South Florida

Doctor accuses UM, Bascom Palmer colleague of Medicare fraud

Bascom Palmer Eye Institute
Bascom Palmer Eye Institute MIAMI HERALD STAFF

A four-year-old lawsuit between a pair of star doctors who had a falling out at the nation’s No. 1 ranked eye institute, Miami-based Bascom Palmer, was finally unsealed on Wednesday — revealing allegations of “false claims” for procedures billed to Medicare based on “fabricated” patient evaluations.

Dr. Philip Rosenfeld, a retinal specialist, accused his one-time colleague, Dr. Timothy Murray, an oncology eye surgeon, along with Bascom’s corporate parent, the University of Miami, of committing fraud in a whistle-blower action.

In the 57-page False Claims Act case, Rosenfeld’s attorneys argued that UM’s Miller School of Medicine and Bascom “retaliated” against him for exposing Murray’s and the university’s “malfeasance” inside the prominent eye institute.

The “university made a deliberate choice to conceal and ignore the Medicare fraud and patient abuse, and to undermine and punish the whistleblower, all with the goal of protecting Bascom Palmer’s number one national ranking at all costs,” wrote attorneys Ryan Stumphauzer and Kevin Jacobs.

They also said attorneys for UM and Murray “conspired” to create a “humiliating and disparaging narrative of Dr. Rosenfeld” in a 2014 Miami Herald story, which broke the news about his sealed civil case and a parallel criminal investigation.

Federal prosecutors indicated in a court filing that they have not decided whether to join Rosenfeld’s civil suit, which claims that Murray performed surgeries such as cataracts and administered injections for wet macular degeneration that were not medically necessary and cost the taxpayer-funded Medicare program potentially millions of dollars.

But prosecutors did acknowledge that they were not willing to pursue civil patient-referral violations by Murray while he worked at Bascom and made more than $1 million a year — among the highest paid employees at the university.

An attorney for Murray, who left Bascom under pressure four years ago, said Rosenfeld’s suit represented a “long-standing personal vendetta” against a surgeon with a “25-year track record of groundbreaking patient care in which he has saved lives and the eyes of thousands of patients.”

“The allegations in the lawsuit go back many years, were carefully reviewed by the University of Miami and found to be unsupported,” said defense attorney Jeff Marcus, a former federal prosecutor.

UM’s attorney, Dan Gelber, said the university and Bascom have “fully cooperated with the inquiry” by the U.S. attorney’s office but declined to comment about the newly unsealed case. Rosenfeld’s attorney, Stumphauzer, also declined to comment further about the allegations.

Rosenfeld not only complained about Murray’s medical practice while they both worked at Bascom, he also brought evidence of alleged Medicare fraud to the U.S. attorney’s office and federal investigators after the surgeon’s departure — including an analysis of dozens of his rival’s patient records. Those files were seized by agents with the FBI and and the Department of Health and Human Services in 2013.

While the civil case has finally been made public by U.S. District Judge Joan Lenard, the FBI, U.S. attorney’s office in Miami and the Justice Department are weighing whether to file criminal charges against Murray and Bascom in the parallel investigation.

That decision could be made by authorities in Washington because U.S. Attorney Wifredo Ferrer and his top assistants, including Gelber’s wife, criminal chief Joan Silverstein, have recused themselves from the investigation.

The targets of both the civil and criminal investigations have long been considered paragons of the medical profession — and not just in South Florida. Bascom Palmer, a branch of UM’s Miller School of Medicine, has been ranked No. 1 nationally for ophthalmology services by U.S. News and World Report for more than a decade — an achievement advertised atop its building at 900 NW 17th St. in Miami.

Before his departure in 2012, Murray was undeniably one of Bascom Palmer’s brightest stars.

A 1985 graduate of the Johns Hopkins University School of Medicine, he joined Bascom Palmer in 1991 and became a tenured professor who published about 300 peer-reviewed articles. Colleagues say he has an uncommon range of expertise and surgical skills, particularly in dealing with rare eye cancers in both adults and children.

At Bascom Palmer, Murray was known as a prolific surgeon who generated a huge stream of Medicare payments for the eye institute. As a result, he ranked among UM’s most highly paid employees.

Rosenfeld, in a 2011 email to a senior Bascom physician, complained about Murray’s pay of $1.2 million in 2008 and 2009, citing UM’s tax returns for those years. Rosenfeld wrote that “my total compensation package is not 75 percent of Tim’s package,” according to the email.

Like Murray, Rosenfeld is also a graduate of Johns Hopkins School of Medicine. He came to Bascom Palmer after landing a coveted fellowship in 1995. A highly regarded authority in the retinal field, Rosenfeld joined the faculty the following year.

A decade later, Rosenfeld pioneered the use of a low-cost cancer drug, Avastin, to treat wet macular degeneration, a retinal disease that causes blindness. He has testified before Congress about the drug’s potential savings to Medicare and has been quoted in numerous articles.

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