It’s been said that people read published lists of disciplined fellow-professionals out of a sense of schadenfreude, the pleasure derived from another’s misfortune.
But in the case of the 324 defendants, including 96 doctors and other licensed medical professionals, charged in connection with the “2025 National Health Care Fraud Takedown”, it’s not so much misfortune as something else, something far darker.
At more than $14 billion in fraudulent claims, it outdid last year’s holiday prosecution special by more than 100%.
Plus, hidden inside the record bust is another bust, one that none of the prosecutors discussed at the press party; the failure of bureaucratic oversight, for which no one will be indicted, sued, or lose a day of pay. Oh well, someone else’s money. Yours.
A LinkedIn pal, a physician, asked about the commonality, the throughline, in the prosecutions.
That’s easy. It’s greed, a way to make some thought-to-be easy money without any actual, patient-benefiting work.
Take, for example, the allegations (and that’s what the government’s announcement was all about, allegations, not actual findings of criminal or civil liability) against Dr. Shivangi Amin of Los Angeles, who the government claims falsely diagnosed Medicare beneficiaries with terminal illnesses and referred them to hospice care facilities without personally evaluating or communicating with the patient or reviewing any medical records.
Or take the allegations against physician Maryam "Meg" Qayum, a physiatrist, who together with a handful of claimed co-conspirators, was charged with multiple counts of illegally distributing controlled substances, among other unlawful activities. The government says that they diverted more than 3 million doses of opioids onto the black market, at least in part through a pill mill selling oxycodone and hydrocodone prescriptions, as well as prescriptions for the combination of hydrocodone and carisoprodol (not so fun fact—a "Las Vegas Cocktail"), to drug traffickers in exchange for cash.
You can read the plethora of published allegations against others yourself, a string of stories of kickbacks, charges for services never delivered, and so on, on the DOJ’s website.
But what you won’t find is an examination of what went on within CMS that permitted many of these alleged frauds to go on for so long.
A private company would go out of business if it were hemorrhaging cash to false claims. Employees who weren’t paying attention would be laid off or fired. But is anyone at CMS going to lose their jobs or even a day of pay?
Don’t hold your breath. It would likely prove fatal.
Oh, one more thing I see all the time.
A doctor seeks to supplement income.
Along comes a friend with some bad advice. Help out a PA I know with a clinic. She’s really great. Supervise her. Sign some charts. You’ll make a few thousand a month. Easy enough.
And then one day the Feds come knocking. The doctor is shocked to find out that thousands of doses of opioids, of which she knows nothing, are being prescribed under her signature.
Or the hospice doctor who’s approached by a nurse practitioner who proposes that Dr. Hospice become the majority owner of a new medical corporation to go into wound care. For her trouble, the doctor will draw $3,000 a month as salary. “Don’t worry,” says the nurse, “I’ll indemnify you.” From what? She can’t do the doctor’s prison time and will surely flip on her to save her own felonious hide.
As physicians get squeezed by insurers and other payers, including Medicare, and as the costs of operating a medical practice increase, more are looking for ways to supplement their income.
Looking is OK. But you must carefully vet, with the assistance of qualified healthcare legal counsel, any deal in which you’re planning to participate. It goes without saying that any deal pitched to you in which it’s proposed that you’ll become the physician co-owner of a medical practice together with non-physicians, a practice in which you’ll have very little to no actual involvement, falls completely within the highly suspect category.
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