UNITED STATES DISTRICT COURT 

SOUTHERN DISTRICT OF FLORIDA 

Case No. 20-80052-CR-RUIZ/Reinhart(s) 

18 u.s.c. § 1347 

18 U.S.C. § 1035(a)(2) 

18 u.s.c. §2 

18 U.S.C. § 982(a)(7) 

UNITED STATES OF AMERICA, 

v. 

LAUREN ROSECAN, 

Defendant. 

I -----------

SUPERSEDING INDICTMENT 

The Grand Jury charges that: 

GENERAL ALLEGATIONS 

At all times material to this Superseding Indictment: 

Medicare Program 

ANGELA E. NOBLE 

CLERK U.S. DIST. CT. 

S. D. OF Fl.A. - MIAMI 

1. The Medicare program ("Medicare") is a federal health care program providing 

benefits to persons who are over the age of sixty-five or disabled. 

2. Medicare is a "health care benefit program," as defined by Title 18, United States 

Code, Section 24(b ). Individuals who receive benefits under Medicare are referred to as Medicare 

"beneficiaries." 

3. "Part B" of the Medicare program is a medical insurance plan that pays Medicare 

providers and suppliers, with the exception of inpatient healthcare facilities, directly for covered 

goods and services. 

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4. "Part C" of the Medicare program allows Medicare beneficiaries to receive covered 

benefits through private health insurance companies, rather than directly through Medicare itself. 

These health care benefit programs follow the Medicare rules and regulations in determining 

coverage and payment for medical services rendered to beneficiaries. 

5. In addition to Medicare Part B and Part C health care plans, beneficiaries may also 

obtain "supplemental" plans from private health insurance companies, which cover the 

beneficiaries' co-pay obligations under Medicare. All of these plans follow Medicare rules and 

regulations as well. 

6. Medicare is administered by the United States Department of Health and Human 

Services ("HHS") through its agency, the Centers for Medicare and Medicaid Services ("CMS"). 

CMS contracts with regional fiscal intermediaries, also known as Medicare administrative 

contractors ("MACs"), to receive, adjudicate, and pay Medicare claims submitted by Medicare 

providers. First Coast Service Options, Inc. ("First Coast") serves as the MAC in the State of 

-Florida. 

7. Medical clinics or doctors who seek to be reimbursed for medical services provided 

to Medicare beneficiaries must first apply for and receive a Medicare "provider number." In 

signing a' provider agreement, the provider agrees to abide by the Medicare laws, regulations, and 

program instructions. Among these obligations is the requirement that the provider submit claims 

only for reasonable and necessary medical services. In submitting a claim, the provider must set 

forth, amongotherthings, the beneficiary's name and Medicare number, the services provided, the 

diagnosis justifying the services, the date the services were provided, the cost of the services, and 

the name and provider number of the physician or other health care provider who ordered the 

services. 

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8. To aid in the processing and adjudication of claims, Medicare providers are 

required to use standardized codes to describe the pertinentdiagnosesand the procedures for which 

payment is being sought. With respect to diagnoses, providers are required to use the codes 

established in the International Classification of Diseases Manual ("ICD Codes"). ICD Codes 

relevant to this Superseding Indictment, include, but are not limited to, the following: 1906, C6930, 

C693 l and C6932, all related to a diagnosis of a malignant neoplasm of the choroid, i.e. choroidal 

melanoma; and 2240 and 2246, related to diagnosis of a benign neoplasm, i.e. a nevus. 

9. The Health Care Financing Administration Common Procedural Coding System 

("HCPCS") is the coding system used by Medicare to identify every task, seryice, or procedure a 

medical practitioner may provide to a patient, including medical, surgical, and diagnostic services. 

