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1)OPINION: Gross malpractice A Times Editorial Times Staff Writer June 20, 2005St. Petersburg TimesFlorida has taken the scalpel out of Dr. Michael A. Rosin's hand, but not his medical license. Roughly 18 months after receiving the first complaints, 13 months after FBI investigators raided his office and two months after a federal indictment, the state Department of Health finally acted on Tuesday. It threw part of the book at him. Rosin stands accused of surgically removing skin from elderly patients who had nothing wrong with them. He would perform the microscopic surgery, removing a layer of skin at a time, under the diagnosis of cancer. But the FBI claims he was removing the skin, at $2,000 per layer, simply to rake in $3.2-million in unwarranted Medicare reimbursement charges. Investigators said 13 of his patients underwent the surgery at least 20 times each, and one patient underwent 122 procedures. They also said Rosin found cancer in every single biopsy he performed, even when he was handed a laboratory slide with chewing gum and one with a thin slice of Styrofoam. The state's action was welcome but confounding. It accused Rosin of "egregious conduct" and "gross or repeated malpractice" and a "flagrant disregard for the duties and responsibilities imposed upon a physician." It said he "erroneously diagnosed many patients with cancer" and "performed multiple unnecessary surgeries on these patients" and that he "presents an immediate and serious danger" to the public health. Yet the state only restricted him from performing further cancer surgeries, as though Rosin is otherwise a fine physician. Can medical trust be parsed so finely? Even more schizophrenic is the federal government's actions. It is claiming, with substantial proof, that Rosin has defrauded Medicare. But it is allowing him to continue collecting Medicare payments as the case winds through the courts. He is certainly entitled to the presumption of innocence as it relates to the criminal charges against him, but why would the government keep paying him if it believes he is stealing? Rosin, a Sarasota dermatologist, may effectively lose his business because of the federal charges and the state restrictions on his license. But what is worrisome about the regulatory action in this case are the scores of patients who may have endured unwarranted surgeries while his work was under official review. For more than a year, the state has been aware of the frightening allegations against Rosin. Surely there are more expeditious ways to deal with a doctor who may have been treating elderly patients as though their skin was a cash crop. 2)Records: Doctor had surgery quota ; Michael Rosin told employees he needed to make $10,000 a day. Doctor accused of falsely diagnosing cancers MIKE SAEWITZ firstname.lastname@example.org May 6, 2005Sarasota Herald-TribuneSARASOTA A Sarasota dermatologist who was indicted last month on charges of falsely diagnosing patients sometimes diagnosed skin cancer even before looking at biopsy slides, his employees told federal investigators. Every biopsy Dr. Michael A. Rosin took was diagnosed as cancerous, they said. He even once performed skin cancer surgery after reviewing a slide that contained a piece of chewing gum, placed there by a laboratory technician who had lost the skin specimen, according to court records obtained Thursday. He performed more than 120 surgeries on one patient over 20 years. Rosin, 54, told his employees he had a daily surgery quota. He told his office manager he had seven children and needed to make $10,000 a day, investigative reports show. Investigators believe he made more than $3 million in three years by falsely billing Medicare. They said he may have made much more because the scheme dates back to at least the early 1990s. Court documents detail what FBI agents say was a long-standing scam in which Rosin falsely diagnosed cancer in dozens of elderly patients at his Hillview Street office, then performed surgery to collect Medicare reimbursements. Rosin "falsely diagnosed the great majority of his patients" with the type of skin cancer that would "yield the maximum cost- effective Medicare reimbursement," a lawyer for Rosin's former office manager wrote in one of the documents. Rosin was indicted last month on 25 counts of health-care fraud, as well as 25 counts of making false statements in health-care matters. He faces up to five years in prison on each false statement charge, and up to 10 years in prison on each charge of health-care fraud. He was released on $100,000 bail after turning himself in to authorities last month, and has forfeited his $1.4 million Bay Shore Road home to the federal government. His office is still open, according to an answering machine message. Rosin's Fort Lauderdale attorney, Theresa Van Vliet, said her client has pleaded not guilty to all of the charges. "This case is going to be vigorously fought in court in Tampa," said Van Vliet, who specializes in white-collar criminal defense law. "These documents present one side of the story. In this case, there is most assuredly another side of that story. Dr. Rosin looks forward to his day in court." The FBI began investigating Rosin after his office manager and billing clerk talked to special agents on April 12, 2004. Rosin was arrested a few days later at Tampa International Airport after trying to board an airplane with a loaded gun, authorities say. He said he had the gun because he often carries large sums of money. A few days later agents raided his office, collecting boxes of patient files. His office manager, Carolyn Ferrara, said at the time that she was "shocked" and had never noticed anything unusual in the office. Investigative reports now show that Ferrara had been talking to FBI agents before the raid. Over the next few months, special agents interviewed laboratory technicians who had worked for Rosin. One technician told an agent she questioned why all of the biopsies were diagnosed as cancerous. Rosin said the results were "always positive for cancer because he only biopsied an area if he believed it was cancer," the FBI agent wrote in a seizure warrant affidavit. Rosin also said the rate was high because his patients had previously had skin cancer and it was "not uncommon for the skin cancer to recur," the agent wrote. But the employees were still suspicious. They told investigators about losing skin samples and replacing them with chewing gum, a piece of plastic foam, and even a raised skin bump off the leg of Rosin's office manager. The diagnoses still came back as cancer, the employees reported. Agents who seized log books from Rosin's office last year said a majority of his recorded diagnoses came back positive for basal cell carcinoma, the most common form of skin cancer, which is often caused by chronic exposure to sunlight. Rosin was one of the few dermatologists in the area specializing in Mohs micrographic surgery, a technique to get rid of skin cancer by removing layers of skin. Medicare reimbursed Rosin for each layer he cut, and he always cut four layers during a surgery, agents said. The FBI had several medical experts review Rosin's patient files. One expert, Dr. Pearon Gordon Lang Jr., reported that Rosin found cancer in nearly two dozen slides that were of such poor quality that a diagnosis could not have been made. Lang, a dermatologist for 30 years and a university professor, said Rosin also found cancer in 19 slides that were of poor quality but showed no signs of cancer. Nine slides had nothing that could be identified as human tissue, and six files simply had no slides at all. "Dr. Lang remarked that it would be nearly impossible for any dermatology practice to have such a high rate of positive basal cell carcinoma," the FBI agent wrote. "He felt that there should be a much wider range of diagnoses, including negative diagnoses." Update WHAT'S NEW: Dr. Michael A. Rosin's former employees told investigators that the dermatologist diagnosed skin cancer in 100 percent of his biopsies -- even on slides containing plastic foam and chewing gum. THE STORY SO FAR: Rosin was indicted last month on 25 charges of health-care fraud and making false statements in health-care matters. WHAT'S NEXT: Rosin and his attorney will be in court this month for a status conference. His trial is set for June, but it will probably be pushed back. PHOTO; Caption: Michael Rosin did 120 surgeries on one patient. 