Insurance Fraud NEWS
Witness stunned by tests allegedly ordered by Florida doc
April 20, 2017, Clearwater, FL
A Clearwater retinal specialist who is defending Dr. Salomon Melgen performed a miniscule number of tests and procedures on his own patients compared to the tens of thousands of tests ordered by the Palm Beach County ophthamologist who is accused of bilking Medicare out of as much as $105 million.
While Dr. Dana Deupree on Tuesday continued to insist that Melgen’s methods were justified, he was surprised to learn how rarely he had ordered similar tests for his own Medicare patients.
For instance, while both treated about 2,300 patients from 2008 to 2013, Melgen billed Medicare 52,673 times for a particular test. By comparison, federal prosecutors said, records showed that during the same six years Deupree submitted 1,579 claims to the federal insurer for the same test.
The number of bills each submitted to Medicare for a scan to determine if elderly patients suffered from wet macular degeneration was even more lopsided. Assistant U.S. Attorney Roger Stefin said the federal agency received 52,111 claims from Melgen compared to the 43 it received from Deupree.
“I thought it would be more,” Deupree said of his own billing records.
Deupree’s testimony comes as the six-week-long trial against Melgen on 76 charges of health care fraud is winding down. He is to be the last witness called by Melgen’s defense team. The case is expected to go to the jury next week.
The wealthy, politically-connected physician also faces corruption charges in New Jersey with his longtime friend, Democrat powerhouse U.S. Sen. Robert Menendez.
Throughout the trial in federal court in West Palm Beach, Stefin and other prosecutors have argued that Melgen, 62, used a cookie-cutter approach, ordering the same often antiquated tests and procedures for patients simply as a ruse to rake in millions from Medicare.
Operating clinics in West Palm Beach, Wellington, Delray Beach and Port St. Lucie, Melgen diagnosed 75 percent of his Medicare patients with wet macular degeneration, a relatively rare malady that robs the elderly of their vision. Some were under 60, an age group that is rarely afflicted with the disease, and some were black, another group where such a diagnosis is infrequent, medical experts hired by the prosecution have told jurors.
Under friendly questioning on Monday by Melgen’s attorney, Matthew Menchel, Deupree said that Melgen’s combination treatment of patients may have been unconventional but is slowly gaining acceptance. Like Melgen, he said he has begun using both lasers and drugs in hopes of saving eyes ravaged by wet macular degeneration.
But during the six years that prosecutors are focusing on to prove Melgen defrauded the federal insurer, Deupree performed far fewer laser treatments than Melgen. He billed Medicare for performing 83 laser treatments during those years. Melgen sent the agency 12,500 claims.
Medical experts described the painful treatments as unnecessary redundancies since drugs were discovered in 2005 that stem the progression of the disease. But, Deupree said, he has discovered that using low intensity lasers along with the drugs provides a powerful punch.
Under questioning by Stefin, he acknowledged that the machine he uses to zap ailing eyes with low intensity lasers is different than the one Melgen was using.
Deupree met Melgen in the mid-1980s in Boston, where both trained under famed retinal specialist Charles Schepens, and said he has served as a consultant for Melgen’s various legal teams for about four years.
He was hired to help Melgen in his unsuccessful fight against the Centers for Medicare & Medicaid Services over Melgen’s practice of using one vial of the drug Lucentis to treat as many as four patients, a practice known as multi-dosing. Then, he said, he was hired by Melgen’s criminal defense team. So far, he said, he has been paid about $135,000.
Source: Palm Beach Post