A Florida physician accused of making a killing by repeatedly billing Medicare for complicated skin cancer procedures that he either never performed or that were unnecessary has agreed to pay the feds $4 million and not to participate in any federally funded health care programs for 5 years.

Donald C. Proctor Jr., MD, FACS, who runs the Face Center of Vero in Vero Beach, Fla., was accused of jacking up reimbursements by billing the government for Mohs surgery, an expensive procedure used to remove certain types of skin cancers. According to the Department of Justice, he routinely lied to patients who'd been referred to him with confirmed skin cancer lesions, telling them that they also had additional lesions that required the surgery.

In Mohs surgery, which is performed in stages, surgeons remove single layers of tissue, evaluate excised tumors and then perform additional stages, if necessary, until all cancer is removed. Dr. Proctor, says the government, increased his take by routinely performing far more stages than were necessary. He also allegedly defrauded Medicare by billing for expensive and time-consuming adjacent-tissue transfers to close surgical defects left by virtually every Mohs surgery he performed, even though many were either unnecessary or never actually done. The volume of tissue-transfer procedures he billed for would have been physically impossible to perform, says the government.

The case was originally filed by whistleblowers Ferdinand F. Becker, MD, a Vero Beach plastic surgeon who'd referred patients to Dr. Proctor, and Linda Wildes, who worked for Dr. Proctor as a histology technician. Under the provisions of the False Claims Act, Dr. Becker and Ms. Wildes are entitled to a portion of the settlement, in this case $920,000.

"I have always attempted to do what is best for my patients," Dr. Proctor tells Outpatient Surgery Magazine. "The settlement did not require me to admit liability. Both my lawyer and the government's attorney firmly believed that the settlement avoided the cost and uncertainty of relying upon a jury's determination of extremely complex medical issues. This has been a painful process. It has made me a wiser physician."

Jim Burger