3)Friends see a totally different Michael Rosin ; The feds say he defrauded Medicare of $3 million; his defenders call him deeply religious and a dedicated doctor. MIKE SAEWITZ email@example.com June 16, 2005Sarasota Herald-TribuneSecond of two parts. SARASOTA -- Dr. Michael A. Rosin is known for seeing things in absolutes. Deeply religious, he is active in the Boy Scouts and embraces the Scout oath. Friends say he is brilliant, hard-working and good-hearted. Yet Rosin is accused of devising a cruel scheme: telling elderly patients they had cancer so he could make extra money performing unnecessary surgery. The federal government says Rosin defrauded Medicare of more than $3 million. "Truly deep in my heart, I know he's a very honest man," said Rabbi Chaim Steinmetz of Chabad of Sarasota and Manatee Counties. "People who know him well know a great injustice has been done." But in documents released Wednesday, the secretary of the Florida Department of Health called Rosin's continued practice an "immediate and serious" public danger, and has ordered that he stop performing surgeries at his Hillview Street office. Rosin, 54, has declined to comment about the case and his upcoming trial. He has pleaded not guilty to charges of health-care fraud and making false statements in health-care matters. "Everybody's accusing him without listening to his side of the story," Steinmetz said. "You can imagine how much it hurts." Rosin comes from a well-known local family. His grandfather, Simon Rosin, arrived in Arcadia in 1905 and is considered one of the area's first Jewish settlers, according to a local historian. His father, M. Aurel Rosin, was Sarasota's city attorney and operated thousands of acres of ranchland. He was 45 years old when he was killed in a car crash on his way to argue at the Florida Supreme Court. Rosin, the youngest of four boys, was 2 at the time. His mother, Elsie, raised the boys in a home on Bay Shore Road in Sarasota. Those who knew her say she was blunt and strong-willed. "She was a strong, powerful woman and raised them tough," said Jerry Swartz, a longtime family friend. "Elsie was a matriarch. There was no question about that." The family spent summers in a tiny house on their Arcadia ranch nine miles from their nearest neighbor. Florence S. Sinclair wrote several anecdotes about the Rosins in her book "From Confederacy to Federation: A History of the Sarasota- Manatee Jewish Community." She wrote about how Elsie would drive the boys 50 miles from the Arcadia ranch to attend services at Temple Beth Sholom in Sarasota. Afterward, the boys would help clean the temple, change into pajamas and ride back late at night. She also told how in Arcadia the Rosin brothers "experienced mistreatment at the hands of the other students." After transferring to St. Martha's Catholic School in Sarasota, it was Michael who explained "the symbols and practices of Judaism" to his classmates. The four boys became lawyers and doctors. Rosin excelled in school, earning straight A's as an undergraduate chemistry major at the University of Florida, where he went on to attend medical school. He was trained in internal medicine at the Washington Hospital Center in Washington, D.C., during the late 1970s, and began a dermatology residency at Jackson Memorial Hospital at the University of Miami School of Medicine. He didn't get along with a professor there, he told another doctor, and enrolled in a residency program at the Vanderbilt University School of Medicine in Nashville. "He was one of my best students," said Dr. Lloyd King, the former chairman of dermatology at Vanderbilt's medical school. "He was certainly one of the smartest." Rosin could also come across as condescending to the other students, King said. While the other med students partied, Rosin stayed in his room and studied. Rosin met his current wife in Israel in 1983, around the time he opened a dermatology practice in Sarasota. Already well-known here, Rosin drew on his personality to treat hundreds of seniors from Sarasota, Manatee, Charlotte and DeSoto counties at his Hillview Street office. Patients say he was chatty. He frequently discussed his Boy Scout trips with patients, who were greeted with scouting memorabilia in his office. The doctor asked patients about their lives and families. Many were impressed that he called them at home after each surgery to make sure they were OK. Still, some patients say he seemed arrogant. They were taken aback by walls full of plaques and degrees and his obvious pride in his accomplishments. Other patients say Rosin was standoffish and aloof. Friends say Rosin is quiet until you get to know him. They also say he's a little quirky. "Michael is definitely a guy who marches to his own drummer," said Joel Srodes, one of Rosin's closest friends. "He really has a set of values and a lot of that is wrapped around his religious beliefs." Rosin's friends say he bought a home in Miami Beach, primarily so his five sons and two daughters could attend a nearby private Jewish school. The Boy Scout troop he led was an Orthodox Jewish troop that roasted kosher marshmallows and hurried to set up the campsite before Shabbat. It is his religious values that lead him to want a simple, uncomplicated life. He doesn't like computers or have a cell phone. "Money does not drive this man," Srodes said. "I don't care what everyone else says. I've known him too long." Rosin gave $50,000 to a Gainesville rabbi who wanted to build a bigger and better center for Jewish students. Rabbi Berl Goldman remembers it as a miracle -- he had met the doctor only days before. "He said he wanted the Jewish students to have an opportunity ... a home away from home," said Goldman, of the Lubavitch Jewish Center at the University of Florida. Rabbi Steinmetz said Rosin has repeatedly turned down opportunities to be honored at annual galas. "He adamantly refused," Steinmetz said. "He did not want to be in the spotlight." Rosin drives to Miami Beach every weekend to be with his family. He sometimes goes fishing with friends. Back in Sarasota, Rosin spends his weeks alone in a $1.4 million home on Bay Shore Road, just a few houses down from where he grew up. Neighbors say Rosin is driven and diligent, even when he's not at work. He spends a great deal of time fertilizing palm trees in his yard, which is surrounded by a stone retainer wall and has a beautiful view of the Sarasota Bay. A history buff, Rosin also has a huge collection of model trains and often goes to train conventions. He spends time on his needlepoint, creating works that look more like paintings than stitchings, according to one man familiar with the art. He often gets up early and goes for long jogs or bike rides. Neighbors have seen him as far north as the John and Mable Ringling Museum of Art and as far south as 10th Street. Srodes said when Rosin takes his car to the dealership for repairs, he often brings his bicycle instead of asking for a ride. Even when it's raining, the doctor bikes home rather than asking for a lift. "He relies on himself primarily for everything," Srodes said. "He doesn't seek a lot of help from other people. He figures he can do it himself." Swartz said Rosin can be obstinate, especially when it comes to political discussions. "If he believes something is right, that's all there is to it," said Swartz, who has known Rosin since he was an infant. "He will listen, but he's pretty much set in stone when it comes to making his own decision on certain things. I respect him because he does not live in a world of grays. He lives in blacks and whites." A friend who worked side by side with Rosin repairing hurricane- damaged roofs in Arcadia says he's too good to do what he's accused of. Other longtime buddies also can't believe the charges. "I don't believe he's a cheater," said fishing guide Chris Mitchell, a friend on whom the doctor performed several free surgeries. "I can understand if he had a money problem," said longtime friend Steve Weisman of Ona. "But he doesn't. It just doesn't make sense. It doesn't add up." Srodes said Rosin is motivated by family and by adherence to religious tradition. Friends say the arrest has put a huge strain on Rosin's personal life. Federal agents applied to seize a securities account containing $6.6 million. He could be forced to forfeit his Bay Shore Road home if he misses court. In court last month, he made his devotion to religion and family evident to a federal judge. Rosin wore a yarmulke, a skullcap worn by Orthodox Jews. His oldest brother, Robert, draped a protective arm around him during much of the hearing. The dermatologist has discussed the burden of the accusations with friends. "Look, you just gotta keep your chin up and just go forward," Weisman says he told Rosin. "You know in your heart what you are." He will fight order Attorneys for Dr. Michael A. Rosin said Wednesday they will challenge a state order preventing the dermatologist from diagnosing cancer and performing surgery. "We will be fighting it tooth and nail," said Theresa Van Vliet, Rosin's Fort Lauderdale attorney. Rosin will "unquestionably" appeal the order within 30 days, she said. Dr. John O. Agwunobi, the secretary of the Florida Department of Health, has accused Rosin of gross malpractice, keeping poor records and "flagrant disregard" for his duties as a physician, according to documents released Wednesday. "Cancer is one of the most feared diagnoses for a patient," Agwunobi wrote, saying that Rosin diagnosed many patients with skin cancer based on inadequate biopsy slides. "Nothing short of the immediate restriction of Dr. Rosin's license will protect the public." PHOTO; Caption: HILLSBOROUGH COUNTY SHERIFF'S OFFICE Dr. Michael Rosin was arrested in April on charges of fraud. 