A recent Wall Street Journal article brought to light that doctors collected more from a single procedure than any other doctor who billed for that procedure, it stated that more than 2,300 providers earned $500,000 or more from Medicare in 2012.
One such doctor is dermatologist, Dr. Gary L. Marder who had practices both in Okeechobee and Port St. Lucie. The WSJ stated that Dr. Marder received $3.7 million from Medicare, of which $2.41 million were for a particular radiation treatment. Only two other doctors had used the same Medicare billing code data in 2012 and neither of them charged Medicare price that Dr. Marder’s practice did.
Dr. Marder used to apply radiation treatment using a special machine and the billing code used is for that specialized machine. This apparently was a higher-voltage radiation treatment machine for which extra shielding is required in a controlled environment shielding similar to that used in the radiation-oncology departments in hospitals.
Surprisingly a lower-voltage machine similar to the pictured-on Dr. Marder’s website would have cost Medicare around $22 per treatment in 2012 while the physician charged $154 per treatment by using a billing code that was meant for higher-voltage machine that Dr. Marder claimed he used.
Dr. Marder used selective codes, performed the procedure on 94 patients, and billed for the procedure 15,610 times in 2012, making it 166 treatments per patient, on average. While Dr. David Beyer, an Arizona-based radiation oncologist, said that the maximum number of radiation treatments appropriate per skin-cancer lesion is 35, while it takes 20 in a normal course and normally several lesions are treated at one time and billed for as a single treatment.
Dr. Marder countered his higher billing count per patient by stating that he billed for each lesion separately and treated each lesion about 40 times. In an email exchange, Dr. Marder claimed that he used a machine different than the one of lower-voltage that is shown on his website, but didn’t offer to tell what kind it was, he insisted that professionals would vouch that he used the right code but didn’t name these ‘professionals’ either.
Earlier too, in 1998, Dr. Marder faced disciplinary action by Florida’s Board of Osteopathic Medicine for alleged ‘fraudulent’ billing He was fined him $2,500 for his allegedly involvement in fraudulently billing private insurers in three different cases and ordered to take courses in medical record-keeping and medical risk management.
Dr. Marder claims that the medical board merely asked him provide better documentation to justify his billings, which he has apparently abided since and that his medical care was never in question.
The common concern of most elderly patients on Medicare who visited Dr. Marder was about blotches on their skin. These patients were having irritated skin, warts or other common skin conditions which he allegedly diagnosed as skin cancer. He would then charge their insurance for expensive treatments and procedures. Many patients did not have skin cancer, yet were given inappropriate medical treatments.
The whistleblower who filed the medical abuse lawsuit accuses Dr. Marder of defrauding the government by billing Medicare and Tricare which is a federal health program for military families both active and retired. According to the lawsuit between January 2008 till May 2014, Marder billed both the programs for more than $49 million. This includes overbilling for biopsies and treatments that were not required. It is noted that at times these procedures and treatments were not even performed and other times they were done by physician’s assistants who were not properly supervised and with improper qualification. The whistleblower added that the doctor charged the insurance for patients treated when he was actually abroad.
Allegations brought forth by the whistleblower were upheld by the judge but the terms of settlement were not being disclosed to the public.
Dr. Marder’s website claims that he has cured over 45,000 nonmelanoma skin cancers with radiation therapy for the past 30 years. He is certified by the American Osteopathic Board of dermatology but the whistleblower claims that Dr. Marder lacks training to perform radiation oncology on his patients.
¬¬¬This whistleblower lawsuit against Dr. Marder started off from a complaint filed by another dermatologist who saw many patients who he felt were misdiagnosed by Dr. Marder. He did a little investigation into his doubts and then under the federal whistleblower’s act hired an attorney.
The doctor/whistleblower who helped in exposing government fraud would receive between 15 and 25 percent of the settlement agreement. The whistleblower states that Dr. Marder told his physician assistants that they needed to increase his billings to Medicare and Tricare and hence perform as many as 50 biopsies a day and whichever physician assistants met this target qualified for cash bonuses of up to $10,000.
The physician assistants confessed that they were not properly training to perform the radiation treatments. A former physician assistant states that Dr. Marder had ordered that every patient be given two radiation treatments a day to each lesion for 20 days. Furthermore, the treatment was the same for every lesion on every patient even the radiation dosage administered by the machine at each location was the same as they were preset.
All the procedures that Dr. Marder allegedly billed Medicare for that too at a higher rate that other physicians were actually performed by the physician assistants and never the Dr. Marder himself.
According to the whistleblower Dr. Marder engaged in a kickback scheme with the pathologist, Dr. Robert Kendall. Dr. Marder allegedly sent 35,000 patient samples to Dr. Kendall, and the pathologist allowed Dr. Marder to bill Medicare for the specimens. Dr. Marder allegedly paid Dr. Kendall an annual salary of $120,000.
Dr. Marder has agreed to settle is a civil case, but there is a criminal investigation conducted by the FBI which is currently underway.
Dr. Gary Marder agreed to pay up to $18 million to reimburse the government for Medicare payments on patients who were not ill.
Gloria Strumalo from Port St. Lucie was one of his patients said she went to Dr. Marder’s office for a check-up and was diagnosed with skin cancer and he recommended radiation therapy. She adds that she went for 20 days of 2 hours each and she didn’t have a clue that she didn’t need radiation therapy because she didn’t have skin cancer to start with. She further states that one trusts the doctors and takes their word for it.
Her unnecessary treatments cost the insurance company between $1,600 and $3,500 for each session. When she went back for checkup a few weeks later Dr Marder said she had to undergo more radiation therapy and she just couldn’t believe her ears. She spoke to other Dr. Marder’s patients and realized that she wasn’t alone, the other patient too added that doctor wanted to do radiation on her again.
Strumalo chose surgery instead of another set of radiation. This time her wound got badly infected and she suffered a lot discomfort and pain. That’s when she visited Dr. Ted Schiff for a second opinion. She wasn’t his first patient from Dr. Marder.
Dr. Schiff says that doctors recognize patients just by the sheer number of biopsies, number of procedures and the excessive use of radiation therapy done in an improper manner. He adds that over a period of three to five years he had seen several of Marder’s patients who had benign conditions such as freckles or warts but were told they had skin cancer. He adds that in all his years in the medical field he hadn’t seen anything like this adding that as doctors they take an oath to do no harm.
Schiff noticed that there was a substantial increase in patients undergoing unnecessary treatments and that led to the whistleblower lawsuit in 2013. He alerted the authorities and worked with the FBI to uncover the magnitude of the fraud and build a case against Dr. Marder. The U.S. Attorney’s Office picked the lawsuit.
The civil case will end with the settlement which includes $5.2 million. Dr Marder has to pay this before the due date to avoid paying the full $18 million. In addition, he has to give the government a vacant lot that he owns on Hutchinson Island in Martin County, valued at $650,000. Fortunately for him, his 12,700-square-foot home, valued at $28 million, can’t be seized.
Despite previous disciplinary actions against him, Marder’s medical license was still active.