The United States has intervened in a whistleblower lawsuit against Donald C. Proctor, Jr., M.D., an otolaryngologist practicing in Vero Beach, Florida, and Grove Place Surgery Center, LLC, an ambulatory surgical center managed by Dr. Proctor, that is located in Vero Beach, Florida.
Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, and Derrick L. Jackson, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), made the announcement.
According to the allegations made in the lawsuit:
Dr. Proctor billed Medicare for Mohs surgeries and related reconstructions that he either did not perform or were medically unnecessary. Dr. Proctor would routinely see patients who had been referred to him with a confirmed skin cancer lesion and inform them that they had additional lesions requiring Mohs surgery, even though the additional lesions had not been confirmed through a biopsy as cancerous or simply did not exist.
Mohs surgery is a specialized surgical procedure for removing certain types of skin cancers in specific areas of the body, including the face. The surgery is performed in stages in which the surgeon removes a single layer of tissue and then, after a microscopic evaluation of the excised tumor, performs additional stages, if necessary, until all of the cancer is removed. To increase his Medicare reimbursement, Dr. Proctor would perform three to four stages, or more, of Mohs surgery in the vast majority of surgeries he performed, even though that is far outside the norm and was often not necessary.
Additionally, it is alleged that Dr. Proctor defrauded Medicare by billing for unnecessary or nonexistent reconstructions, called adjacent tissue transfers, to close up surgical defects allegedly left by the Mohs surgeries.
Adjacent tissue transfers are complicated and often time-consuming procedures sometimes performed by physicians to close a defect resulting from the removal of a lesion on a patient’s skin. The lawsuit alleges that Dr. Proctor billed for these procedures in connection with virtually every Mohs surgery he claimed to have performed, even though in most cases they were not medically necessary or not performed at all.
“Physicians who perform unnecessary procedures, or bill for procedures they did not perform, put their own financial self-interest over their duty to their patients and raise the cost of health care for all of us, as patients and taxpayers," said U.S. Attorney Ferrer. “We will not relent in our efforts to combat this type of fraud and abuse that plagues the Medicare program and threatens its financial stability."
“Physicians who try to enrich themselves by performing medically unnecessary surgeries can cause their patients very serious health issues, waste millions in taxpayer dollars each year, and undercut the public’s trust in the medical profession," said Derrick L. Jackson, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General. “The Office of Inspector General will continue to protect beneficiaries and hold health care providers accountable for such outrageous behavior."
The case is captioned United States ex rel. Becker & Wildes v. Donald C. Proctor, Jr., M.D. et al., No. 11-14214-Civ-Martinez (S.D. Fla.), and was filed by Ferdinand F. Becker, M.D., a facial plastic surgeon and former Mohs surgeon who referred patients to Dr. Proctor, and Linda Wildes, who was employed as Dr. Proctor’s histology technician for over eight years. They filed the case under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private parties to sue on behalf of the federal government and receive a share of any recovery. The Act also authorizes the federal government to intervene in and assume primary responsibility for litigating a filed lawsuit, as the government has done in this case.
The claims asserted against Dr. Proctor and Grove Place Surgery Center are allegations only, and there has been no determination of liability.
A copy of this press release may be found on the website of the United States Attorney's Office for the Southern District of Florida at http://www.usdoj.gov/usao/fls. Related court documents and information may be found on the website of the District Court for the Southern District of Florida at http://www.flsd.uscourts.gov or on http://pacer.flsd.uscourts.gov.
Source: U.S. Department of Justice, Office of the United States Attorneys
