Endangering Lives

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18237674 - doctor

The government takes fraud very seriously, especially when it involves endangering the lives of American citizens. For more than six years, a Florida dermatologist operated a sophisticated scheme to steal $49 million from two government medical benefits programs – Medicare and Tricare. In the process, he endangered the lives of many of his patients with radiation therapy that was not needed.

The doctor who masterminded the scheme gave his patients false skin cancer diagnoses, then charged the insurance programs for unnecessary biopsies and radiation treatments that were either not performed, supervised or given by a qualified physician assistant. (Apparently, the dermatologist was not even in the country when many of the procedures were supposedly performed, although he claimed to be available by phone if needed.)

A fellow dermatologist in a neighboring county became alarmed when many of the other doctor’s patients began to seek another opinion. (It turns out that in many cases, the patients had freckles, warts or irritated skin, but not skin cancer.) Unfortunately, by that time, the patients had experienced multiple instances of radiation at 45-minute intervals that could have put them at an increased medical risk.

Once an investigation was opened by the U.S. Attorney’s Office in the Southern District of Florida, the doctor’s records, calendars and statements from former physician assistants were examined. Investigators found that the doctor had ordered his physician assistants to perform up to 50 biopsies a day. If they met their quota, they received a $10,000 cash bonus. (That’s quite an incentive. I wonder how the people with band aids covering their faces felt about the unnecessary biopsies?)

Auditors also discovered that the doctor rarely showed up at his clinics. Further research shows that Medicare was billed for more than $2.7 million for 8,000 procedures that were performed while the dermatologist was out of the country for a total of 256 days. (Medicare paid him $830,000 for the bogus claims that were submitted over six years.)

The doctor also submitted claims for radiation therapy using equipment that he doesn’t own (and probably doesn’t know how to operate.) His former physician assistants admitted they didn’t know how to properly operate the radiation machine. Even though the assistants did the work, the doctor billed the insurance companies as though he performed the treatments himself.

The doctor, who lives in a $28 million oceanfront mansion, agreed to settle the case with the federal government by paying $18 million on allegations of Medicare fraud. As you might guess, the dermatologist didn’t carry out the scheme on his own. A pathologist, who worked with the mastermind and is a codefendant in the case, agreed to pay $250,000 for his role in the scheme, which involved kickbacks.

This dermatologist paid his bill to the government and his practice remains open. His website currently boasts that his dermatology practice has cured over 100,000 skin cancers. That may be true, but what about the risk incurred by former patients whose lives were endangered by unnecessary radiation treatment? Do you think the government chose the right punishment or cure for this negligent doctor?

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”Florida Physician to Pay $18 Million for Medicare Fraud,” posted on Medscape.com on February 15, 2017.

A Florida dermatologist has agreed to settle a case with the federal government for $18 million on allegations of Medicare fraud.

Gary Marder, DO, allegedly diagnosed and treated patients for skin cancer that they didn’t have, put them through medically unnecessary treatments, and then pocketed millions from Medicare and other insurers.

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Larry Benson, Senior Director of Strategic Alliances, LexisNexis Risk Solutions - Government

Larry Benson is responsible for developing strategic partnerships and solutions for the government vertical. His expertise focuses on how government programs are defrauded by criminal groups, and the approaches necessary to prevent them from succeeding.

Mr. Benson has 30 years of experience in sales and business development. Before joining LexisNexis® Risk Solutions, he spent 12 years founding and managing two software technology startups. During the 1990s he spent 10 years as a Regional Director helping to grow a New England-based technology company from 300 employees to 7,000. He started his career with Martin Marietta Aerospace working on laser guided weapons and day/night vision systems.

A sought-after speaker and accomplished writer, Mr. Benson is the principal author of “Fraud of the Day,” a website dedicated to educating government officials about how criminals are defrauding government programs. He has co-authored WTF? Where’s the Fraud? How to Unmask and Stop Identity Fraud’s Drain on Our Government, and Data Personified, How Fraud is Changing the Meaning of Identity.

Benson holds a Bachelor of Science in Physics from Albright College, and earned two graduate degrees – a Master of Business Administration from Florida Institute of Technology, and a Master of Science in Engineering from Lehigh University.