4)Comment: If prosecutors made right diagnosis, this medical fraud was violent crime Tom Lyons April 14, 2005Sarasota Herald-TribuneThe federal indictment of Dr. Michael A. Rosin should not be lumped in with white collar criminal cases in general. Bad as some white collar crimes are, especially those that devastate victims financially, the crimes the Sarasota dermatologist stands accused of are worse. If white collar crime means fraudulent acts that don't involve violence or putting people in fear of physical harm or death, then Rosin is not accused of a white collar crime at all. Think about it. If a robber put a knife to your face, and then cuts you a few times to make easy cash by terrifying you into cooperation, what kind of prison sentence would you expect for such a thug? And if prosecutors could prove that such a robber did that repeatedly, to multiple victims, for years? I'd expect that brutal robber never to see a day outside the crossbar hotel. He'd be so obvious a sociopathic menace that, upon conviction, I can't imagine a judge cutting any slack. And then there's Dr. Rosin. He is charged with making fraudulent diagnoses of skin cancer and other serious conditions, and then performing needless surgical removal of this or that skin feature, to collect fees for his fraudulent services. You may have read the Herald-Tribune story that quoted Al Silber, a Longboat Key man in his 90s. He said he and his wife thought his cancer diagnosis might well be his ticket to the cemetery. His trusted doctor performed five surgeries on his face, as if to save him. Later, the FBI told Silber he didn't have skin cancer at all. They said Dr. Rosin routinely lied to elderly patients like him, giving them phony diagnoses and performing surgery they didn't need. If true, that's not paperwork fraud. That's violent crime, committed by a person in a position of trust. One of those who trusted Rosin is Marj Baldwin, known for directing Sarasota's Tiger Bay chapter. She says she has to wonder if the same happened to her. Baldwin had to point to various parts of her face, head and back to add up the times that friendly Dr. Rosin cut little pieces of skin off her. Now she, too, has been contacted by the FBI, but she hasn't learned anything as yet. So who knows? I doubt if the FBI will always be able to tell whether patients were diagnosed and treated fraudulently after dummied up biopsies and such. Some patients may always have to wonder. Did they really have a narrow brush with a serious health problem, one that could recur at any time, or were they just victimized in a medical scam based on their doctor's willingness to lie to patients, frighten them and cut them needlessly? Think how bad this is for other doctors, and for their patients. How many people going to honest doctors will now wonder? How many patients will think they need a second opinion even in the most straightforward cases, not because the doctor might be wrong but because the patient wonders if the doctor could be lying? Maybe that won't really happen much. Most people no longer expect doctors to be perfect, but most of us continue to trust our own doctors to be truthful and to sincerely try to help. That's the very reasonable belief the feds say Rosin exploited. The good news is that the FBI and federal prosecutors are handling this. Conviction could mean serious prison time. If it was just the Florida Board of Medicine cracking down, Dr. Rosin would be facing several years of bureaucratic plodding by state officials and, if eventually found guilty, a stiff fine and a stern lecture about medical ethics while he continued to practice. Tom Lyons can be contacted at firstname.lastname@example.org or (941) 957-5367. 5)'Medically unreasonable' ; Indictment, patients tell of repeated surgeries by Dr. Rosin MIKE SAEWITZ email@example.com April 13, 2005Sarasota Herald-TribuneWhen Dr. Michael A. Rosin told Al Silber that he had skin cancer last year, the 93-year-old Longboat Key man and his wife were so scared that they began planning for his death. "I thought I was going to lose him," said Merry Silber, who's been married to her husband for 70 years. "I thought this would be the end." It was an FBI agent who told Silber he was cancer free. The agent also told Silber he didn't need the five surgeries on his face that the Sarasota dermatologist had performed. Federal prosecutors say Rosin routinely lied to elderly patients, falsely diagnosing cancer and then performing "medically unreasonable and unnecessary" surgeries to collect Medicare reimbursements. He turned himself in to authorities Monday and was charged with 25 counts of health-care fraud, as well as 25 counts of making false statements in health-care matters, according to an indictment. Several former patients interviewed Tuesday said that Rosin was so "affable" that he often called at night to check on a patient's well-being. So they trusted the doctor, even as they questioned why he continually recommended surgeries. "I come from the old school where we thought doctors were on a special level," said Al Silber, a lawyer from Michigan. "And if they said something, you should follow their instructions. He seemed to be very friendly. I had no reason to suspect he was doing anything that was not legitimate." Rosin, 54, did not answer repeated calls to his cellular phone and Hillview Street office, where he continues to practice after being released from custody on a $100,000 bond. An attorney who didn't leave his name said in a voicemail that he was calling on Rosin's behalf and that the doctor "expects to be fully vindicated." A trial date has yet to be set. Some patients whose cases were used to charge Rosin defended the dermatologist. "We really didn't have any problem with him," said Sarasota's Barbara Eisenstein, a former patient who underwent surgery. So did her husband, Albert. "As far as I'm concerned, everything went satisfactorily." Investigators with the Office of Inspector General at the U.S. Department of Health and Human Services have been investigating Rosin since before May, when federal law enforcement agents raided his office and took boxes of records. Just a month before that, Rosin was arrested at Tampa International Airport trying to board an airplane with a loaded gun. He told federal officials he carried the gun for protection because "he often travels with a large sum of money," according to a report. The indictment on health-care fraud accuses Rosin of using elderly residents here by lying about biopsy slides to make false diagnoses of skin cancer in 50 cases involving patients from Sarasota, Venice, Nokomis, Longboat Key and Bradenton. He then went on to perform Mohs micrographic surgery on patients, freezing parts of their bodies and cutting them with a scalpel to remove what he told them were cancerous tumors and lesions. Some of the cases go back to 1996. Prosecutors want Rosin to forfeit about $3.2 million he made from those cases through Medicare reimbursements. Rosin made recommendations of surgery based on biopsy slides that "contained no identifiable human tissue in some cases, and in most instances, based on biopsy slides that were inadequate for accurate diagnoses," according to the indictment. "It would be pretty egregious, if these charges are valid," said Dr. Craig Eichler, a Naples dermatologist and the president of the Florida Society of Dermatology and Dermatologic Surgery. Patients described being told over and over that they needed more surgery, even after they thought the cancer had been removed. In only a few years, Peter Hillenbrand Sr. of Sarasota had about 30 operations on his face, his eye, and his ears, said his wife, Sophie. "He trusted Rosin," Sophie Hillenbrand said. "You have to believe in your doctor, or you wouldn't be going. He should have gotten a second opinion. We kept telling him that. He was getting too many cuts." When Hillenbrand, who's in his early 80s, read about Rosin's indictment this week, he "almost cried," his wife said. "He said, 'I thought he was my friend,' " Sophie Hillenbrand said. John Stoltz, a 77-year-old retired farmer who lives in Bradenton, said he had between 15 and 20 Mohs procedures before he began questioning why he needed so many surgeries. Not long after Rosin recommended surgeries, Stoltz said he went to another dermatologist for another opinion. "He checked me all over and said, 'I see nothing that requires surgery,' " Stoltz said. "I have been told that at least some of the surgeries I had were not malignant," he said. "Without a doubt, a number of my surgeries were not necessary." Al Silber said the FBI agent had an expert check his biopsies, only to find there was no malignancy. "The word cancer just raises so many red flags," he said. "Am I going to survive? How long am I going to survive it? What should I be doing about winding up my affairs?" His wife, Merry, said she's glad that the FBI is investigating Rosin, and also that her husband does not have cancer. "My life, my heart, my soul, my buddy, my everything," she said of Al. "And to put us through this unnecessarily so he could collect an extra surgery fee is unbelievable." SNN reporter Rich Matthews contributed to this report PHOTO 2; Caption: STAFF PHOTO / ELAINE SKYLAR / firstname.lastname@example.org Told he had cancer, Al Silber had several surgeries at the hands of Dr. Rosin. "The word cancer just raises so many red flags. Am I going to survive? How long am I going to survive it? What should I be doing about winding up my affairs?" Dermatologist Dr. Michael A. Rosin is charged with 50 health-care related counts. 