The HCPCS is based upon the Physicians' Current Procedural Terminology code book ("CPT 

Code") developed by the American Medical Association. On their claims for payment, medical 

providers state the HCPCS/CPT Codes (hereinafter referred to as "CPT Codes") that identify 1he 

types of services for which Medicare is being charged. These codes are used to determine 

reimbursement. For any claim to be payable, the procedure performed must be reasonable and 

necessary for the particular diagnosis. In other words, the diagnosis, as reflected in the ICD code, 

must support the medical necessity of the particular procedure performed. CPT Codes, their 

Medicare definitions and common descriptions relevant to this Superseding Indictment include, 

but are not limited to, the following: 

CPT Code Medicare Definition Common DescriQtion 

67210 Laser destruction of retinal growth, I or Focal laser photo coagulation 

more sessions ofretina 

67220 Destruction of vascular growth between Focal laser photocoagulation 

retina and the sclera, I or more sessions of choroid 

67228 Laser destruction of leaking retinal Pan Retinal Photocoagulation 

blood vessels, I or more sessions ("PRP") of retina 

76510 Ultrasound of eye tissue and structures A andB-Scan 

3 

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CPT Code Medicare Definition Common Descrintion 

76512 Ultrasound of eye disease, growth or B-Scan structure 

10. In addition to the basic CPT Codes, there are a number of"modifiers"that are twodigit or two-letter supplements that provide additional information about the procedure. For 

example, in ophthalmology, the provider must specify the eye upon which a procedure has been 

performed. For some procedures, the modifier "50" is used to indicate that the procedure was 

bilateral, i.e., performed on both eyes. For other procedures, the suffix RT or LT is used to indicate 

that the procedure was performed on the right eye or left eye, respectively. 

11. Under the laws that regulate the Medicare program, no payment may be made for 

any expenses incurred for items or services that are not reasonable and necessary for the diagnosis 

or treatment of illness or injury. In general, Medicare makes the physician the "gatekeeper" for 

determining when medical testing and treatment are medically reasonable and necessary. To 

receive reimbursement, providers are obligated to follow all Medicare rules and regulations. 

12. Medicare permits claims to be submitted electronically. To do so, a provider must 

enroll in electronic billing through the MAC. By submitting an enrollment form, a provider agrees 

that all claims will be accurate, complete, and truthful. Further, the provider's unique identification 

number affixed to a claim constitutes a lawful electronic signature verifying that the services are 

medically reasonable and necessary and were performed as billed. In order to timely process the 

many millions of claims generated annually in the Medicare program, Medicare relies upon the 

honesty and integrity of providers who certify the validity of their claims. 

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The Defendant 

13. The defendant, LAUREN ROSECAN, operated medical clinics under the name 

The Retina Institute of Florida ("RIF"). The defendant had several office locations in Palm Beach, 

Martin, and Port St. Lucie Counties in the Southern District of Florida. 

14. The defendant was an ophthalmologist and retina specialist licensed to practice 

medicine in the State of Florida. As a retina specialist, the defendant treated conditions and 

diseases of the retina. At all times material to this Superseding Indictment, the defendant was 1he 

only licensed physician practicing at RIF. 

15. The defendant was an approved Medicare service provider. A substantial portion 

of his client base was composed of elderly patients who were Medicare beneficiaries. 

Choroidal Melanoma 

16. Choroidal melanoma (hereinafter referred to as "CM") is a malignant cancer or 

tumor of the eye originating in the choroid, which is a vascular layer of tissue located behind 1he 

retina. CM is a very rare form of cancer, being diagnosed in approximately five personspermillion 

per year in the United States. There are highly trained ophthalmologists, known as ocular 

oncologists, who specialize in cancers of the eye. 

17. There are several treatment options for CM, ranging from observation (for small 

tumors), to radiation (medium-sized tumors), to enucleation or removal of the eye. The most 

successful treatment in the past decade has been radiation, which, for small and medium-sized 

tumors, has had a non recurrence rate of approximately 9 5 %. 

18. Laser treatments have also been used to treat small CM tumors, the most common 

being transpupillary thermotherapy ("TIT"). TTT involves the use of a diode laser to slowly heat 

the tumor, thus killing the cancer cells. 

