Ophthalmologist David Ming Pon, MD, MPH, was sentenced last week in a federal district court in Jacksonville, Florida, to 10 years in prison for bilking Medicare out of nearly $10 million.

One could call it a light sentence. Federal prosecutors had sought at least 40 years in prison for the 59-year-old Dr Pon, not just on account of the dollars at stake, but also on account of what they described as "evil" treatment of his elderly patients.

Dr Pon, after all, had told some 600 patients that they had wet age-related macular degeneration (AMD) when in fact they didn't, and that they needed laser photocoagulation lest they go blind, according to prosecutors. To top off the fraud, he faked the treatments that he billed for. His actions disturbed two fellow eye surgeons so much that they did something relatively uncommon as physicians in a criminal proceeding — they asked the judge to go hard, not easy, on a colleague. Both had testified at trial as expert witnesses for the government.

"I have personally had to look dozens of his victims in the eye and explain to them that they had been wasting their time and money for years, receiving imaginary treatments for disease they did not have," Adam Berger, MD, wrote in a letter to the court. "The look of anguish on their faces only hinted at the terrible feelings of violation that they had experienced."

Thomas Friberg, MD, the other expert witness, asked the court to give Dr Pon a sentence that might deter other physicians "who might be the slightest bit inclined to consider such deceptions."

"The scope of this fraud was nothing short of shocking," Dr Friberg wrote.

"A Complete Lack of Character and Empathy"

Justice walked a slow course in the case of Dr Pon.

He was charged with Medicare fraud in April 2014 and found guilty in a jury trial in October 2015. Prosecutors said he performed a faux version of photocoagulation by aiming a laser at patients' eyes, but setting the energy level so low that it could not seal a leaking blood vessel. This was a moot point for the patients falsely diagnosed with wet AMD, but not a moot point for some of Dr Pon's patients who did have this condition. They received concomitant injections of antivascular endothelial growth factor drugs along with the useless laser treatment.

Dr Pon also subjected patients to unnecessary diagnostic tests, which included injecting fluorescent dyes into their bloodstream, a procedure that comes with the extremely rare, but definite risk for cardiopulmonary arrest.

In a legal brief on the sentence the judge ought to hand down, prosecutors said 40 years in prison would be lenient for Dr Pon, given how he lied to patients about the threat of blindness.

"The level of depravity [Dr] Pon exhibited to fuel his own greed shows a complete lack of character and empathy for others," they wrote. "[Dr] Pon's conduct can only be described as evil."

Dr Pon's attorneys countered that their client's offense did not merit the 40 years in prison that prosecutors had recommended, much less the 200 years that were theoretically possible under sentencing guidelines. They said that Dr Pon's history of service and generosity represented "an extraordinarily powerful argument" for leniency.

"Dr Pon has helped untold number of patients, even when he knew he would never be paid for his work, even when it required him to work nights, weekends, and holidays, and even when other doctors said the work was hopeless," the brief stated. It quoted a visiting clinician from Puerto Rico who wrote the court that he called Dr Pon on a Friday night about a retinal tear and received treatment the next day.

"Dr Pon's arrival to my life was God sent," the clinician wrote. "I never expected to find such an unselfish attitude toward his patients."

There were other arguments for leniency. Dr Pon already had suffered significant punishment for his offenses, given the loss of his medical license, personal trauma in his family, and stress that may have contributed to a transient ischemic attack that he experienced while in custody, according to his attorneys. And "the case already has sent a strong message of deterrence to the community," they wrote.

When he sentenced Dr Pon on March 13, US District Judge Brian Davis said that the physician's greed "convinced him that he was helping his patients," the Florida Times-Union in Jacksonville reported. "It's easier to steal if you lie, and it is made even easier if you believe the lie. It makes it no less wrong."

The judge told Dr Pon that he could turn over a new leaf when he leaves prison, according to the Florida Times-Union. Davis said: "Hopefully, you will return to our society as a productive member."

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