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    Retina surgeon’s AMD regimen at center of Medicare fraud case

    Editor’s Note: Welcome to “Eye Catching: Let's Chat,” a blog series featuring contributions from members of the ophthalmic community. These blogs are an opportunity for ophthalmic bloggers to engage with readers with about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Adam Berger, MD. The views expressed in these blogs are those of their respective contributors and do not represent the views of Ophthalmology Times or UBM Medica.

    Earlier this month, a jury convicted West Palm Beach retina surgeon Solomon Melgen, MD, on 67 counts of Medicare fraud. This high-profile case hit very close to home, as myself and another retina specialist from my own community were on opposing sides of the case.

    Michael J. Tolentino, MD, testified for the defense team. Meanwhile, I was asked to testify as an expert witness for the prosecution. Until recently, we were in practice together at The Center for Retina & Macular Disease, Winter Haven, FL. Dr. Tolentino is no longer with the practice. Neither of us accepted a fee for our testimony. (Editor's Note: Dr. Tolentino was not paid for his testimony, but was paid a "retainer fee" pre-trial.)   

    According to Dr. Tolentino, there was a principle at stake.

    Related: Ophthalmologist pleads guilty to fraud charges

    In his sworn testimony, he said, “Nobody can tell you what to do as a doctor. A lot of medicine is in your gut. And if somebody tells me that I can't do this and I can't do that . . . , and I know in my gut that this is the best thing for the patient, well, guess what? That offends my principle; and that's why I'm not taking a fee.”

    I saw it much differently.

    It’s one thing to study innovative treatments in a controlled clinical trial with institutional review board (IRB) oversight, informed consent, a proper control group, and safety monitoring.

    It’s quite another to treat patients with unproven, experimental procedures without their knowledge or consent, and then try to trick Medicare into paying for it by billing for it under a different code. That is exactly what Dr. Melgen was doing.

    Unfortunately, this scam is not unique. Last year, I testified against David M. Pon, MD, who earlier this year was sentenced to 10 years in federal prison in a similar fraud case.

    Charging for multi-dosing

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