Interesting and Sad Story: Re Lucentis

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

exPCM

Membership Revoked
Removed
10+ Year Member
15+ Year Member
Joined
Apr 12, 2006
Messages
919
Reaction score
8
The physicians in the Eye Specialty Group in Memphis thought that their partner, Dr. Seth Yoser, was faking out patients.

They investigated and turned their findings over to the Centers for Medicaid and Medicare Services. They alleged that instead of giving patients full doses of a drug used to treat macular degeneration and prevent blindness, Yoser was giving them half a dose or no dose at all.

That would have been bad enough.

But Yoser allegedly took the fakery a step further. He sold the unused vials of Lucentis, worth about $2,000 each, to a medical supplier who then sold them back to Eye Specialty Group.

Thanks to the group's tip, federal prosecutors were able to build a strong case against Yoser. They accused him of falsely billing the agency for $1.6 million in drugs that he never actually used to treat patients. In July, Yoser pleaded guilty to 35 federal fraud charges as part of a plea agreement. He is scheduled to be sentenced on Thursday.

As a reward, the medical group is stuck with the bill. As Tom Wilemon of the Memphis Daily News explained in a great piece about the case:

The practice now has to pay back hundreds of thousands of dollars to the federal government, write off about $300,000 worth of expired drugs and cover the costs of an internal investigation plus a civil lawsuit against Dr. Seth Yoser, the partner they reported to authorities.

The Tennessee Board of Medical Examiners has yet to lift a finger. The board's spokesman, Shelley Walker, gave this surprisingly blunt response to the Memphis Daily News:

"There is no state law, nor is there any rule within the boards, for health professionals that automatically prompts action against a licensed health professional for a criminal conviction," Walker said. "In other words, a criminal conviction or even an arrest does not prompt automatic action against the health professional's license."

Message to patients: Don't expect the medical board in Tennessee to protect you from doctors who perform fake treatments on very real diseases.

If you are a patient at the Eye Specialty Group, though, you can rest assured that the doctors are looking out for you – no pun intended.

Final question: How does Medicare expect doctors to report fraud if they are going to be forced to pay back penalties to the government? Should the burden be on the perpetrator? And should any deal prosecutors cut with the accused require that doctor to pay back the government, the medical group and any other victims?

http://www.reportingonhealth.org/bl...rists-earn-black-eye-reporting-medicare-fraud

Comments: Many interesting issues raised in this case. Should the partners have talked to the doc first before going to the Feds? What about whistleblower immunity? What about the extreme high cost of Lucentis? etc, etc. What about the licensing board issues raised?

Members don't see this ad.
 
Tragic story, indeed. This guy was part of Krauss's group in Memphis. He actually did his VR training there! Talk about betrayal! He was sentenced in February to 42 months in prison and ordered to pay $400k in restitution to his old practice. That's in addition to the $1.6m he has to pay to CMS. Way to throw your life away.
 
The physicians in the Eye Specialty Group in Memphis thought that their partner, Dr. Seth Yoser, was faking out patients.

They investigated and turned their findings over to the Centers for Medicaid and Medicare Services. They alleged that instead of giving patients full doses of a drug used to treat macular degeneration and prevent blindness, Yoser was giving them half a dose or no dose at all.

That would have been bad enough.

But Yoser allegedly took the fakery a step further. He sold the unused vials of Lucentis, worth about $2,000 each, to a medical supplier who then sold them back to Eye Specialty Group.

Thanks to the group’s tip, federal prosecutors were able to build a strong case against Yoser. They accused him of falsely billing the agency for $1.6 million in drugs that he never actually used to treat patients. In July, Yoser pleaded guilty to 35 federal fraud charges as part of a plea agreement. He is scheduled to be sentenced on Thursday.

As a reward, the medical group is stuck with the bill. As Tom Wilemon of the Memphis Daily News explained in a great piece about the case:

The practice now has to pay back hundreds of thousands of dollars to the federal government, write off about $300,000 worth of expired drugs and cover the costs of an internal investigation plus a civil lawsuit against Dr. Seth Yoser, the partner they reported to authorities.

The Tennessee Board of Medical Examiners has yet to lift a finger. The board’s spokesman, Shelley Walker, gave this surprisingly blunt response to the Memphis Daily News:

“There is no state law, nor is there any rule within the boards, for health professionals that automatically prompts action against a licensed health professional for a criminal conviction,” Walker said. “In other words, a criminal conviction or even an arrest does not prompt automatic action against the health professional’s license.”

Message to patients: Don’t expect the medical board in Tennessee to protect you from doctors who perform fake treatments on very real diseases.

If you are a patient at the Eye Specialty Group, though, you can rest assured that the doctors are looking out for you – no pun intended.

Final question: How does Medicare expect doctors to report fraud if they are going to be forced to pay back penalties to the government? Should the burden be on the perpetrator? And should any deal prosecutors cut with the accused require that doctor to pay back the government, the medical group and any other victims?

http://www.reportingonhealth.org/bl...rists-earn-black-eye-reporting-medicare-fraud

Comments: Many interesting issues raised in this case. Should the partners have talked to the doc first before going to the Feds? What about whistleblower immunity? What about the extreme high cost of Lucentis? etc, etc. What about the licensing board issues raised?

There is much more updated information in this link:

http://www.memphisdailynews.com/Search/Search.aspx?fn=&ln=Yoser&redir=1

It appears that that Dr. was sentenced to 42 months in February of this year.

There is also an interesting piece in that search where the other doctors specifically address the issue of how they could have easily just gone and told him to knock it off but they were trying to do the right thing. It appears that that investigation grew out of a larger audit from a billing recovery contractor which is a whole separate interesting read and presents it's whole separate set of issues.

Regarding his license, it would seem somewhat obvious that someone convicted of a crime like this would lose their license but at the same time, I think it IS in fact prudent that medical boards review these cases on a case by case basis rather than making a blanket rule.

For example, in the sentencing article it talked about how Dr. Yoser was practicing with another doctor after his indictment. If a person is accused of a crime, should their license be suspended before they are convicted? What if he was found innocent? Should it be suspended if they are convicted of ALL crimes, or just some crimes? Misdemeanors? Felonies? Felonies that have no impact on your ability to practice medicine? Moral character?

Interesting questions.
 
Top