After fraud trial, Melgen faces corruption case, several civil trials

Palm Beach Post (FL)

April 28--WEST PALM BEACH -- Dr. Salomon Melgen returned to his waterfront home near Juno Beach on Thursday, still waiting for a federal jury to decide whether he is guilty of 76 charges of health care fraud.

But while the 12 jurors who have deliberated for nearly 15 hours over two days will return to U.S. District Court today, even when they reach a verdict in the $105 million Medicare fraud case, the 62-year-old ophthalmologist's legal woes will be far from over.

He faces corruption charges in New Jersey, with his longtime friend, U.S. Sen. Robert Menendez. A trial that is likely to snare headlines nationwide is expected to be held in Newark in the fall. Prosecutors there claim Melgen showered the Democratic lawmaker with campaign contributions and free trips in exchange for favors, including intervening in his ongoing fight with federal health regulators and helping him get mistresses into the country.

Further, more than a half-dozen of Melgen's former patients have filed civil lawsuits against him in Palm Beach County Circuit Court, accusing him of medical malpractice. One lawsuit was settled for a reported $155,000, federal prosecutors said in court papers.

Attorney Michael Brown watched parts of the two-month criminal trial. He said he was gathering information for additional medical malpractice lawsuits against Melgen, who specialized in treating people for age-related macular degeneration at clinics in West Palm Beach, Wellington, Delray and Port St. Lucie.

In addition, American Express is suing Melgen, claiming he owes it nearly $228,660 for unpaid charges on Centurion and Platinum business credit cards, court records show.

Despite his legal problems, Melgen has looked upbeat throughout the trial and jury deliberations.

Fort Lauderdale attorney Richard Doyle, who is representing six of Melgen's former patients, said he and his clients have been watching the criminal trial closely. "My clients are very elderly and anxious to see the results of this," he said.

Some of their allegations turn on drugs prosecutors claim Melgen gave patients as part of his scheme to defraud Medicare. Some lawyers privately questioned whether any money would be left for patients if Melgen is found guilty and the government seizes his money. But, Doyle said, he isn't worried.

"He has insurance," he said simply.

Like prosecutors, Doyle is focusing on drugs Melgen used to treat patients for the malady that attacks the retina, slowly robbing the elderly of their vision.

Four of the cases involve Melgen's practice of using a single vial of Lucentis on multiple patients, a practice known as multi-dosing. In the criminal case, prosecutors claimed Melgen violated federal rules that bar multi-dosing because he discovered it was an easy way to increase his profits. Instead of being reimbursed roughly $2,000 for using a vial on a single patient, he was reimbursed as much as $8,000 by using it on four patients, they claim.

In Doyle's lawsuits, he claims Melgen's practice of multi-dosing caused patients to lose their eyesight. Because the drug wasn't properly sterilized before it was used again, the interior of the eyes of several patients became inflamed causing them to to lose their vision entirely, he claims in the lawsuits.

He makes similar allegations about the way Melgen dispensed another medication used to treat macular degeneration. While the Department of Veteran's Affairs issued warnings that the drug, Avastin, should not be put in individual syringes at compounding pharmacies because it could be contaminated, Melgen continued to do so. His three clients lost vision in their eyes as a result, he wrote.

Attorney Michael Petruccelli, who is representing Melgen in the lawsuits, denied the allegations in court papers. Melgen, he claims, had no control over the compounding pharmacies.

In closing arguments Monday in the criminal trial, Melgen's attorney Matthew Menchel insisted that such medical malpractice suits were the appropriate way to resolve any complaints about the physician's methods. While admitting Melgen may have made mistakes, Menchel said he didn't commit any crimes.

"This is the craziest health care fraud case," Menchel told jurors. "This has been treated like a medical malpractice case."

Prosecutors repeatedly talked about "standard of care" and Melgen's failure to follow accepted medical practices, he said. But, he said, that's the test for medical malpractice not a criminal prosecution.

Prosecutors countered that Melgen intentionally failed to follow acceptable protocols to maximize profits. He repeatedly billed Medicare for unreadable diagnostic tests and treatment of people with prosthetic, blind and shrunken eyes, said Assistant U.S. Attorney Alexandra Chase. He gave patients injections of Lucentis even though medical experts said there was no evidence they had the disease.

"Mistakes happen once or twice but when it happens over and over again, you know it's deliberate," she said. "He created and perfected a system where he could defraud Medicare out of millions and millions of dollars."

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