6)Doctor accused of false diagnoses ; Federal prosecutors say Dr. Michael Rosin then billed Medicare for reimbursements. MICHAEL POLLICK email@example.com April 12, 2005Sarasota Herald-TribuneSARASOTA Federal prosecutors have charged Sarasota dermatologist Dr. Michael A. Rosin with falsely diagnosing patients with cancer, then performing unnecessary surgery and billing Medicare for reimbursement. In some cases, Rosin diagnosed cancer based on biopsy slides "that contained no identifiable human tissue," the U.S. Attorney's Office announced Monday in a statement about the indictment. Reached Monday by phone, Rosin declined to comment on the charges. The 54-year-old doctor runs a solo practice at 1966 Hillview St. in Sarasota. Rosin was arrested and charged with 25 counts of health-care fraud in addition to 25 counts of making false statements in health- care matters, U.S. Attorney Paul Perez and Acting Inspector General Daniel R. Levinson announced in the statement. The potential penalties are stiff: five years in prison for each false statement count and 10 years for each health-care fraud charge. Rosin turned himself in to U.S. marshals in Tampa on Monday, made an appearance before a U.S. magistrate and was then released on $100,000 bail. Victims identified by the U.S. Attorney's Office will be notified by mail about the indictment and their rights, federal officials said. "This case shows a clear violation of the public's trust and puts an unfair burden on America's taxpayers and vulnerable patients," Levinson said in the statement. The U.S. Department of Health and Human Services, the FBI and the Office of Inspector General were also involved in the Sarasota case. The charges against Rosin are not unique. On March 17, a Boston skin doctor was charged with falsifying diagnoses of patients so that he could get reimbursements for treating them. As in Rosin's case, the lead investigative group was Health and Human Services. In Boston, federal officials accused Dr. Razzaque Ahmed, 56, of mixing blood samples from patients who had a rare skin disease covered by Medicare -- pephigus vulgaris -- with the samples of those who had a less serious disease not eligible for Medicare coverage. The diagnoses qualified the less-ill patients for expensive intravenous immunoglobulin treatments. PHOTO; Caption: Dr. Michael A. Rosin is charged with 25 counts of health- care fraud. 7)Sarosota doctor charged with fraud in false cancer tests, surgery April 12, 2005Associated Press NewswiresSARASOTA, Fla. (AP) - A doctor has been charged with $3.2 million in health care fraud for getting federal reimbursement for unnecessary skin cancer surgery based on false biopsy reports and medical histories. Dr. Michael A. Rosin ran an eight-year scheme to defraud the Medicare system with false claims and medical records, according to the indictment listing 50 patients. Doctors are required to retain slides showing cancer cells to document the need for surgery, but in some cases Rosin's slides contained no human tissue, prosecutors charged. Twenty-five patients received four-stage cancer surgery based on false diagnoses from 2000 to 2004, the indictment said. The other 25 patient were listed by the Sarasota dermatologist on Medicare claims falsely stating their surgery was medically necessary from 2001 to 2004. Rosin, 54, who runs a solo practice, turned himself in to federal marshals in Tampa on Monday, made an appearance before a magistrate and was released on $100,000 bail. Reached Monday by phone, Rosin declined comment on charges carrying a possible 10-year prison sentence. Patients identified by prosecutors will be notified by mail about the indictment and their rights, federal officials said. "This case shows a clear violation of the public's trust and puts an unfair burden on America's taxpayers and vulnerable patients," Daniel R. Levinson, acting inspector general of the Department of Health and Human Services, said in the statement. U.S. Attorney Paul Perez called the fraud "outrageous conduct."
8)Feds raid doctor's office, take patient files LISA RAB and MARGARET ANN MIILLE STAFF WRITERS May 27, 2004Sarasota Herald-TribuneSARASOTA Federal law enforcement agents raided the office of a local dermatologist Wednesday, seizing records for an investigation into possible health care fraud. Michael A. Rosin, 53, is under investigation by the Office of Inspector General at the U.S. Department of Health and Human Services, a spokeswoman for the federal agency said. The agents had a warrant to search his office. Agents from the Inspector General's office usually work on issues related to Medicare, the federally funded program for seniors and disabled people, and Medicaid, which assists low-income people, spokeswoman Judy Holtz said. Rosin has no Medicaid clients, but almost all of his several hundred patients receive Medicare, according to his officer manager. Rosin was out of town Wednesday and could not be reached for comment. His office manager, Carolyn Ferrara, said federal agents arrived at Rosin's Hillview Street office just after 8 a.m. Wednesday. They sent Ferrara home, then called her back to lock up the office when they finished their search around 3:30 p.m. "I was in shock. I'm still trembling," Ferrara said when she returned. Employees at nearby businesses watched as a group of uniformed agents carried piles of boxes out Rosin's back door. "We pulled in at 8:30 a.m. and they were all out there with their boxes," said Lynne McPherson, an Allstate insurance sales associate who works a few doors down from Rosin's office. By the time Ferrara returned "just about everything" was gone, including patient files, she said. "I'm still in shock, so I haven't really inventoried everything yet," she said. In the nearly seven years she has been in charge of Rosin's paperwork, Ferrera said, she never noticed anything out of the ordinary. "I didn't see any discrepancies. He's been billing the same since I've been here," she said. Florida Department of Health records show that Rosin has a clear and active medical license. He graduated from medical school at the University of Florida in 1976, and began practicing in 1983, shortly before completing a fellowship in microsurgery at George Washington University in Washington, D.C. He is certified by the American Board of Internal Medicine and the Medical Board of Dermatology and has staff privileges at Sarasota Memorial Hospital. "He's a respected physician in this community," said John Strausser, a plastic surgeon whose office is a few doors away. Rosin specializes in Mohs micrographic surgery, a highly advanced technique used in treating two of the most common forms of skin cancer. It involves removing a thin slice of tissue to create a "map" of any remaining cancer cells. The process can require the taking of multiple slices and possibly multiple office visits. Last month, Rosin was arrested after trying to board a plane with a loaded gun at Tampa International Airport. He told federal officials he had forgotten the .22-caliber revolver in his carry-on bag. According to a police report, Rosin said he carried the gun for protection because he often travels with large sums of money. He was taken to Hillsborough County jail, where he was charged with a misdemeanor concealed weapons permit violation and released on $250 bail. PHOTO; Caption: Michael A. Rosin is under investigation for possible health care fraud. 9)INFORMATION ISSUED BY U.S. ATTORNEY'S OFFICE FOR THE MIDDLE DISTRICT OF FLORIDA ON APRIL 11: SARASOTA DERMATOLOGIST INDICTED FOR HEALTH CARE FRAUD April 11, 2005US Fed NewsTAMPA, Fla., April 11 -- The U.S. Department of Justice's U.S. Attorney's office for the Middle District of Florida issued the following press release: United States Attorney Paul I. Perez and Acting Inspector General Daniel R. Levinson today announced the arrest of Michael A. Rosin, a 54-year-old resident of Sarasota, charging Rosin with twenty-five counts of health care fraud, and twenty-five counts of making false statements in health care matters. The maximum penalty for each false statement charge is five years' imprisonment and the maximum penalty for each health care fraud charge is ten years' imprisonment. Rosin turned himself in to the U.S. Marshals in Tampa today. He had initial appearance this afternoon before U.S. Magistrate Judge Mary S. Scriven and was released on a $100,000 secured bond. According to the indictment, Rosin is a dermatologist who has a solo practice in Sarasota. The indictment alleges that Rosin performed biopsies on patients and falsely diagnosed those patients with cancer, typically basal cell carcinoma. In some cases, according to the indictment, Rosin diagnosed cancer based on biopsy slides that contained no identifiable human tissue. The indictment further alleges that, based on his false diagnoses of cancer, Rosin performed medically unnecessary surgeries, and then fraudulently billed Medicare for reimbursement for the surgeries. United States Attorney Paul I. Perez stated, "This type of outrageous conduct cannot be tolerated. We will continue our aggressive assault on healthcare fraud and do everything we can to protect the citizens of our community from this type of abuse." "This case shows a clear violation of the public 's trust and puts an unfair burden on America's taxpayers and vulnerable patients," said Acting Inspector General Daniel R. Levinson. "My office simply won't tolerate those who abuse our programs, such as Medicare, and make illegal profit off the pain and suffering of our beneficiaries, " he said. Victims identified by the U.S. Attorney's Office will be notified by mail about the indictment and their rights as victims. The case was investigated by the Office of Investigations of the U.S. Department of Health and Human Services, Office of Inspector General and the Federal Bureau of Investigation, and will be prosecuted by Assistant United States Attorney Katherine Ho. An indictment is merely a formal charge that a defendant has committed a violation of the federal criminal laws, and every defendant is presumed innocent until, and unless, proven guilty. HTS uksc 050412-93741 SCHOUDHURY Steve Cole, 813/274-6352. 10)Dermatologist barred from surgery SUSAN TAYLOR MARTIN Times Staff Writer June 16, 2005St. Petersburg TimesThe 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." Susan Taylor Martin can be contacted at firstname.lastname@example.org
