Bribery Trial Testimony Focuses on Melgen’s Billing for Lucentis

October 6, 2017: By Joan McKenna

legal issuesTestimony in the fifth week of a federal bribery trial against Sen. Robert Menendez, D-New Jersey, and retina specialist Salomon Melgen, MD, focused on Melgen’s billing practices for Lucentis.

Prosecutors in the case claim that Menendez tried to intervene in Melgen’s $8.9 million billing dispute with Medicare by asking senior health officials to consider whether billing policies should be changed.

Menendez received gifts and campaign contributions from Melgen in return, US attorneys allege.

The Centers for Medicare and Medicaid Services (CMS) accused Melgen of overbilling Medicare $8.9 million in 2007 and 2008 by charging the government per eye patient, even though he repackaged single-use Lucentis vials into multiple syringes to treat several patients in a practice called multidosing. Medicare’s policy is to reimburse doctors per vial.

The cost of Lucentis in the US is about $1,900 per vial. A single-use vial holds extra solution, which Melgen used to treat two or three other patients, rather than throwing away potentially thousands of dollars in product. At issue in the case is the fact that he sought Medicare reimbursement for the number of patients treated rather than the far lower number of Lucentis vials used.

In May 2016, Melgen’s attorneys argued before a federal judge that dose splitting is common throughout medicine and Medicare would have paid $1,900 per injection if Melgen used a fresh vial for each patient.

Witnesses testifying for the prosecution Oct. 3 included former CMS head Marilyn Tavenner, who said she was not aware of any other doctor billing Medicare in the way Melgen did, according to The Associated Press.

Menendez met separately with Tavenner and former health secretary Kathleen Sebelius in 2012, asking them to reconsider the billing policy, they both testified. They declined to do so.

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