5 

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19. Focal laser photocoagulation ("focal laser") consists of shining a high-intensi1y 

laser light beam into the eye under magnification in order to bum, or cauterize, actively leaking 

blood vessels. Focal laser has also been used in the past to treat CM, but has largely been 

abandoned in favor of more successful treatments, in particular, radiation. 

20. Pan retinal photocoagulation ("PRP") is a laser treatment used to treat people who 

have developed new abnormal blood vessels at the back ·of the eye in the retina, generally in 

patients with diabetic retinopathy. It is not a recognized treatment for CM. In PRP the laser is 

applied in a scatter pattern over a wide area of the retina. Medicare reimburses a doctor for the 

performance of PRP at a higher rate than that of focal laser. 

Choroidal Nevus 

21. A choroidal nevus is a benign lesion or growth located in the back of the eye. It is 

sometimes referred to as an eye freckle and is relatively common in Caucasians, occurring in about 

5-8% of that population. A nevus can generally be differentiated from a melanoma based on its 

size (1 mm or less in thickness), color, and other distinguishing features. It has no effect on vision, 

and no treatment of a nevus is medically indicated. 

Diagnostic Testing 

22. Ultrasonography (A-scans and B-scans) is an essential tool in the diagnosis and 

treatment of CM. Ultrasonography is a diagnostic imaging procedure that uses sound waves to 

capture images of the inside and back of the eye. In addition to being used to assess the internal 

structure of the eye when the physician's view into the eye is otherwise obscured, an ultrasound 

may also be used to measure the height and reflectivity of tumors in the back of the eye. 

Consequently, ultrasound is used to capture and document the presence and size of a CM. 

6 

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23. Fundus photography is routinely utilized by ophthalmologists for diagnosis and 

documentation of a variety of retinal diseases and conditions. The interior of the eye, known as fue 

fund us, may be photo graphed with a specialized camera that is attached to a low-power microscope. 

A fund us photograph captures the same view of the retina as would be seen by a doctor upon visual 

examination of the eye through a magnification device called an ophthalmoscope. Fundus 

photographs may be taken in color or without color. The photographs that are not in color are 

referred to as "red free" photographs. Fundus photography is used to capture and document the 

presence of an abnormality such as CM. 

24. Fluorescein angiography ("FA") and indocyanine green angiography ("ICG") also 

capture abnormalities in the retina and choroid. These tests begin with the intravenous 

administration of certain dyes into a vein in the patient's arm, following which pictures are taken 

of the retina and choroid through special filters on the fundus camera. FAs and ICGs are used to 

capture and documentthe presence ofan abnormality such as a CM. 

COUNTSl-14 

Health Care Fraud 

(18 u.s.c. § 1347) 

25. Paragraphs 1 through 24 of the General Allegations section of this Superseding 

Indictment are realleged and incorporated by reference as though fully set forth herein. 

26. Beginning at least as early as 2012, the exact date being unknown to the grandjuiy, 

and continuing at least to and through December 31, 2015, in Palm Beach, Martin, and St. Lucie 

· Counties, in the Southern District of Florida, and elsewhere, the defendant, 

LAUREN ROSECAN, 

in connection with the delivery of and payment for health care benefits, items, and services, did 

knowingly and willfully execute, andattemptto execute, a scheme and artificeto defraud Medicare 

and other health care benefit programs affecting commerce, as defined by Title 18, United States 

7 

Case 9:20-cr-80052-RAR Document 41 Entered on FLSD Docket 02/05/2021 Page 7 of 14
Code, Section 24(b), and to obtain, by means of materially false and fraudulent pretenses, 

representations, and promises, money and property owned by and under the custody and control 

of Medicare and other health care benefit programs. 

Purpose and Object of the Scheme and Artifice 

27. It was the purpose and object of the scheme and artifice for the defendant, 

LAUREN ROSECAN, to unlawfully enrich himself by, among other things, falsely diagnosing 

patients with choroidal melanoma ("CM"); performing medically unreasonable and unnecessaiy 

diagnostic tests and procedures; making false entries in patients' medical charts; and submitting 

claims to Medicare and other health care benefit programs based upon said false diagnoses, 

treatments and entries in patient medical charts. 