For Background:KOSHER TROOP OF BOY SCOUTS THRIVES IN MIAMI BEACHSouth Florida Sun-Sentinel (Fort Lauderdale, FL)December 2, 2004by Lisa J. Huriash Kosher ConnectionOne of the most popular activities Boy Scouts have is sitting around a campfire roasting marshmallows and trading tales after a meal of hot dogs and hamburgers. For boys from observant families, this can be a problem. Who knows what's in those hot dogs? How were the utensils used? And what about camping on Saturdays?"When you go camping, you have to cook with your patrol: eight to 10 boys. And if you're the only one keeping kosher, you can't use the same utensils. It becomes more of a concern if you're Sabbath observant because most events happen on the weekends," says Michael Poretsky, chair of the Greater New York Councils Jewish Committee on Scouting.But for the 25 members of the Miami Beach Troop 627, aged 10 through 19 (which include Scouts and Eagle Scouts), being kosher doesn't mean staying home. In fact, the troop keeps the rules of kosher as well as the laws of the Sabbath.Although you'll find many predominantly Jewish Boy Scout units around the country (the National Jewish Committee on Scouting estimates there are 30,000 Jewish kids in Boy Scouts troops and 6,000 of them are in units chartered to Jewish organizations), there are only a handful of strictly kosher ones in places such as Brooklyn, Queens, Baltimore, Boston, Los Angeles, Detroit and New Jersey.But this is the only one in Florida."Most of the parents are grateful because these are things the kids would otherwise never get to do," says scoutmaster Michael Rosin, a doctor from Miami Beach. His troop does everything conventional Scouts do, and his boys can earn the same merit badges in cooking, camping, computer science, pottery, nature, sports, rock climbing, astronomy and leatherwork.But when it comes to food, they follow special rules.For example, on Friday afternoons during camping trips, before the Sabbath begins, the troop pitches their tents and starts the fire. The evening meal usually consists of steak, chicken, baked potatoes, corn and cholent. They also prepare some foods for Saturday morning breakfast such as hard-boiled eggs.Saturday breakfast is cold foods such as cereal, bagels, lox and cheeses. Lunch is cold cuts: turkey, pastrami and roast beef as well as chicken and steak left over from the night before.Saturday dinners are hamburgers, hot dogs and marshmallows. Sunday morning is usually eggs and pancakes, "unless we're in a rush," Rosin says.Nathaniel Rosin, 19, who is a second-year college student at Talmudic University of South Florida in Miami Beach, has been a member of his father's kosher troop since the third grade.He knows that without a kosher unit, he would be unable to participate in campouts. "When you do cook, you cook in quantity. It would be difficult for me to push for my own thing in other [non-kosher] groups. It would be difficult being the only one who [needs kosher food and utensils and pots]. You would lose a lot of the teamwork aspect. When you go out in the woods with seven other boys, you have to work with other people," he says.Kosher Restaurant Guide: Great Kosher Restaurants Magazine is a super magazine that features 128 pages listing top kosher restaurants throughout the country, including some menus, rabbinical supervision information and business hours. The listings include a few places in South Florida, New Orleans, Denver, Boston and New Jersey. The bulk of restaurants are in Long Island and New York City. The $4 guide is available at Barnes & Noble and Jewish bookstores in Miami and Hollywood. For information, call 718-253-9210. Many of the restaurants are also listed on its Web site, www.GreatKosherRestaurants.com.Nosh, Nibble & Cook Class: Instructor Karen Brenker will lead a hands-on workshop on how to create festive foods for Jewish holidays. The classes are open to the community and will be 9 to 11 a.m. Sunday, April 10 and May 8 at Temple Beth Torah, 9101 NW 57th St., Tamarac. The cost is $6 per class for materials. To register, call 954-721-7660, ext. 25.Even More Kosher: Empire Kosher Poultry Inc. is introducing 14 new products including chicken breast entrees with pesto, broccoli, mixed vegetables and wild rice, specialty hors d'oeuvres such as mini stuffed cabbage, turkey meatballs and mild or spicy chicken wings, and Tasty Burgers (chicken and turkey), which are individually pre-made and frozen for convenience. Empire will also offer fresh ground chicken for customers to use in making their own burgers, meatloaf, meat sauces and other dishes. The new products are available at most kosher butchers, delis, specialty retailers and major supermarket chains.Kosher Condos: The Jewish Journal of Greater Los Angeles reports that in California, real estate developer George Saadin is working to build condos that cater to kosher consumers. His condos feature two dishwashers, two separate counters and two sinks to allow religious Jews to cook and clean dairy and meat products separately. The units will also have programmable timers to automatically turn lights off and on during Shabbat and a netila station -- a sink for ritual handwashing.A Word On hanukKah: Tuesday night begins the eight-day Jewish Feast of Lights. Hanukkah, whose name is Hebrew for "dedication," recalls the Jews' recapture of the ancient Temple in Jerusalem from a pagan tyrant.The celebrated events took place 165 years before the traditional date of Jesus' birth, when Israel was ruled by a Greco-Syrian king named Antiochus Epiphanes. The king banned Judaism.Led by the five Maccabee brothers, the Israelites revolted, wanting their freedom of religion. They miraculously defeated the Greek army and set out to rededicate the Temple, but found only one day's supply of oil for the Great Menorah. In the story's second miracle, the oil burned eight days, long enough to purify a new supply.Hanukkah celebrations feature the lighting of candles and festive foods: latkes (potato pancakes) and sufganiot (doughnuts filled with jelly or chocolate). Both are deep-fried in oil, recalling the miracle of the Temple lamp.books for kosher cooks: Joan Nathan's Jewish Holiday Cookbook (Schocken Books, $29.95) includes classic recipes from her publications The Jewish Holiday Kitchen and The Jewish Holiday Baker, plus new recipes from her public television series. Recipes include Italian matzo, chocolate babka, apricot honey cake and Romanian zucchini potato latkes. One thing I love about this book is that it includes sample menus for the "minor" holidays often overlooked by other cookbooks. These include Tu Bishvat, Israeli Independence day and a Lag Ba-omer picnic. There are also menu ideas for weddings and bar mitzvahs.easy access: www.holidays.net/highholydays/sweets.htm has nifty recipes for challah, apple and plum kugel, carrot kugel and honey cake ice cream.What's New: Products recently certified kosher by the Union of Orthodox Jewish Congregations of America include Silver Tray Cookies brand of assorted French cookies, Character Cookies, Dietetic Cookies, Guava Mini Crme Cake, Mango Mini Crme Cake and Pina Colada Mini Crme Cake. Silver Tray Cookies is based in Hialeah.Labeling Alerts: The Union of Orthodox Jewish Congregations of America put out an alert recently on Astri Spumante Sparkling White Wine. The product bears an unauthorized OU symbol and is not certified as kosher by the Orthodox Union. Consumers spotting this product are requested to contact the Orthodox Union at 212-613-8148 or by e-mail at email@example.com.Also, El Burrito Mercado's Tamales-Chicken and Green Chile Flavored and Tamales-Pork Flavored products, which are sold exclusively in Super Target stores, bears an unauthorized OU-D symbol. The product is not kosher and is being withdrawn from the marketplace. Other El Burrito Mercado products are kosher when bearing the OU symbol.Kosher Connection appears on the first Thursday of each month. Lisa, who keeps a kosher kitchen in her Broward home, can be reached at firstname.lastname@example.org or 954-572-2008. Be sure to include your telephone number.SIDE DISH/PAREVE/DAIRYADA SHOSHAN'S APPLE LATKESTHIS IS PERFECT FOR CELEBRATING HANUKKAH.2 eggs, well beaten*1 1/2 cups orange juice, yogurt or milk2 cups all-purpose flour1 teaspoon, baking powderDash salt1/4 to 1/2 cup sugar, depending on taste3 medium apples, peeled, cored and coarsely gratedVegetable oil, for fryingConfectioners' sugar, for dustingMix eggs with orange juice, yogurt or milk in a (nonreactive) bowl.In a separate bowl, combine flour, baking powder, salt and sugar. Add dry ingredients to egg mixture along with grated apples.Heat a thin layer of oil in a skillet. Drop 1 heaping tablespoon batter per latke or pancake into hot oil. Cook about 2 minutes on each side, or until slightly golden. Drain on paper towels, sprinkle with confectioners' sugar and serve. Makes 36 latkes.Per latke (with orange juice): 85 calories, 53 percent calories from fat, 5 grams total fat, 10 milligrams cholesterol, .41 gram saturated fat, 1 gram protein, 9 grams carbohydrates, .36 gram total fiber, 24 milligrams sodium, 4 grams total sugars.Per latke (with milk): 86 calories, 55 percent calories from fat, 5 grams total fat, 11 milligrams cholesterol, .60 gram saturated fat, 1 gram protein, 8 grams carbohydrates, .36 gram total fiber, 28 milligrams sodium, 3 grams total sugars.