patient. But 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.

In a 2012 report by the Health and Human Services’ inspector general, the agency recommended that Medicare officials stop using the drug because it was so costly, noting there was a cheaper and equally effective alternative called Avastin. In 2010, Medicare approved $1.1 billion in reimbursements for Lucentis, a drug manufactured by Genentech.

http://www.miamiherald.com/2013/02/07/3222772/so-fla-eye-surgeon-under-scrutiny.html