Lacking Vision

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Macular degeneration is the leading cause of vision loss and impacts more than 10 million Americans. The progressive disease causes the central portion of the retina to deteriorate, making it very difficult to read, drive, recognize faces or colors, or see details. A West Palm Beach, Florida eye doctor committed Medicare fraud by misdiagnosing his patients with this devastating disease. He treated them for a condition they didn’t have and sent the $73 million bill to the federal government healthcare program. (He was obviously near-sighted and could not see ahead to the punishment he would receive for his illegal acts.)

First, let’s back up a bit to give you a different perspective on this man’s crime. It may not have come into focus without his involvement in a federal trial related to a friend, who happened to be a New Jersey senator. The eye doctor was known for contributing to politicians on both sides of the aisle, but after several trips and large donations to the senator’s campaign, he found himself under the government’s magnifying glass.

The eye doctor hosted a Democratic fundraiser in his spacious mansion in North Palm Beach, donating $32,000 to a close friend, the New Jersey senator. The eye doctor also flew the political friend by private jet to the Dominican Republic and shuttled him to France as well. After the extravagant trips became public knowledge, the senator reimbursed the eye doctor for $58,500. (It’s amazing how fast indiscretions become rectified when public knowledge makes everything clear.) The eye doctor and his friend were charged with bribery and fraud, but a hung jury effectively ended the NJ federal court trial. (But, even though the eye doctor left the court house with rose colored glasses on, it wasn’t long before he donned dark shades to hide from more accusations.)

So how did the eye doctor fund the trips and the luxurious trips? (You guessed right — Medicare fraud.) Through his St. Lucie and Palm Beach offices, the eye doctor routinely diagnosed patients with medical conditions they did not have so he could prescribe diagnostic procedures and medical services that were not medically necessary or needed. This illegal practice allowed him to become one of the largest Medicare billers in the nation, even though his diagnoses were unsupported by medical records. (That means he had a target on his head. It’s a given that the government was examining his practice to find out why he was the top biller.)

The eye doctor was found guilty by a West Palm Beach jury of 67 counts of healthcare fraud. He was sentenced to 17 years in prison and ordered to serve three years of supervised release after his prison sentence is complete. He also must pay $42,561,205 in restitution. (Apparently, the government had eyes in the back of its head and saw everything that went on.)

 This man was a typical fraudster who became over-confident in his abilities to live larger than the law. (While the optometry jokes are getting cornea and cornea, it’s sobering to see what a spectacle this once wealthy man made of himself.) He must have been blind to the ramifications of his illegal actions and will most likely be shedding a lot of tears over the next 17 years while behind bars.

 Today’s “Fraud of the Day” is based on an article entitled, “Eye doctor is sentenced in $73 million Medicare fraud,” published by the Miami Herald on February 22, 2018.

Florida eye doctor Salomon Melgen learned Thursday that $73 million of attempted Medicare fraud equals 17 years in federal prison.

Melgen’s sentence after a federal jury in West Palm Beach found him guilty of 67 counts of healthcare fraud and also includes a preliminary order of restitution of $42,561,205 and three years of supervised release after prison.

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Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.