* Break each egg into a dish and discard those with blood spots. Only eggs without blood are kosher.Adapted from Joan Nathan's Jewish Holiday Cookbook (Schocken Books, September 2004, $29.95).
http://www.heraldtribune.com/apps/pbcs.dll/article?AID=/20050615/NEWS/506150679Sarasota Herald-Tribune, FLJune 15, 2005Fort Lauderdale attorney Theresa Van Vliet, left, walks with her client Dr. Michael Rosin as they leave the Sam M. Gibbons United States Courthouse in downtown Tampa. Rosin has pleaded not guilty to all of the charges.License restrictedThe state Department of Health on Tuesday restricted Dr. Michael Rosin from performing surgery. Rosin was arrested in April on federal charges of health-care fraud.The doctor is prohibited from treating any patient for suspected or confirmed skin cancer and must refer any patient with a suspected cancer to another physician.A sense of betrayalHow a patient's doubt and anger, shared by others, led to federal charges against a prominent skin-cancer doctorBy MIKE SAEWITZmike.email@example.comSARASOTA -- Ellen Murray had long wondered about her visits to Dr. Michael Rosin. Every time she saw the dermatologist, he sliced skin from her body and told her it was cancer.It was after the ninth surgery -- a tumor Rosin said he cut from her back -- that she decided to seek a second opinion. What she found out confirmed a gut feeling.There was no cancer."It was betrayal that got me so angry," said Murray, 65. "I can't believe I trusted him so much."Murray was so angry she went to federal authorities, who arrested Rosin in April on charges of defrauding Medicare. Authorities say that Rosin may have made at least $3 million by performing unnecessary surgeries after falsely diagnosing hundreds of patients.Murray's sense of betrayal is now common among many elderly patients raising the same disturbing questions about Rosin's treatment.Did I have cancer? If not, did I really need surgery?And they wonder whether Rosin, a Boy Scout troop leader and family man, would lie to them just to make money, as federal agents say. If he is found guilty, he could spend the rest of his life in prison.With his trial months away and his practice still open, the state Department of Health on Tuesday restricted Rosin's license to prevent him from performing surgery.Rosin, 54, has pleaded not guilty to all of the charges. His friends say the dermatologist isn't driven by money, and there's no way the charges are true.Rosin's lawyers say the doctor is innocent and that there are "big, gaping holes" in the evidence against him."When everything comes out in front of a jury, it's going to be clear that this is a case that is an overreaction on the part of some people and, in large part, a misunderstanding," said Theresa Van Vliet, Rosin's Fort Lauderdale attorney.'Demonstration of concern'When Rosin was arrested, Nancy Anderson remembered the day the dermatologist performed surgery on her lower left eyelid seven years ago.It was one of several surgeries Rosin performed on the Siesta Key retiree. But that surgery was particularly painful and left Anderson tired and pale."If that diagnosis was a fake," says the 85-year-old, "I'll kill him with my own two hands."Most of Rosin's patients were older and came to see him many times in the 22 years he has practiced here.Anderson, concerned about a life in the sun, says she found Rosin in the 1980s because he was the only doctor here practicing Mohs micrographic surgery, then a cutting-edge technology considered a fast and reliable way to detect and eliminate skin cancer.Anderson remembers Rosin's surgeries were long and left her achy. Yet she was impressed with the doctor, particularly because he always called her at home after a surgery. "He was ingratiating to start with," she said.It was that personal touch that endeared him to hundreds of patients."With my dad, he thought this guy walked on water," said Larry Perczak, whose father saw Rosin until his death. "The demonstration of concern, my dad loved that."Longtime patient Eleanor Bloom described Rosin's concern for his patients as almost familial."He tried to be more like a son than a doctor," she said.A skilled needlepoint artist with awards to prove it, Rosin performed suturing that some patients described as immaculate.You would never know Bloom had 14 stitches down the center of her nose. Rosin's work left no scar."He was really good at what he did, and he knew it," Bloom said.Although many patients continued to see him for years, they say now they wondered about what seemed like an endless string of surgeries."It was never less than two and usually three or four," Anderson said. "I never remember coming out of there after only one."In between cuts, patients remember going back to a waiting room full of bandaged people. Many hung around for four hours of procedures."Those cuts were no joke," said Margaret Sowney, a North Port woman who had surgeries on the side of her face, above her eye and on her cheek.Court records show Rosin became a millionaire by removing layers and layers of skin from hundreds of seniors in Sarasota, Manatee, Charlotte and DeSoto counties. And Medicare paid the bills for most of Rosin's patients. The federal program reimburses 80 percent of charges for most medically necessary procedures, and each layer of Mohs surgery was separately reimbursable.Stories of repeated cuts got around to at least one Sarasota dermatologist, Dr. Mark Burnett. Some of Rosin's patients no longer believed Rosin's diagnoses, Burnett said.Yet Burnett said he had no reason to report their complaints because he hadn't seen Rosin's patient files."When you have a few folks who are telling you the same thing, you have to say, 'I wonder,'" he said. "I don't like to ...one's work based on a patient's statements. It's hearsay until the records are examined."Building a caseEven after Murray got her second opinion in July 2003, she says she chastised herself for thinking that Rosin might purposely be making false diagnoses."Your mind doesn't want to accept somebody's doing this," said Murray, a retired IBM product planner from New York. "Nobody would think a doctor would do something like that."She forwarded three additional Rosin slides to a dermatology and pathology specialist, who found materials not recognizable as skin in two of them, according to recently unsealed court records. In the third, there were thin superficial portions of skin and numerous air bubbles, the specialist found.Murray was outraged. To her, the idea of Rosin taking a scalpel to her body for no reason was no different than a criminal attack with a knife, she said.Compelled to do something, she says she tried nearly a dozen times to complain to Centers for Medicare and Medicaid Services. The agency was difficult to deal with, she said.Sometimes, she'd get so frustrated she'd hang up on workers there. Other times, she'd leave messages that were never returned.She talked to other doctors and lawyers about Rosin, but wasn't interested in filing a medical malpractice lawsuit. She wanted to bring him to justice.Murray said she eventually enlisted the help of Carolyn Ferrara, Rosin's office manager since 1997.She had become friendly with Ferrara while in the waiting room, and knew the office manager suspected Rosin of lying and performing medically unnecessary surgeries.Ferrara said it wasn't long before she knew something was wrong at Rosin's office."It was the same patients day after day after day," she said.Just a few months before Murray began her campaign, Ferrara filed a fraud complaint with Medicare. The agency had a contractor investigate, according to a report by a special agent with the U.S. Department of Health and Human Services.The contractor interviewed patients and analyzed data, according to the report. Ferrara also gave the contractor copies of patient complaint letters. Nothing came of the complaint."I got nowhere," Ferrara said.Frustrated and certain that Rosin was scamming his