Frank A. Rubino, ESQ.

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Florida opthamologist accused of Medicare fraud

An ophthalmologist based in West Palm Beach, Florida, is hailed by some as a revolutionary eye doctor whose treatments have benefited them. Testimonials to his capability have come from patients including a successful Miami journalist. However, the U.S. Health and Human Services Department takes a different view, accusing the doctor of Medicare fraud.

The doctor, 59, has been investigated by the FBI in tandem with a grand jury investigation for over a year. The investigators claim that he provided treatments that were unnecessary for patients and then billed Medicare for them. If true, that would be a fraudulent action.

The key treatment in question is one using an expensive drug called Lucentis. It is designed to improve a condition called wet macular degeneration. The condition involves fluids leaking and damaging vision, and Lucentis is meant to block that from happening.

One disagreement in the case is about the amount of drug that was used compared to how much should be used. An audit asserts that one vial of the drug should provide a single dose for one patient at a cost of $2,000. The doctor is accused of multidosing, treating four patients with each vial of the drug and billing Medicare $8,000.

That practice is still under investigation, specifically regarding 2007 and 2008. After temporarily suspending reimbursements to the doctor's clinic, Medicare reinstated them. However, both sides are still disputing $9 million in reimbursements, with the doctor asserting that those are legitimate and still due to his company. The legal wrangling over that sum is expected to be ongoing for some time.

The doctor's associations, including with prominent politicians, are also being looked into. Investigators want to know if there any aspects of those associations that could have an effect on the case.

Medicare fraud is a serious issue. The program affects millions of people, with hundreds of millions of dollars at stake. Anyone accused of Medicare fraud is advised to seek an attorney right away so that they can build a strong legal defense.

Source: Miami Herald, "Despite federal probe, patients of Palm Beach County eye doctor see him as ‘godsend’" Jay Weaver, Dec. 15, 2013

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