The Florida Department of Health has barred Sarasota dermatologist Michael A. Rosin from doing surgery because of "egregious conduct" in falsely diagnosing patients with skin cancer and operating on them unnecessarily.
In a major blow to Rosin's once-thriving practice, the emergency order also requires him to refer all patients with confirmed or suspected skin cancer to other doctors instead of treating them himself. The order says Rosin, 54, poses "an immediate and serious danger to the health, safety and welfare of the public."
The order was welcomed by Rosin's former business manager and a former patient, who together filed a whistleblower suit in 2004 that led to state and federal investigations.
"I really feel like I was criminally assaulted," said Ellen Murray, 65, a retired IBM product planner who says Rosin falsely diagnosed her with cancer at least three times. "It's just like a stranger taking a knife and stabbing me to get my pocketbook, only he was doing it to my body to get Medicare" reimbursements.
Carolyn Ferrara, who handled Rosin's billings, said she was pleased by the order but surprised it was so long in coming. Although she and Murray could collect a percentage of any money the government recovers from Rosin, "even if I don't get a penny it doesn't matter to me."
Of primary importance, Ferrara said, "is just seeing justice done for the patients. I've seen things go on in seven years that shouldn't have."
Rosin has 30 days to appeal the order, which was issued late Tuesday and took immediate effect. He was in his office Wednesday afternoon but did not want to comment, according to a woman who answered the phone. His lawyers did not return calls but have said he is innocent and will be cleared at trial.
The state apparently began investigating Rosin last year after federal agents raided his office and carted off hundreds of patient files. This April, he was indicted in federal court on 50 counts of health care fraud and making false statements. He is accused of illegally collecting at least $3.2-million from Medicare, the taxpayer-supported program that provides health care for the elderly.
As detailed in a St. Petersburg Times story Sunday, many of Rosin's patients became suspicious when he repeatedly diagnosed them with skin cancer and performed Mohs surgery, a procedure in which the doctor removes layers of tissue until the cancer is gone. Rosin typically removed four layers during surgery: Each layer is reimbursable by Medicare, meaning the more layers he removed, the more money he got.
"Cancer is one of the most feared diagnoses for a patient," the state order says.
It blasts Rosin for diagnosing cancer "without justification and operating on those patients by performing all four stages of cancer surgery."
According to an unidentified expert quoted in the order, "it is almost impossible" for so many patients to have tumors serious enough to require removing four layers of tissue.
In 2001 and 2003, Rosin performed four levels of surgery on 100 percent of his patients diagnosed with basal cell carcinomas. By comparison, the expert said, physicians typically are able to remove most basal cell tumors in one or two stages, with less than 10 percent needing four levels of surgery.
The order says Rosin also kept inadequate records and based his cancer diagnoses on poor quality biopsy slides, some of which "contained no identifiable human tissue."
According to the FBI, the doctor told one patient she had "very aggressive" cancer after looking at a slide that contained a sliver of Styrofoam instead of a skin specimen. In another case, he based his diagnosis on a slide that held chewing gum.
Murray, the former patient, said she was referred to Rosin in 1996 after another doctor diagnosed squamous cell carcinoma, a common type of skin cancer. At the time, Rosin was the only physician in Sarasota trained in Mohs surgery, considered the most effective treatment for squamous and basal cell tumors.
Rosin was so insistent that Murray have frequent checkups, she said, he even called her at her Sarasota home to remind her she was overdue for an appointment. "Every time I went it was cancer, every time I went it was surgery."
In June 2003, Rosin told her she had cancer on her back, but this time Murray went to another doctor for a second opinion and biopsy. He sent the tissue sample to a lab in Tampa, which found no cancer.
Murray said she called the state Health Department, the Health Care Finance Administration and Medicare's fraud unit, to no avail.
"You couldn't get anybody's attention. I told Medicare Fraud that he was doing unnecessary surgery and they said, "If he did surgery, he's entitled to get paid,' so that was the end of my conversation."
Murray then told Ferrara, Rosin's business manager, about the false diagnosis. "She said, "You're not the only one' - other people had come back and told her the same thing."
Ferrara, 55, said she had noticed that Rosin did four stages of Mohs surgery "all the time." When she questioned him about one man on whom he had performed 122 surgeries: "I was told to mind my business and sit down."
In late 2003, Ferrara and Murray met with Tampa lawyer Barry Cohen to discuss suing Rosin under the federal False Claims Act. Commonly known as the "whistleblower act," it offers a financial incentive for providing information about anyone suspected of cheating the government.
Cohen in turn met with federal authorities, who, he said Wednesday, "were obviously interested."
On behalf of the U.S. government, Ferrara and Murray sued Rosin in April 2004. The lawsuit said the doctor "routinely and falsely" diagnosed the vast majority of his patients with the fourth stage of skin cancer so he could get the maximum Medicare reimbursement.
Rosin told an elderly woman she had a basal cell tumor and scheduled surgery even though he based his diagnosis on a "healthy tissue sample" obtained from Ferrara herself, the suit says. Rosin also performed three skin cancer surgeries and one biopsy on Murray based on false diagnoses of cancer.
A federal judge sealed the lawsuit so Rosin wouldn't know he was being investigated by federal authorities.
In May 2004, agents seized patient files and gave 75 to a medical expert for review. He found that most biopsy slides were of such poor quality it was impossible to make an accurate diagnosis.
As a result of Rosin's indictment, the lawsuit is on hold. It will be reactivated after the criminal charges are resolved: If the court rules in their favor, Murray and Ferrara could collect up to 25 percent of whatever money the government recovers from Rosin.
Public records show the doctor has a home on Sarasota Bay conservatively valued at $1.43-million, and an $800,000 house in Miami Beach, where his wife and seven children live.
Murray and Ferrara both say money was not a motive in suing Rosin.
"I never had money my whole life - I didn't even know going into this there was such a thing" as a False Claims Act, Ferrara said. She resigned from Rosin's office last August and is working for another doctor, though not a dermatologist, she said emphatically.
Murray could have filed a malpractice suit against Rosin, but "my intention was not to see him just get a slap on the hand, which basically a malpractice (ruling) is," she said.
"He would just continue his medical career and continue doing what he's doing."
Despite the state emergency order, Rosin remains in the Medicare program and is eligible to receive reimbursement for procedures not involving skin cancer. If convicted, he would be expelled from the program for five years. The Florida Board of Medicine could also take disciplinary action, including suspending or revoking his license.
Murray and Ferrara agree that doctors who perform Mohs cancer surgery should be required to send the biopsy slides to an independent lab.
"The big loophole is allowing these Mohs surgeons to do their own biopsy readings and not having to get a confirmation from an outside place," Murray said. "To me, that is such a temptation for anybody who wants to do what Rosin did because nobody else can check up on him."