The Scheme and Artifice 

28. The manner and means by which the defendant sought to accomplish the purpose 

and object of the scheme and artifice to defraud included, among other things, the following: 

a) The defendant would falsely diagnose a substantial number of his Medicare patients 

with CM, either upon the initial patient visit, or in a subsequent visit. In many instances, the 

defendant would diagnose the condition bilaterally, that is, in both of the patient's eyes. In other 

instances, the defendant would diagnose the condition in both husband and wife of a married 

couple. 

b) The defendant would take ultrasounds (A and B-Scans) of patients' eyes and would 

then place markers on the images, purportedly to measure mid to large sized tumors, when, in fact, 

no such tumors were present. 

c) The defendant would perform laser treatments on said patients, primarily pan 

retinal photo coagulation, which has never been a recognized treatment for CM. 

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d) The defendant would not refer said patients to an ocular oncologist or even another 

ophthalmologist in order to provide a second opinion. To the contrary, the defendant actively 

discouraged patients from obtaining a second opinion. 

e) The defendant would cause patients to return to his clinic on a regular basis for 

followup visits, which, in some instances, involved repeated laser photocoagulation sessions. 

f) The defendant would cause patient files to contain false information, including false 

diagnoses, measurements, drawings, and diagrams. 

g) The defendant would cause the submission of claims to Medicare for exams, 

diagnostic tests, and laser treatments based upon the false diagnoses and medically unnecessary 

and medically unreasonable treatments for CM. 

Execution of the Scheme and Artifice 

29. In execution of the scheme and artifice to defraud, in Palm Beach, Martin, and St. 

Lucie Counties, in the Southern District of Florida, and elsewhere, the defendant, 

LAUREN ROSECAN, 

in connection with the delivery of and payment for health care benefits, items, and services, did 

knowingly and willfully execute, and attempt to execute, the above-described scheme and artifice 

to defraud a health care benefit program affecting commerce, as defined in Title 18, United States 

Code, Section 24(b ), and to obtain, by means of materially false and fraudulent pretenses, 

representations, and promises, money and property owned by, and under the custody and control 

of, said health care benefit program, in that the defendant did submit and cause the submission of 

claims to Medicare under diagnostic code 1906 ( choroidalmelanoma) for the below-listed patients, 

among others, on or about the dates as further described below: 

9 

Case 9:20-cr-80052-RAR Document 41 Entered on FLSD Docket 02/05/2021 Page 9 of 14
COUNT PATIENT DATE OF DATE OF PROCEDURE CODE AND DESCRIPTION AMOUNT 

