doctor "earns" $21 mil/year billing medicare

[OBLAMA2009]

it looks like medicine has become a good profession again:

http://www.nytimes.com/2014/04/10/b...billings-is-no-stranger-to-scrutiny.html?_r=0

 

[Jimzz]

That and big Pharm was helping as well...

The doctor billed mostly for Lucentis, a medication used to treat macular degeneration made by a company that pays generous rebates to its doctors.

 

[Newell Steamer]

It's OK - because he is going to totally use that to create jobs.

 

[senseamp]

Sunshine is the best disinfectant. BTW, it was Obamacare that made this information public, not sure why GOP opposed it, or maybe they just haven't got around to it...

 

[MrPickins]

That and big Pharm was helping as well...

The doctor billed mostly for Lucentis, a medication used to treat macular degeneration made by a company that pays generous rebates to its doctors.

That is something that should be banned.

Giving kickbacks to doctors for prescribing drugs that are billed to Medicare sounds like fraud to me...

 

[Sunburn74]

Florida has a long track record of all sorts of seedy behavior by physicians. They are still dealing with their pill farm scandals. With this particular doc, he was prescribing to patients a non-generic very expensive medication with medicare footing the bill. Its unclear why he was prescribing this particular medication as opposed to generic medications (which are generally cheaper). Its possible the drug was slightly better, I really am not sure. However, it appears that he was financially profiting from the use of these agents through the form of rebates from the drug company making this drug.

Kickbacks (direct payments for prescribing drugs) are generally illegal in this country. However, there are all sorts of ways a doc can profit from a drug company without direct payment (giving paid talks to other doctors for example). I'm not really sure how these rebates work, but it does sound very seedy indeed. Long story short, it sounds like he didn't do anything illegal, but I think that it could be considered unethical. If he simply sold the medication to patients as the best drug for them, without telling them that he was financially profiting from it, I think then he probably acted unethically.

 

[soulcougher73]

It's OK - because he is going to totally use that to create jobs.

I laughed

 

[bshole]

That and big Pharm was helping as well...

The doctor billed mostly for Lucentis, a medication used to treat macular degeneration made by a company that pays generous rebates to its doctors.

That is absolutely fucking disgusting. This POS should be banned from medicine and Lucentis should be fined multiple billions of dollars.

 

[Anubis]

That is something that should be banned.

Giving kickbacks to doctors for prescribing drugs that are billed to Medicare sounds like fraud to me...

most kickbacks are banned. i actually thought they all were

FFS drug reps cant even take docs out to lunch/dinner anymore. not sure what this dude has going on

 

[boomerang]

it was Obamacare that made this information public, not sure why GOP opposed it

Didn't see anything about that in the article. What have you got that Obamacare brought this to light and what have you got on the GOP opposing it?

 

[boomerang]

most kickbacks are banned. i actually thought they all were

FFS drug reps cant even take docs out to lunch/dinner anymore. not sure what this dude has going on

The link in the article about kickbacks points to an article from November of 2010.

 

[Genx87]

I have no idea of this guy's guilt. But does anybody else think it is wasteful for a multi-dose medication to be thrown out per Medicare rules?

 

[Attic]

That is something that should be banned.

Giving kickbacks to doctors for prescribing drugs that are billed to Medicare sounds like fraud to me...

You just aren't duplicitous enough to rationalize it properly.

/s


It's fraud/wrong, glad this guy is exposed.

 

[BoberFett]

I'm sure this is all the Republican's fault, as everything bad in the universe is from stubbed toes to stars going supernova, but part of the corruption investigation is this doctor's involvement with a Democrat senator.

Dr. Melgen donated more than $700,000 to Majority PAC, a super PAC run by former aides to the Senate majority leader Harry Reid, which then spent $600,000 to re-elect Mr. Menendez. Mr. Menendez also publicly and privately helped his friend with business disputes. The senator made calls on Mr. Melgen’s behalf to the Department of Health and Human Services in the dispute over the injection dosing and advocated on behalf of the doctor during a Senate hearing into a port security contract in the Dominican Republic.

I don't believe it. I think it was the Koch Brothers, framing these poor, innocent advocates for the downtrodden.

http://www.menendez.senate.gov/issues/health-care

Senator Menendez was instrumental in shaping health insurance reform, securing provisions he authored to end insurance industry abuses, promote women and children’s health, and provide for a robust health care delivery system to meet the needs of all New Jerseyans.

Senator Menendez strongly believes that all Americans regardless of age, race, gender or socioeconomic status, should have access to affordable comprehensive health care. He will continue to stand up for policy solutions that will strengthen America's health care system by increasing both access and quality, while reducing costs.

