In a prior post, we blogged about the Third Circuit’s ruling that the political case against Senator Bob Menendez can proceed to trial. Now, in a separate civil matter, the U.S. Court of Appeals for the Eleventh Circuit has denied a rehearing en banc to the Florida opthamologist from whom Menendez allegedly solicited and received bribes.
Vitero Retinal Consultants, a clinic owned by Dr. Salomon Melgen, challenged a Medicare Appeals Council decision that the Centers for Medicare & Medicaid Services overpaid the clinic more than $9 million by extracting multiple dowses of the macular degeneration drug, Lucentis, from a single-dose vial. In September 2014, the U.S. District Court for the Southern District of Florida (Judge Marcia G. Cooke) upheld the Council’s decision. A three-judge panel affirmed, rejecting the clinic’s argument that Medicare has established a practice of reimbursing for other multi-dosed drugs with a “single use” instruction. According to the Court, the “single use” instruction for those other drugs was intended to prevent doctors from administering medications stored past the acceptable eight-hour timeframe. Lucentis, in contrast, has a label that states each vial should, under all circumstances, be used just once, and any excess should be drawn into a syringe and expelled.
The clinic petitioned the Court for a rehearing en banc, arguing in part that the panel’s ruling permitted CMS to supervise the “manner in which medical services are provided . . . ,” in violation of the Social Security Act, by making a determination as to the propriety of administering multiple doses of Lucentis. The Eleventh Circuit (Judge Robin S. Rosenbaum) issued an order denying the petition without an accompanying opinion.
Melgen faces separate criminal charges for the alleged overbilling and bribery of Senator Menendez in the U.S. District Court for the Southern District of Florida.
More White Collar blogs can be found here.
As COVID-19 continues to spread globally and throughout Pennsylvania, most employers will be faced with the question of how to respond when an employee tests positive, or has exposure to the coronavirus, and will need to determine when those employees can safely return to work. In part, it depends on whether the employee has simply… Read more »Read More
Partner Marc S. Raspanti will be speaking at the Health Care Compliance Association’s virtual 2020 Healthcare Enforcement Compliance Conference in November. During the three-day conference, attendees will hear first‑hand from government officials about regulatory changes, expectations, and key priorities in the Healthcare Enforcement sector. Attendees can further gain the knowledge and skills needed to properly… Read more »Read More
Nationally-recognized False Claims Act Attorney Pamela C. Brecht will present “The False Claims Act and Dealing with Whistleblowers” at Seton Hall University School of Law on Wednesday, October 14, 2020. Ms. Brecht, Chair of the Firm’s Qui Tam & False Claims Act practice, will be co-presenting with Morgan Lewis Partner Meredith S. Auten. For more… Read more »Read More
Pietragallo Gordon Alfano Bosick & Raspanti, LLP Partner Pamela Coyle Brecht will present “The False Claims Act Update” at the Pennsylvania Bar Institute’s (PBI) A Day in Health Law program on October 28, 2020 in Philadelphia, Pennsylvania. A Day on Health Law is a one-day, six-hour spin-off of PBI’s annual Health Law Institute. The Health… Read more »Read More