elderly patients, Ferrara and Murray filed a false claims, or whistle-blower, lawsuit against Rosin in federal court on Feb. 24, 2004. Rosin's lawyers are sure to question the women's motives.Under the whistle-blower's act, if the government wins its case and collects the $9 million in damages it's seeking, the women will receive as much as 25 percent, or about $2 million, for uncovering the fraud.Murray says money was never the issue and that the lawsuit seemed to be the only way to get the government's attention.Investigators with the FBI and Health and Human Services met the women in April.FBI reports show that Ferrara told the federal agents that 100 percent of biopsies Rosin reviewed came back as cancer. Ferrara also said that Rosin told her he had a five-surgery-per-day quota because he had seven children and needed to make $10,000 a day.Over the next few weeks, federal investigators interviewed others who had worked for Rosin. Former employees confirmed some of Ferrara's accusations and added their own, the report shows.One former employee said that Rosin performed skin cancer surgery after reviewing a biopsy slide containing a piece of chewing gum, placed there after the employee had lost the skin specimen, according to the FBI agent's report.Dusty Wells, another former employee, told investigators she was suspicious of Rosin and decided to "test" him by replacing the skin with a piece of Styrofoam. Ferrara told investigators she overheard Rosin tell that patient that the cancer was "very aggressive," and then performed surgery on the patient's ear.Rosin's lawyers may also attack Wells' credibility because Rosin once accused her of stealing money, and told a police officer he planned to fire her for poor performance, according to a Sarasota police report.Still, former employees gave investigators enough fuel to go after records. Agents in May 2004 spent more than seven hours in his Hillview Street office, a block from Sarasota Memorial Hospital.They took boxes of patient files and log books, according to a Health and Human Services investigator. They left with "just about everything," Ferrara told the newspaper at the time.Surgeries upon surgeriesMuch of the case, investigators say, is in the records, boxes of log books going back to the 1980s.The records show that most of the biopsies were diagnosed as cancer, according to an FBI agent's report. They also showed a pattern of removing four layers of skin.Several patients had gotten more than 30 surgeries over a period of a dozen years, court documents show. One patient had had more than 120 surgeries over 20 years.The records were forwarded to Medicare statisticians, who found that Rosin performed surgery far more than other doctors practicing Mohs.In 2000, reports show, the dermatologist performed surgery on 533 of 633 Medicare beneficiaries he saw. Rosin billed for one skin cancer surgery an average of 162 times per 100 patients, the statisticians said, while his peers billed for the same surgery an average of six times for every 100 patients.Dr. Pearon Lang Jr., a dermatology professor at the University of South Carolina's medical school and the president of the American College of Mohs Micrographic Surgery and Cutaneous Oncology, reviewed 75 patient files, according to the FBI report.Lang said most of the slides were of such poor quality that a cancer diagnosis couldn't have been made. He also told an FBI agent that it would be "nearly impossible" for any dermatology practice to have such a high rate of skin cancer diagnoses.Burnett, the Sarasota dermatologist, says what the FBI may view as certain proof may be far from that.Rosin told an employee he only biopsied areas he believed were cancerous, according to court records. If most of Rosin's slides came back as cancerous, says Burnett, that may mean that he was excising the right lesions.The slides the FBI examined will be an issue, too. Burnett said that because they are a few years old, the skin tissue may have deteriorated.In defense of repeated surgeries, Rosin told a suspicious employee that skin cancers often recur, according to a federal investigator's report. And repeated surgeries are not uncommon on elderly patients who spent a great deal of time in the sun.'It's about time'In early April, many of Rosin's elderly patients got a rather cryptic letter from the FBI informing them that they may be the victim of a federal crime. It didn't mention Rosin.Ten days later, they got a letter from federal prosecutors announcing Rosin's indictment on 25 counts of health-care fraud and 25 counts of making false statements relating to health-care matters.The letter also offered a phone number for updates and an acknowledgment: "We recognize the impact these allegations have on you personally."If the charges against Rosin are true, Anderson said, "It's just unconscionable."Going to Rosin, she said, was l ike going to a dentist. You did whatever he said. Even if it might hurt.Since the letter, his patients have been calling the U.S. Attorney's Office and the Herald-Tribune to find out whether they are victims.The federal prosecutor has asked a judge to quickly schedule the trial because so many elderly people want to know whether the doctor they trusted was a sham. The trial could be as early as this summer or as late as next year.Ferrara and Murray are both happy to hear that Rosin won't be performing surgery anytime soon."It's about time," Ferrara said of the license restriction.Anderson acknowledges that even a trial may not tell her whether her surgeries were legitimate."I'll never know, I'm sure," she said.
http://www.sptimes.com/2005/06/12/State/And_he_s_still_practi.shtmlAnd he's still practicingFEDERAL ACCUSATIONS: 25 counts of health care fraud. 25 counts of making false statements. Performed "medically unnecessary" surgeries. Operated on one patient 122 timesBy SUSAN TAYLOR MARTIN, Times Senior CorrespondentPublished June 12, 2005Dr. Michael A. Rosin, SarasotaOccupation: DermatologistSpecialty: Skin cancerAction by Florida Board of Medicine: NoneAction by Florida Department of Health: NoneAction by medicare program: NoneStatus of license to practice medicine: "Clear/active" SARASOTA - William Kapfer, an 88-year-old retiree, thought he was in good hands with Dr. Michael A. Rosin.A physician since 1978, Rosin was among the most respected dermatologists in Sarasota. And he was one of just two with intensive training in Mohs microscopic surgery, a state-of-the-art procedure effective in curing the most common types of skin cancer.Over a span of four or five years, Kapfer often found himself in Rosin's office undergoing Mohs surgery. So often that he began to wonder if he really had as many skin cancers as the doctor diagnosed."I'm a lay patient and you have to go by what somebody tells you - if he takes a sample and says it's cancer and you need to be treated, you accept that," Kapfer said. "However, the number of times he did that became rather large, and I began to get suspicious."In April, Kapfer's doubts were confirmed: He was among dozens of elderly patients listed in a federal indictment that accuses Rosin of falsely diagnosing skin cancer and performing unnecessary surgery.From 1996 through last June, the indictment says, Rosin schemed to "deceive his patients" into thinking they needed cancer operations so he could bill the Medicare program for their treatment. He is accused of illegally collecting at least $3.2-million in Medicare payments.In one case, FBI agents found, Rosin based his diagnosis on a slide that contained chewing gum, not human tissue.In another case, the FBI said, a lab technician decided to test Rosin by substituting a sliver of Styrofoam for a tissue sample. After examining the slide, Rosin told the patient that her cancer was "very aggressive" and that she needed surgery the next day.Rosin, 54, would not comment for this story. At a hearing in April, he pleaded not guilty to criminal charges - 25 counts of health care fraud and 25 of making false statements - that could put him in prison for life. One of his lawyers, Greg Kehoe of Tampa, said the allegations are "absolutely not true.""The work he did was proper in all respects," Kehoe said. If the government was so concerned about Rosin's practice, Kehoe added, why didn't it do something a year ago when it started investigating him? Rosin is still performing surgery and is still in the Medicare program. Neither the Florida Board of Medicine nor the state Health Department has taken any action against him; prospective patients checking him out on the department's Web site would find that his license remains "clear/active.""I think that's outrageous," said Kapfer's 80-year-old wife, Rosalie, who also underwent surgery by Rosin. "I don't understand why they don't close him down - it seems terrible having people cut up perhaps unnecessarily. He whacked us up good, we both have scars all over.""Medically unnecessary' Rosin's credentials are impeccable.A graduate of the University of Florida, he did residencies at George Washington University, the University of Miami and Vanderbilt. Patients generally found him professional and friendly, devoted to his seven children.His office, across from Sarasota's main hospital, has two signs in the window: "Lionel Trains