Who is fleecing Medicare and Medicaid? The answer might surprise you

There is a serious misconception about Medicare and Medicaid fraud in WV and elsewhere. Many people believe that the primary abuse of the system is by benefit recipients. While there are some who “scam” the system, the primary culprit of Medicare and Medicaid fraud are doctors and hospitals. Each year, billions of dollars are stolen from Medicare and Medicaid from greedy hospitals and doctors when they bill for unnecessary procedures, “up code” or otherwise take advantage of a recipient’s benefits. Consider the case of Florida ophthalmologist, Salomon Melgen, M.D., who milked the system of over $100 million in false claims to Medicare for medically unnecessary procedures. Dr. Melgen is but one example of a greedy physician who stole millions from tax payers. There are many, many more. But, greedy healthcare providers typically go unnoticed and the public is led to believe Medicare and Medicaid recipients are to blame for the systems’ failures.

Florida physician convicted on 67 counts of Medicare fraud

by Ayla Ellison

After three days of deliberation, a jury convicted Salomon Melgen, MD, a Florida ophthalmologist, on 67 counts of Medicare fraud Friday, according to Politico.

The government alleged the 62-year-old physician submitted more than $100 million in false claims to Medicare for eye procedures that were medically unnecessary or never performed.

Dr. Melgen first made headlines for his billing practices in 2014 when CMS released data showing he was the No. 1 recipient of Medicare dollars in the U.S. in 2012, receiving $20.8 million in Medicare Part B reimbursement. After he was arrested in 2015, federal prosecutors described his practice as a “high-volume operation,” where patient files included false information and fraudulent billing submissions.

Sentencing in the healthcare fraud case is slated for July 14, and a federal prosecutor told Politico sentencing guidelines call for the physician to spend 15 to 20 years in prison.

Although the fraud trial is over, Dr. Melgen’s legal troubles are far from over, as a joint trial for him and Democratic New Jersey Sen. Robert Menendez is set to begin in August.

The pair was indicted in 2015 over allegations Sen. Menendez improperly used his office to help Dr. Melgen in exchange for hundreds of thousands of dollars in gifts. Prosecutors allege the senator performed many favors for Dr. Melgen, including intervening with a federal probe into the physician’s billing practices, according to Politico.

Sen. Mendedez has denied any wrongdoing.


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