Wednesday, July 4, 2012

"Am I a Criminal?"

     After the FBI raid on my clinic I began to entertain the possibility that I might be a criminal.  The raid was so brazen, the FBI agents so full of religious conviction, and the scattering effect on all the props and assumptions of our little clinic so complete that every one of us was having the same thoughts:  "How did Dr. C. perpetrate such terrible acts?" and "Where in the dickens did she find the time?"
     I was wondering these things too.  Caught up in the drama I began to ask if I might be schizoid, like Dr. Jekyll and Mr. Hyde.  Had I been splitting myself in half some of those late nights I spent at the clinic after everyone else had left, ostensibly working on charts, sorting out personnel problems, and reviewing orders for supplies--had I, instead, been scheming against the government?  Maybe in some industrious dark corridor of my soul I had been doing dirty work, sending charges to Medicare for patients who didn't exist, or for services and supplies the clinic hadn't delivered.  It happens, doesn't it?  And isn't it the basis for the last-resort defense, "criminally insane"?
     The raid had the tone of a religious crusade.  The dark--almost black--uniforms, wide holsters sagging with loaded guns, embroidered epaulets, sparkly badges and close-cropped hair of the agents made them look like deputies of God on Judgment Day, and their certainty about their mission was contagious.  There was no question whose side we all wanted to be on.  "Hold up your hands!" they commanded, and everyone did.  Wouldn't you?
     I had seen in the movies how quickly a gun could be drawn and fired by an experienced cop.  I knew that in such moments right and wrong were almost irrelevant, that fear carried the day, that a fearful man who was heavily armed should be listened to without argument.  My habit of questioning and doubting, of challenging a person's self-image, of confronting--for example--illness, head-on, had to be stayed, in this situation.  I had to give the appearance of humility.
     My staff had certainly stepped to attention.  "Yes, Sir, " "No, Sir," "Right this way, Sir," they were saying, and I was proud.  We weren't asking for more trouble.  No doors would be bashed down, no closets hacksawed open.  I attempted deference too, but I know it was mixed and therefore irritating to the agents who dealt with me.  I interrupted their work.  "Excuse me, Sir, but what exactly are you guys doing?" and "Show me the search warrant!"  
     Later, speaking with Special Agent Robert Murphy, I looked him straight in the face and asked with what I'm sure he perceived as false civility, "If you're so convinced I'm a criminal then why aren't you handcuffing me?"  I held out my two wrists and let them hover, untrembling, in the space between us.  His Glock 23 was inches away.  "Why aren't you taking away my license?  Why isn't my clinic being shut down?  Well?  Well?"      
     People in uniforms don't like to be provoked.  There is something about government-issued garb that infuses the wearer with terrific importance, not-to-be-questioned authority.  But over the years I have honed a habit of provoking the truth out of people, getting them to tell me in the secret language of metaphor what is wrong with them.  I am familiar with the not inconsequential gap between who-they-think-they-are and who-they-really-are.  I tickle it, I probe it, in an effort to narrow it, in the interest of eking out self-awareness and therefore better health. 
     But this wasn't the time to practice my more esoteric doctoring skills.  My lawyer gently touched my arm and coaxed me back into the material world.  I was being accused.  My clinic was being raided.  An attack was underway.  Like citizens in a village subject to a sudden besiegement I was being taken hostage, at least psychologically--a prisoner-of-war.  But what war?  I had an inkling that a war was, in fact, being waged by militarized men against doctors, and I didn't like it.  But I couldn't put my finger on it, whereas the FBI agents seemed to know it all, and they "knew" me, as in "We know your kind!"  Their certainty was infectious.  Could they be onto something?
     Therefore in the months following the raid I questioned everyone.  
     "Have I been doing something you think might be illegal?"  I asked my staff, over and over. "Could we  have billed wrongly, or sent claims for procedures we didn't do?  Could we have reversed one of the ICD-9 or CPT digits, thereby accidentally transmitting erroneous charges?"
     I put in a formal request to Medicare asking for a list of all charges billed with my Medicare ID number in the past 5 years.  Maybe someone else had hacked into my data base and sent fraudulent charges, collecting the payments off-site?  But Medicare never sent the list.  Multiple inquiries went unanswered.  It was as though I didn't exist for them.
     The billing staff combed through all the charges back to the date we opened this new clinic, only sixteen months earlier, for the 3,000 patients we had treated.  Nothing seemed out of order.  They checked my ID number through the Medicare portal and saw no inexplicable charges.
     "Could I be psychotic?" I asked.  In that case I wouldn't have knowledge of what "the other half" was doing.  "Do I say strange things?  Do I hallucinate?  Do I seem like someone other than myself?  Could I be tricking all of you?"
     "No, Dr. C.," they chuckled, glancing at one another as though sharing a private joke.  "You're the same old person.  You haven't changed.  You haven't changed at all."  
     "Are there any clues that I might have a secret business?  Maybe laundering money, as the feds say?  Maybe sending out charges to Medicare after hours, consorting with cartels, selling drugs or equipment on the black market?"
     My receptionist rolled her eyes and shook her head, speaking for everyone.  "Dr. C.," she said firmly.  "When would you have time?  We know what you do.  You're not a criminal."
     The nurse-practitioner who has worked with me for many years--and who followed me together with many other employees from the Hawthorne clinic to this new office--nudged me into the here-and-now.  "Don't get paranoid," she spoke tenderly.  "You have to keep functioning.  You have patients to see.  They need you.  Forget the feds.  Look at all the good you do."
     These days when I scan the office it doesn't look like a place that's been raided.  The shelves are full, the waiting-room is crowded with people.  We have new charts and many new patients--who either don't know about the raid or seem to think it's irrelevant.  They want their Pap tests. They want to know if they broke a toe.  They want treatment for cellulitis.  They tell me their dreams.  They talk about their own pain and sadness.  They want me to ferret out the truth in the spaces of their psyches they don't know are there.  They keep showing up to see me, and they don't think I'm a criminal. 
     I ask myself whom to believe.  
     The churlish FBI agents?  
     The FBI's solicited informants, who are banking--in this depressed economy--on whistleblower fees?  
     Or my patients, my staff, my family, those who have known me for decades, who have mirrored my candor, and who, when I ask for the truth, have never hesitated to declaim it?  

1 comment:

  1. Medicare (or the FBI) has contacted a number of your former Hawthorne patients, myself included, asking if you waived Medicare co-pays as a matter of routine. I did not know that this was illegal when I told them that on several occasions, you generously waived my 20% co-pay due to my economic hardship. I did not understand why this could possibly be wrong, but they explained that patients don't complain about unnecessary tests if they don't have to pay for them. They asked me if I would be available for a face-to-face interview. I agreed, but I never heard from them again. Is it possible that you are being targeted for your generosity? It seems that it should be your business if you provide a discount to your customers, given that all of the services provided are legit. Just a thought. I wonder if the government will ever show up at my house with documentation of 1000 times I broke the speed limit.

    Good luck,
    John D.