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.

Need Deeper Analysis? Sign up for Market Scope's monthly newsletter to get in-depth coverage of the ophthalmic market, including quarterly procedure volumes based on survey data and meeting coverage from around the world.

Recent Ophthalmic News

Imprimis Offers Compounded Alternative to Restasis for Dry Eye

US District Court Invalidates Four Restasis Patents

BioTime Prices $25 Million Public Offering of Common Stock

Gemini Completes $42.5 Million Series A Financing for Dry AMD Treatment

BIOPHYTIS Raises €10.4 Million to Develop Anti-Aging Drugs, One for Dry AMD

Amydis Receives $530 Thousand NIH Award to Advance Ophthalmic Diagnostic Probes

Realm Announces Completion of $26 million Private Placement

Sight Sciences Secures $10 Million in Oversubscribed Series C Financing

Aerpio Names Stephen Hoffman CEO; Founder Joseph Gardner Remains President

FDA Advisory Panel Recommends Aerie’s Rhopressa for Glaucoma Patients

FDA Panel Unanimously Backs Spark’s Luxturna as Retinal Gene Therapy

PanOptica Secures $11 Million to Advance Topical Anti-VEGF Eye Drop for Neovascular AMD

Nicox and pSivida to Collaborate to Develop a Sustained Release Drug to Lower IOP

Azura Nets $16 Million in Series B Funding for Dry Eye Treatment

Alcon’s AcrySof Intraocular Lens Reaches 100 Million Implants

Notal Vision’s ForeseeHome Reaches Milestone of 3 Million Tests

FDA to Review Spark’s Retinal Gene Therapy Candidate Oct. 12

Alcon’s AutonoMe IOL Injector Gains CE Mark Approval

Shire Sues Allergan, Claiming Bundling Tactics Block Restasis Competitors

Allergan Decries ‘Unfair’ Patent Challenge Process as US House Launches Probe of Tribe Deal

Coming soon

2017 Refractive Surgery Report: A Global Market Analysis for 2016 to 2022