Exposing Fraud: Melanoma or Just a Mole?

She’s had multiple surgeries and every time she goes back to the doctor, they find more areas of concern, which always seem to turn up as cancer.

She is so glad to have found this doctor who is alert, aggressive, and watching out for her best health. The surgeries are difficult with the doctor having to dig down through many layers of skin to remove the offending cancer, but it’s worth it if it means staying alive. It’s already been 10 surgeries, but she’ll do as many as needed to stay ahead of this nasty cancer thing. Whatever it takes …

Every time we turn around, we are reading yet another article about the dangers of skin cancer and the importance of using proper sun products. And really, you can’t be too careful when you spend time in the sun. Floridians like myself who have grown up in the sun, sand, and surf and spent more time in the water than outside of it, could write those articles with our eyes closed. We get it. We understand the risks and we do our best to be smart about sun exposure.

As in every area of life, there are frauds and fakes in the healthcare industry. And I’m not talking about snake oil salesmen touting lotions and potions, I’m talking about doctors who are abusing the Hippocratic Oath by telling their patients that they have cancer when they do not. These unscrupulous doctors, nurses, and their staff members play on our greatest fears about the “C” word and then maximize their income by conducting the most financially lucrative surgeries.

A very close friend of mine, “Tina,” just ran into this type of doctor in Central Florida after having been treated for a mole that turned into melanoma several years ago. In her quest to find a good dermatologist, she was referred by friends to a doctor whom she was told was quite aggressive in identifying and treating skin cancer. As soon as the doctor’s staff checked her out, they identified new cancerous lesions that needed to be removed right away.

Tina was treated by the doctor three times for moles that the doctor and his in-house pathology laboratory identified as being cancerous. The first one Tina was pretty sure had to go, the other two—she just wasn’t sure. Those spots on her body were different. They looked like regular moles, not the first one which was itchy, raised, and seemed to be changing appearance. After the three surgeries, the doctor’s staff kept identifying more and more areas of concern, literally oohing and ahhhing as they checked her back saying things like, “Oh wow, look at that. Oh gosh … Ewww. Look at these—gasp!”   Not exactly a professional skin check.

Correspondence from the doctor’s office notified Tina that she had, “displastic nevus– precancerous melanoma.” I did some research on the Internet and it appears that this diagnosis is factually incorrect. The condition cannot be all of those things at the same time. According to Dr. Abby Van Voorhees, the physician editor of Dermatology World, “Dysplastic Nevus Syndrome” refers to the kind of moles that are more likely to develop melanoma.”  She explains, “Nevus is the fancy Latin word for “mole,” which is a benign growth, but melanoma is a skin cancer that if not diagnosed and treated early can be lethal.” So it appears that the diagnosis should either be dysplastic nevis or melanoma. The spot can’t be both precancerous and cancerous at the same time. It’s one or the other.

Tina’s three surgeries had been fairly traumatic because so many layers of skin were removed and required many stitches. She couldn’t believe that the doctor’s office was now telling her that six more spots needed to be removed immediately. Tina wavered. A feeling deep in her gut told her that something wasn’t right. She sought a second opinion. The second dermatologist reviewed her medical records and pathology reports and informed her,

“The first surgery was necessary because it was cancerous. The second and third surgeries were bogus. They were just regular moles, as are the other six areas on your body that they call cancer and want to remove. There was nothing wrong with those moles. I am aware of this doctor. You are not the first patient to come to me with concerns. This doctor is mutilating both young and old in Central Florida. I would highly recommend that you do not go back to that practice.”

Since then, Tina has met five other women who have had multiple surgeries by the same doctor who are being told that they require several more surgeries. These women are living under the terrible fear of dying from cancer, spurned on by letters from the doctor’s office which state, “Please understand that if you decide to not seek further treatment, this could result in death.” The doctor’s office has resorted to scare tactics to keep moving people through its surgical doors.

Unfortunately, this is not an isolated case. Dr. Michael A. Rosin was a dermatologist in Sarasota, FL who specialized in Mohs micrographic surgery, a technique that excises skin cancer via the removal of multiple thin layers of skin. The more layers of skin he removed, the more Dr. Rosin was reimbursed by Medicare, so he usually removed four layers of tissue during surgery. He instituted a daily surgery quota to his employees who were forced to participate in this scheme in which the team conducted up to 10, 20, and 30 surgeries on individual patients over time. Can you imagine? These poor people were led to believe that every time they turned around, skin cancer was popping up all over their bodies.

One patient questioned the results of her biopsy, so she took the slides to an independent laboratory which was unable to find any traces of skin cancer in the samples. Furthermore, additional investigative efforts showed that many of the biopsies that the doctor handled in his in-house laboratory couldn’t even be positively identified as containing skin. In 2006, a Tampa jury found Dr. Rosin guilty on 70 counts of health care fraud and making false statements in health care matters. He was ordered to pay $7.2 million in fines and restitution and was sentenced to 22 years in prison after members of his staff reported his illegal and inhumane practices to authorities.

Another case in the Tampa area involved dermatologist Dr. Steven J. Wasserman whom the U.S. Justice Department say entered into an illegal kickback arrangement with Tampa Pathology Laboratory in 1997. Wasserman was also accused of performing “thousands of unnecessary skin surgeries known as adjacent tissue transfers on Medicare beneficiaries in order to obtain the reimbursement for them, not because they were medically necessary.” The dermatologist agreed to pay $26.1 million to settle the Medicare fraud allegations.

Here are some tips to help you avoid becoming a victim of these dirty, rotten scoundrels:

• Watch for scare tactics. There is a thin line between a doctor’s office being responsible about getting you back into the office if a pathology report shows a problem and a doctors office using fear tactics and intimidation to get you into the surgical office. The staff at Tina’s doctor’s office was teetering on the edge of harassment in their efforts to get her to schedule the six follow-up surgeries.

• Beware of on-site pathology labs. The presence of an in-house laboratory in a doctor’s office can be an immensely positive situation as it can facilitate quicker testing and evaluation of your medical issues; however, be aware that deceiving medical practitioners often use these labs to facilitate their dishonest practices and fleecing of patients and insurance companies.

• Numbers and percentages tell a good story. If the doctor finds new cancer every time he or she looks at you, then, this should serve as a red flag. For Tina, the numbers of cancerous lesions on her body and those of the five other women she knew being treated by the doctor (between 5-20 surgeries each) didn’t jive with the general population’s incidence of skin cancer, even for people who have already had melanoma. The numbers seemed way to high, and the spots on her body that the doctor’s office said were cancer looked like regular moles to Tina. Turns out that’s all they were.

• Listen to your gut. If the physician or their staff tells you something and it doesn’t sit well in your spirit or feel right to you, seek a second opinion. It will give you peace of mind either way—it can confirm what the doctor has already told you, or potentially save you from unnecessary pain, procedures, and emotional trauma.

So if anyone knows a malpractice or insurance fraud lawyer looking for a solid case in Central Florida, we’ve got a good one for you….

*** INSIDER KNOWLEDGE: If you know someone involved in these type of illegal, fraudulent, and abusive activities, it’s time to speak up. When you have knowledge of these types of activities, closing your eyes and wishing it would go away is not alright. It’s time to speak up for the victims. It could even be in your financial best interest to do so. Pathologist Dr. Alan Freedman was awarded $4.046 million in February 2013 for being the relator in a qui tam (whistleblower) lawsuit he filed against Dr. Wasserman. Knowledge is power, and significant number of cases on the Internet show how effective prosecutions are against these doctors who should not be practicing on our friends and family members. Please do something about it. Enough is enough.

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