Wanted" and "Official Boy Scout Gear." Inside, among framed medical certificates, are several examples of his needlework.One patient recalls Rosin excitedly announcing that he had won a blue ribbon for needlepoint at the Sarasota County fair. He told another patient that he took up the hobby to keep his hands limber for surgery."At first I was kind of surprised, but when he explained it I could understand it," said Jean Schnurle, 90, a former secretary.Rosin is among just 744 fellows of the American College of Mohs Micrographic Surgery and Cutaneous Oncology. Members are required to complete months of training in the delicate surgery Dr. Frederic Mohs developed in the 1930s.Mohs surgery is primarily used to treat basal and squamous cell carcinomas, the most common and curable types of skin cancer. After the obvious tumor is removed, the surgeon takes an additional layer of tissue and examines it under a microscope for evidence of any remaining cancer cells. If it contains cancer, the doctor removes another layer of tissue from the site. The process continues layer by layer until the cancer is gone."I don't think you can go wrong with Mohs because it is the most meticulous way to make sure you remove all the cancer," said Dr. David Brodland of the Mohs College board of directors. "That said, is it necessary to treat everybody with Mohs? Not at all."Doctors in Sarasota, Manatee and Charlotte counties often referred patients to Rosin. Among them were the Kapfers of Englewood, whose dermatologist was concerned about what seemed to be a growing basal cell tumor near Rosalie Kapfer's eye."While we were up there, I had him (Rosin) look at me, too, and he found something," recalled Kapfer, a retired chemical engineer. "We stayed with him for several years because I liked the idea of Mohs surgery, where you didn't have to wait a week before they knew what was going on - they could get it all done in the same day."Rosin did a "couple of dozen surgeries" on him, Kapfer said, and several on his wife, including one so painful she still shudders to think about it.Disenchanted with Rosin, the Kapfers quit seeing him two years ago. "Since then we started going to a dermatologist down here who doesn't find something every time," Mrs. Kapfer says. "In fact, he hasn't found anything."Rosin's own staff was growing suspicious, as well. The FBI began investigating early last year, acting on a complaint from his longtime business manager Carolyn Ferrera.According to an FBI warrant, Rosin told Ferrera he had a quota for the number of surgeries he needed to perform to support his large family. He said he had to make $10,000 daily; employees noticed that he performed five surgeries a day, reimbursed at the rate of about $2,000 per surgery.Employees said they also questioned Rosin as to why 100 percent of the biopsies he reviewed were diagnosed as cancerous. His response: The results were positive because he only biopsied areas he thought were malignant. Moreover, he said, most of his patients previously had skin cancer and it was not uncommon for the cancer to recur.In one case, though, Rosin reportedly examined a slide that contained chewing gum. A lab technician told the FBI she put the gum there because a patient's skin specimen was too small to process.In two other cases, a technician overheard Rosin telling patients they had cancer and required surgery - before he had even looked at their slides.On April 14, 2004, police at Tampa International Airport arrested Rosin when he tried to pass through security with a loaded .22-caliber revolver. Rosin, who had a concealed firearm permit, said he forgot the weapon was in his duffel bag."He further stated that the firearm was for his protection because he often traveled with a large sum of money," the police report said.The case was dropped. Six weeks after Rosin's arrest, though, agents from the U.S. Department of Health and Human Services, which administers Medicare, raided his office and carted off dozens of patient files.Of those, 75 were turned over to Dr. Pearon Gordon Lang, president of the Mohs College, for review. He found that only six slides were of "satisfactory quality" and contained cancerous tissue.Many of the other slides, Lang said, were of such poor quality that no diagnosis could be made. Six of the Medicare claims did not have any biopsy slide at all.Rosin's records showed he diagnosed most cases as basal cell carcinoma. "After reviewing the log books, Dr. Lang remarked that it would be nearly impossible for any dermatology practice to have such a high rate of basal cell carcinomas," the FBI warrant says. "He felt there should be a much wider range of diagnoses, including negative diagnoses."According to another government court filing, Rosin performed so many skin cancer surgeries "that the sheer quantity . . . suggests many of them were medically unnecessary."At least 13 patients underwent surgery 20 or more times. One patient was operated on 104 times; another, 122 times.Typically, Rosin removed four layers of tissue during surgery; each layer was reimbursable by Medicare, meaning the more layers he removed the more money he got."Four stages is not unusual for difficult cases," said Brodland, the Mohs expert. "But if you do four stages on everybody, that's pretty unusual."A risk? Concerned by all the "cutting and stitching" Rosin did on her, Barbara Sweeney already had switched doctors by the time he was charged. She is among the patients listed in the indictment.The FBI said "one of the procedures was not necessary, but which one it was I have no idea," said Sweeney, 73, who worked in sales. "As soon as I heard about the problems I pulled all my records out, such as they were. They were just a couple of lines for each procedure, handwritten and hard to read."Peter Hillenbrand feels betrayed by a man he not only held in professional regard, but considered a friend. Rosin once brought his children to the Hillenbrands' Sarasota home."I didn't know all this time he was so deceiving," said Hillenbrand, 84, a former builder and postal employee. "It made me feel like I can't trust any doctors anymore."Other patients remain fiercely devoted to Rosin."He's 100 percent the finest doctor I've had in 87 years," says Stuart Magowan, a retired marketing executive. "I think the charges are probably the work of some idiot in the FBI, and we know what they've proven to be with this Deep Throat mess."Magowan was among those, the FBI said, whom Rosin diagnosed with cancer and operated on even though his skin specimen was "normal."At the April hearing, prosecutor Katherine Ho said she was concerned that Rosin continued to see patients. His trial should be held as soon as possible, she said, because of the risk to patients, many of them old and in fragile health.But Rosin's lawyer said the doctor is presumed innocent and should be allowed to practice while awaiting trial."The U.S. has had this information for over a year and did nothing about precluding him from practicing," Kehoe said. "If they were so concerned about the patients, why didn't they do something about it a year ago? Why all of a sudden should he be stopped now?"The publicity has had a "devastating effect" on Rosin's business, Kehoe said, but he still has many loyal patients who are among those expected to testify at his trial."Our client is not guilty and there are plenty of people who will come forward as well as expert testimony to prove that." Due to scheduling conflicts, the trial is not expected to be held for several months.The state Department of Health can take emergency action against a doctor who represents "an immediate and imminent danger to the health and safety" of the public. Action can include suspending a doctor's license or restricting practice, such as a ban on performing surgery.As of Friday, no action had been taken, and department spokesperson Lindsay Hodges said, "I can't confirm or deny" an investigation is under way.Physicians also can be disciplined by the Florida Board of Medicine, a process that typically takes months. Again, Hodges would not comment.Rosin remains in the Medicare program and eligible for reimbursement. If convicted, he would be automatically expelled for five years.Though he can still collect Medicare funds, the government has started forfeiture proceedings against property "derived" from the $3.2-million Rosin is accused of fraudulently receiving thus far. That could include his 3,500-square-foot home on Sarasota Bay, conservatively valued at $1.43-million; a "Michael A. Rosin" is listed as owner of an $800,000 house in the Miami area, where the doctor has told patients he spends time.Rosin also faces potential malpractice suits from seven former patients who have asked that the statute of limitations be extended.Among those considering legal action are Loyal Behling, 78, and his wife, Patricia, 80. Rosin did numerous surgeries on both; their daughter, Norvia, said each has a disfiguring scar on the nose, where Rosin cut off the tip."My father and mother finally just stopped going to him - they weren't going to have a face left."Times researcher John Martin contributed to this report. Susan Taylor Martin can be contacted at firstname.lastname@example.org
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