Health Information Management

Florida physician will pay $4 million, accept five-year ban from Medicare in False Claims Act settlement

HIM-HIPAA Insider, June 29, 2015

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by John Castelluccio, Editor
A Florida plastic surgeon has agreed to pay $4 million and accept a five-year ban from Medicare, Medicaid, and other federally-funded healthcare programs to resolve allegations under the False Claims Act that he billed Medicare for surgical procedures he either didn’t perform or were not medically necessary.
Donald Proctor, Jr., MD, is a Mohs and facial plastic surgeon who manages the practice at Grove Place Surgery Center, LLC, in Vero Beach, Florida. Federal officials said the case began with a whistleblower suit filed by Proctor’s former histology technician and another plastic surgeon who referred patients to Proctor. Under the whistleblower provision of the law, the two of them will receive $920,000 of the settlement.
Wifredo Ferrer, U.S. Attorney for the Southern District of Florida, announced the settlement June 18 with officials from the HHS Office of Inspector General. The FBI and Defense Criminal Investigative Service assisted in the case.
“The settlement announced today demonstrates this office’s commitment to aggressively pursue physicians who put their own financial self-interest over a duty to their patients and thereby raise the cost of healthcare for all of us as patients and taxpayers,” said Ferrer in a statement. “We will not allow physicians to put patients at risk by performing unnecessary procedures, or permit them to make up phantom claims to increase their reimbursements from Medicare.”
Authorities said an extensive investigation revealed Proctor routinely saw patients who were referred to him with confirmed skin cancer lesions and then falsely told them they had additional lesions that required Mohs surgery, even though he never confirmed this through biopsies or the lesions simply didn’t exist.
Proctor would also allegedly perform advanced stages of Mohs surgery that were often not medically necessary solely to boost his Medicare reimbursements. As a result, patients would have much longer stays at Grove Place Surgery Center and be subjected to surgeries they didn’t need.
Lastly, Proctor was accused of billing for unnecessary or nonexistent complicated surgeries to close up wounds supposedly left by Mohs surgeries. Authorities said he billed Medicare for these procedures on nearly every Mohs surgery he claimed to perform, even though the investigation found it was physically impossible in most cases for him to have done so.

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