SERVICE CLAIM BILLED 

1 BenjaminF. 4/14/15 4/20/15 67228- Destruction ofleaking retinal blood 

RT vessels [PRP] $1,930 

2 BenjaminF. 4/21/15 4/22/15 67228- Destruction ofleaking retinal blood 

LT vessels [PRP] $1,930 

3 DorothyR. 4/15/15 4/20/15 67228- Destruction of leaking retinal blood 

RT vessels [PRP] $1,930 

4 DorothyR. 4/17/15 4/22/15 67228- Destruction of leaking retinal blood 

RT vessels [PRP] $1,930 

5 BarbaraF. 4/13/15 4/20/15 67228- Destruction of leaking retinal blood 

RT vessels [PRP] $1,930 

6 AnnaP. 5/4/15 5/5/15 67228- Destruction ofleaking retinal blood 

LT vessels [PRP] $1,930 

7 AnnaP. 5/18/15 5/19/15 67228- Destruction ofleaking retinal blood 

RT vessels [PRP] $1,930 

8 RichardL. 6/5/15 6/9/15 67228- Destruction of leaking retinal blood 

LT vessels [PRP] $1,930 

9 RichardL. 6/12/15 6/22/15 67228- Destruction of leaking retinal blood 

RT vessels [PRP] $1,930 

10 ThelmaF. 6/11/15 6/12/15 67228- Destruction ofleaking retinal blood 

RT vessels [PRP] $1,930 

11 WilmaM. 8/17/15 8/20/15 67228- Destruction of leaking retinal blood 

LT vessels [PRP] $1,930 

12 WilmaM. 8/19/15 8/24/15 67228- Destruction of leaking retinal blood 

RT vessels [PRP] $1,930 

13 FredM. 8/17/15 8/20/15 67228- Destruction ofleaking retinal blood 

RT vessels [PRP] $1,930 

14 FredM. 8/19/15 8/24/15 67228- Destruction ofleaking retinal blood 

LT vessels [PRP] $1,930 

All in violation of Title 18, United States Code, Sections 1347 and 2. 

10 

Case 9:20-cr-80052-RAR Document 41 Entered on FLSD Docket 02/05/2021 Page 10 of 14
COUNTS 15-22 

False Statements Relating to Health Care 

(18 U.S.C. §§ 1035(a)(2) and 2) 

3 0. Paragraphs 1 through 24 of the General Allegations section of this Superseding 

Indictment are realleged and incorporated by reference as though fully set forth herein. 

31. On or about the dates set forth below as to each count, in Palm Beach, Martin, and 

St. Lucie Counties, in the Southern District of Florida, the defendant, 

LAUREN ROSECAN, 

in a matter involving a health care benefit program, to wit, Medicare, did knowingly and willfully 

make and use a materially false writing and document knowing the same to contain a materially 

false, fictitious, and fraudulent statement and entry, in connection with the delivery of and payment 

for health care benefits, items, and services, in that the defendant would make and cause to be 

made false entries into the charts of Medicare patients, that is, false measurements of purported 

choroidal melanoma, as well as false diagnoses and fictitious retinal drawings, as further set forth 

below: 

Count Patient Date of Service 

15 BeniaminF. 4/14/15 

16 Dorothy R. 4/15/15 

17 BarbaraF. 4/13/15 

18 AnnaP. 5/4/15 

19 Richard L. 6/5/15 

20 ThelmaF. 6/11/15 

21 WilmaM. 8/17/15 

22 Fred M. 8/17/15 

All in violation of Title 18, United States Code, Sections 1035(a)(2) and 2. 

11 

Case 9:20-cr-80052-RAR Document 41 Entered on FLSD Docket 02/05/2021 Page 11 of 14
FORFEITURE ALLEGATIONS 

1. The allegations of this Superseding Indictment are hereby re-alleged and by this 

reference fully incorporated herein for the purpose of alleging forfeiture to the United States of 

America of certain property in which the defendant, LAUREN ROSECAN, has an interest. 

2. Upon conviction of a violationofTitle 18, United States Code, Sections 1035(aX2) 

or 134 7, as alleged in this Superseding Indictment, the defendant shall forfeit to the United States 

all property, real or personal, that constitutes or is derived, directly or indirectly, from gross 

proceeds traceable to the commission of such offense, pursuant to Title 18, United States Code, 

Section 982(a)(7). 

All pursuant to Title 18, United States Code § 982(a)(7), and the procedures set forth in 

Title 21, United States Code, Section 853, as incorporated by Title 18, United States Code, Section 

982(b)(l). 

A TRUE BILL 

FORE~ 

ARIA FAJARDO ORSHAN 

UNITED STA TES ATTORNEY 

ALEXANDRA CHASE 

ASSISTANT UNITED STATES ATTORNEY 

12 

Case 9:20-cr-80052-RAR Document 41 Entered on FLSD Docket 02/05/2021 Page 12 of 14
LiNITEilSTATES DiSTRICT COURT 

SOUTHERN DISTRICT OF FLORIDA 

UNITED. STA tES OF AMER.IC,\ CASE NQ .. 20c80052~CR-RUIZ/Reiiihart(s) 

Y, 

LAUREN RQSECAN, CERTIFICATE OF TRIAL ATTORNEY~ 

Sup,ersecl!ng Case Information: 

befcndan·t. 

Co~rl Division: (S~le~t One) . 