As long as his buddy was a Democrat, I'm sure this was all a big misunderstanding. Nothing to see here

 

[Slew Foot]

Technically medicare didnt pay him, they simply reimbursed the cost of the medication. Its not unusual for monoclonal antibodies ( any drug that ends in mab) to cost 20k or more per dose. Do 50 a year and bam, youve billed a million bucks but you dont get to keep any of it. The payments from the drug company seem illegal, like was said earlier, drug companies cant hand out pens anymore(unless youre a politician) so im nit sure how this guy git anything.

 

[ivwshane]

Sunshine is the best disinfectant. BTW, it was Obamacare that made this information public, not sure why GOP opposed it, or maybe they just haven't got around to it...

Interesting claim, do you have a link or more info about this? I'd search myself but I don't even know what search terms I would use to research this myself.

 

[MomentsofSanity]

Interesting claim, do you have a link or more info about this? I'd search myself but I don't even know what search terms I would use to research this myself.

http://www.washingtonpost.com/blogs...ays-unprecedented-medicare-pricing-data-dump/

Also interesting in this other link about the data dump.

http://www.washingtonpost.com/busin...01a77e-bf39-11e3-b574-f8748871856a_story.html

What may be most interesting about Melgen’s practice, however, is that he could have used a much cheaper drug than Lucentis — one called Avastin that many ophthalmologists consider an equivalent.

Had he used the cheaper alternative, his bill to Medicare for the shots would have dropped from $11.8 million to less than $500,000.

 

[Jimzz]

I have no idea of this guy's guilt. But does anybody else think it is wasteful for a multi-dose medication to be thrown out per Medicare rules?

The rule is if you bill for the FULL dose you use it or throw it away. What he was doing was using it twice, allowed per the medication, but billing as though he used 1 multi-dose on each patient.

So the rule is you don't have to throw it away you can't double bill. If you bill for the full dose then you have to throw it away as you have been paid in full for it and you are not supposed to bill for that same dose again.

I think that was part of the 9million he had to pay back.
"Dr. Melgen was forced to pay back $9 million he was suspected of overbilling."

 

[Wreckem]

Just reading the NY times article it appears the "rebates" are volume discounts and volume discounts are legal as long as certain guidelines are met. 300 Drs were getting said volume discounts. Not just this guy. It doesn't appear anything was done illegally by the pharma company.

The one drug is $2000 an injection(1 injection a month), the alternative is $50 and works the same as the $2000 but isn't approved to treat the condition and has to be used off label. Govt bureaucracy at its finest.

 

[Wreckem]

http://www.washingtonpost.com/blogs...ays-unprecedented-medicare-pricing-data-dump/

Also interesting in this other link about the data dump.

http://www.washingtonpost.com/busin...01a77e-bf39-11e3-b574-f8748871856a_story.html

The Govt hasn't approved the cheaper version as a treatment of macular degeneration, which is probably why the second drug exists in the first place. The govt can't really argue nor force a Dr to use a treatment the govt hasn't approved more so when the off label drug has more serious adverse reactions at a higher frequency(probably why it won't ever be approved).

 

[cubby1223]

http://www.washingtonpost.com/blogs...ays-unprecedented-medicare-pricing-data-dump/

Interesting that it was the publisher of the Wall Street Journal, a News Corp company, who is responsible for bringing about the lawsuit which forced medicare information to be public, because they wanted to investigate medicare fraud.

Obamacare seems to have absolutely nothing to do with this, despite the claim made in this thread. The Obama administration was fully content with keeping that information locked up the same as it had been since the Carter administration.

 

[Hayabusa Rider]

Didn't see anything about that in the article. What have you got that Obamacare brought this to light and what have you got on the GOP opposing it?

He's lying again.

From the Washington post link someone provided.

You would think that a publicly-funded program would have been pretty transparent about its data, but this information had been off-limits dating to 1979. That's when a federal injunction stopped Medicare from releasing physician-identifying information, but a federal judge overturned the injunction last year in a lawsuit brought by Dow Jones, thus bringing us today's data dump from CMS.

If he can show that Dow Jones is Obamacare then he would be telling the truth, but it's not and he isn't.

 

[Hayabusa Rider]

Sunshine is the best disinfectant. BTW, it was Obamacare that made this information public, not sure why GOP opposed it, or maybe they just haven't got around to it...

No tale too tall if it forwards your agenda, eh?

 

[ivwshane]

http://www.washingtonpost.com/blogs...ays-unprecedented-medicare-pricing-data-dump/

Also interesting in this other link about the data dump.

http://www.washingtonpost.com/busin...01a77e-bf39-11e3-b574-f8748871856a_story.html

Thanks for the link! I see this a good thing even if it didn't come from the ACA.

Sorry senseamp, four Pinocchio's

 

[Hayabusa Rider]

Thanks for the link! I see this a good thing even if it didn't come from the ACA.

Sorry senseamp, four Pinocchio's

Yep it is good. No one needs that POS doctor. A thorough investigation and if the evidence warrants (and it will be hard to imagine it won't) then a loss of license, severe financial penalties and jail.

No sir, I don't like it.