Statistician: Government used faulty extrapolation in $100M Medicare fraud case

Federal prosecutors claim Salomon Melgen, MD, a Florida ophthalmologist who was convicted on 67 counts of healthcare fraud earlier this year, submitted more than $100 million in false claims to Medicare. However, an expert hired by defense counsel challenged the government's method for calculating the false claims at a sentencing hearing Wednesday.

The government said it examined a random sample of 310 patients to determine Dr. Melgen submitted more than $100 million in fraudulent claims to Medicare. At the hearing this week, Donna Mohr, PhD, a statistician and former University of North Florida professor, testified that the sample of claims wasn't random, making the extrapolation inaccurate, according to the Palm Beach Post.  

During Dr. Melgen's trial, one of the most egregious cases cited by prosecutors involved Dr. Melgen billing Medicare for treating a patient's prosthetic eye. According to Dr. Mohr's testimony this week, it appears the government added that patient to the group that was supposed to be a random sample.

Based on Dr. Mohr's testimony, Dr. Melgen's attorneys argued the government has only proven the physician stole $64,269 from Medicare, according to the report.

Although Dr. Melgen has already been convicted on all counts, the amount he stole will be used to determine the length of his sentence. Dr. Melgen was originally scheduled to be sentenced this week, but the judge has now ordered both sides to return to court again before he is sentenced, according to the report.

More articles on legal and regulatory issues:

Prosecutors charge 4 physicians in $146M healthcare fraud scheme
Former head of IT accused of stealing $800k from California health clinics
Whistle-blower: California managed-care company improperly denied care to thousands





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