Two Florida physicians who were Medicare’s top-paid doctors in 2012 are also major contributors to the Democratic Party. The two physicians have turned to top Democrats in recent years for help in defending themselves against suspicions of Medicare fraud.
Dr. Salomon E. Melgen, a Florida ophthalmologist, was the top-paid Medicare physician in 2012, receiving $21 million from the government insurer. Most of Melgen’s billings were for Lucentis, a medication used for treating macular degeneration. Genentech, Lucentis’ manufacturer, pays large rebates to physicians who use their product.
Melgen donated over $700,000 to Majority PAC, a super PAC run by former aides to Nevada Democrat Harry Reid, senate Majority Leader. The super PAC spent $600,000 of that money to help reelect New Jersey Democratic senator Robert Menendez, a close friend of Dr. Melgen’s.
Sen. Menendez was a target of investigators last year after he interceded with federal officials on Dr. Melgen’s behalf when Melgen was being scrutinized by Medicare. The examination began after a government contractor noticed that he was billing for significantly higher amounts of Lucentis than his peers. The Justice Department investigation determined that Melgen overbilled by $9 million, which he had to pay back.
Mendez admitted in the investigation against him that in 2009 he had contacted the director of Medicare regarding Melgen’s $9 million overpayment bill, and had also brought up the issue in a 2012 meeting with the acting head of Medicare.
Federal lawyers accused Dr. Melgen of gaming the system by billing three to four times the actual cost of Lucentis. Investigators found that Melgen was using one $2,000 vial to treat up to four patients, but billing as though he used a new vial each time. Melgen’s clinics have been raided by FBI agents twice, and at one time he was suspended from the Medicare program. He was reinstated and is once again approved to receive Medicare payments.
Another top-paid Medicare doctor with close Democratic political ties is Dr. Asad Qamar, a Florida interventional cardiologist paid over $18 million by Medicare. Dr. Qamar donated at least $250,000 over the past 10 years to help fund the political campaigns of President Obama and other top Democrats. He is also being watched in regard to high billing volumes.
Qamar has been under prepayment review by Medicare officials, which entails detailed audits of all his billings before payment is authorized. This step is typically taken after Medicare picks up patterns that lead them to suspect inappropriate billing.
At the same time Qamar was donating to Democratic candidates, his attorneys helped him contact over a dozen members of Congress, asking them for help in addressing his examination by federal government auditors. He asked the Congressional lawmakers to help him get Medicare to back off.
28 of the 100 highest paid Medicare doctors are from Florida. Doctors in the state have also been the targets of numerous Medicare fraud investigations. A number of the top-paid physicians have been under investigation for possible overpayments.
The pattern of large political donations and high payments from Medicare became public this week when physician payment records were released for the first time by the Department of Health and Human Services. The department released the records, which identify the top-paid Medicare doctors, after years of refusing to make the data public.
By Beth A. Balen