Medicare Fraud With Help From Washington

Medicare fraud hurts everyone. It hurts even more when a Washington insider is assisting in the fraud. Democrat Sen. Robert Menendez, already under suspicion of sexual indiscretions with underage females, now finds the Medicare fraud investigation is widening while the noose is tightening.

Menendez (D-N.J.) initially contacted federal officials in 2009 about the government’s audit of Salomon Melgen, complaining to the director overseeing Medicare payments that it was unfair to penalize the doctor because the billing rules were ambiguous, the aides said.

Last year, in a meeting with the acting administrator of the agency in charge of Medicare and Medicaid, Menendez again questioned whether federal auditors had been fair in their assessment of Melgen’s billing for eye injections to treat macular degeneration, the senator’s aides said.

The agency had ordered Melgen to repay the $8.9 million

Washington Post

But wait. There’s more.

Menendez, who became chairman of the Senate Foreign Relations Committee this month, is under scrutiny because of his close relationship with Melgen. The doctor donated more than $700,000 last year to Menendez’s reelection campaign and other Senate Democrats. And when Melgen needed help with a port security contract in the Dominican Republic last year, Menendez urged U.S. officials to press the country to carry out the multimillion-dollar agreement.

Menendez is facing a Senate ethics inquiry about two free trips he took in 2010 on Melgen’s private plane to the doctor’s seaside mansion in the Dominican Republic. Menendez acknowledged this month that he had not properly disclosed the trips

Power can corrupt. Medicare fraud is still theft.

Federal investigators and health-care auditors have had concerns about Melgen’s billing practices at various times over the past decade, two former federal officials said. In part, they have examined the volume of eye injections, surgeries and laser treatments performed at his West Palm Beach clinic.

Past decade?

How incompetent are these auditors?

At issue in the reimbursement dispute is Melgen’s multiple use of individual vials for eye injections to treat macular degeneration. Federal auditors have said Melgen often billed the government three to four times for injections from a single vial, according to two federal officials and lawyers familiar with the case.

The government’s Medicare program reimburses providers $2,000 for each vial, so Melgen was billing $6,000 to $8,000 for each vial.

Melgen’s attorneys said the doctor was properly billing for treating four patients with medical injections, albeit from one vial.

Splitting hairs to justify taking advantage of the taxpayer.

Medicare fraud is rampant, and even worse when Washington cronyism is suspected.