_· Ntiami _ .Key West 

New d~feridant(s) • Yes 

Number ofne,v defendants - FTL · ,, WP.B FTP Total nurnber ofcqurtts 

I. i ·hav.e car¢fuHy consjdered the allegiltio11s of the indictment, the number ofdeft;:ndants, t!ie nt1mber of' 

probable whne$ses and the legai complexities of the lndidment/Infonnation anachedhercto. 

2, I a.in aware thi,i:t .the infonnation · ~tippli~cl on this st!iterncni will be reli~(l upon by the juages tjf this 

,Court in setting their calendars and scheduling criminal trials under the mandate -of (he Speedy tdal 

Act; Title 28 U .S.C. Section 3161. · · 

3. h1terpreter: {Y~s or ;t-.Jo) No 

;J)st langua~e and/qr dialect 

4. This case will take .. 20 clays.for the parties to try. 

5. P!~ase ched, appropriate category ;ind f)'pe ofoffense listed belo,v, 

(l'.,1,cck only·one) (Check only one) 

I Oto 5 days Petty 

II 6 to 10 days Minor 

Ill ,JI to 20 gays ✓ Misdem, 

IV 21 to 60days Felony 

V 61 qays and over 

.I 

6. Has this case previousiy been file1fin this District ~oμrt? (Yes or No) Yes 

ifyesdudge Ruiz · Case No. 2Q~80052-CR~Rl:JIZ/Reinhari 

(Attach copy of dispositive order) · · 

Has a complainfbeen fiiec,i in tl1i:s matter? (Yes or No) _N_o __ 

If yes: MMistrate C<JSe Ne>; 

R.efr.1ted .mis_cel ianeous numbers: 

Defondant(s) in feder.al custody as of 

Defenc,iant(s) in ~t~te custody ·;is of 

Rtile ~O fr9m the District of 

i~tijis a potential death penalty case? (Yes or.No) 

1. bo~s this case ·ofig11_111te froni a matter pending in th~ Centr~I Region of the tJ.s. Attorney's Office 

prio~'.to August 9, 2013 (Mag. Judg~ Alicia Q. Vall~)? . Y~s. N~ . " 

8. Poes this .c~e originate from a riiatter p~hding in the N<>rtherh Regiori of the U.S. Attorney's Offict! 

prior to A Ligtist 8, 2014 {Mag. j udg~ Shan(ek Maynard)? Yes 'Nd. " 

9, Opes .thJs case od_gina!~ fro0 a 111at_ter pending jn the,.Centra! Regi~n of. the \LS. ?,.tt.orney'~ Qffi_ce 

Prior [6 Optob0r ;l; 20\9.(Mag, Jmjge Jo«d Stra<~ ~' 

ALEX RAC ASE ~ 

ASSJST ANT UNiTED STATE~•ATTORNEY :!:penahy ·Sl1ee((s) attachecl pistrict Ccliirt No. A55Q1746 REV.6/s!.lo20 

Case 9:20-cr-80052-RAR Document 41 Entered on FLSD Docket 02/05/2021 Page 13 of 14
UNITED STATES DISTRICT COURT 

SOUTHERN DISTRICT OF FLORIDA 

PENALTY SHEET 

Defendant's Name: Lauren Rosecan 

Case No: 20-800052-CR-RUIZ/Reinhart(s) 

Counts #1-14: 

Health Care Fraud 

Title 18 United States Code Section 1347 

*Max. Penalty: Ten years' imprisonment: $250,000 fine or twice the value of the gross gain or 

loss, whichever is greater: three years' supervised release: restitution: criminal forfeiture: and a 

$100 special assessment 

Counts #15-22: 

False Statements Relating to Health Care 

Title 18, United States Code, Sections 1035(a)(2) and 2 

*Max. Penalty: Five years' imprisonment: $250,000 fine or twice the value of the gross gain or 

loss, whichever is greater: three years' supervised release: restitution: criminal forfeiture: and a 

$100 special assessment 

Case 9:20-cr-80052-RAR Document 41 Entered on FLSD Docket 02/05/2021 Page 14 of 14