Saturday, September 1, 2012

Are There Quotas for Healthcare Fraud Seizures?

   If you're a state trooper assigned to I-75, and week after week you issue zero speeding tickets, what happens?  The lieutenant calls you in and says, "You're not doing your job."  He's knows that 10% of the drivers are speeding, and he expects you to pull them over and issue tickets.  If you don't, you're a slacker.
   By the same logic, if government officials estimate that 10% of Medicare payments are for fraudulent claims, they probably expect agents to "find that money and seize it."  These days, medical billing fraud is the crime du jour for the government.  Most of the fraudulent money is swiped in lucrative scams by non-physicians.  Since those are very difficult to unravel, federal officials have to "find" money somewhere to meet (invisible) quotas.
   It's illegal to establish quotas, at least in the area of traffic tickets.  "Traffic ticket quotas are explicitly prohibited by most jurisdictions," says an article on on-line publication by The Safety Council, Inc.  It points out, nevertheless, that traffic tickets generate millions in revenue for states and local municipalities every year.   
   Though ticket quotas are continuously denied to exist by police chiefs and uniformed officers around the country, evidence suggests there is an unspoken directive in some police stations and state trooper offices.  In Connecticut, for example, one lieutenant offered incentives to troopers who issued the most tickets--before this was made public.
   In July 2006, an internal memo from a lieutenant in Florida to all his patrol personnel appeared to imply a quota for writing tickets. According to a First Coast News report, the memo, in part read:

   “After assessing the April Statistics it was obvious I had not made the department's expectations for an Officer's monthly activity known. Thus, following is a list of my expectations for the minimum activity for each patrol officer/supervisor each month. 1) Approximately 2 UTC's for each shift worked. 2) Approximately 2 traffic warnings for each shift worked.”
    A U-T-C is a Uniform Traffic Citation. But Florida State Law forbids quotas. According to the 2003 Legislative session, Title XXIII Motor Vehicles 316.640: "An agency of the state as described in subparagraph 1. is prohibited from establishing a traffic citation quota."
    Florida is not the only state where ticket quotas are a reality, and states like Missouri and Pennsylvania have experienced similar revelations. Pennsylvania State Police documents show that not only is there a system of monetary reward and punishment for state troopers based upon numeric ticket goals, there is a clear effort to prevent anyone from ever speaking about it.
     Is there a(n) (invisible) quota system for medical billing fraud, too?  Is the money taken from doctors like me--in an unprecedented number of seizures--necessary for balancing the budget for law enforcement agencies? 
     The federal government announced that it "recovered" more than $4 billion related to healthcare fraud in 2010.  It was the largest amount every recorded, according to the U.S. Department of Health and Human Services, which said:
“Our aggressive pursuit of health care fraud has resulted in the largest recovery of taxpayer dollars in the history of the Justice Department,” said Associate Attorney General THomas Perrelli. “These actions are in large part because of the great work being led by the Health Care Fraud Prevention and Enforcement Action Team. Through this initiative, we are working in partnership with government, law enforcement and industry leaders, and the public to protect taxpayer dollars, control health care costs, and ensure the strength and integrity of our most essential health care programs.”  
     When my bank accounts were seized last August 2011, however, this was not a "recovery" about which the federal government had a right to brag.  It should not have counted this money in its seizure statistics, nor should the raid on my clinic have received a gold star.  There was no rationale for either.  I am not guilty of fraud, and I continue to practice medicine according to the standards I was taught--I provide comprehensive healthcare, focused on identifying conditions early, and preventing disease.  Perhaps this style of practice is unusual these days?  I wonder if I actually fit the "profile" for a doctor guilty of healthcare fraud:  a middle-aged female doctor billing out more than her age-equivalent colleagues in family practice, a doctor too thorough, too exacting about coding, too ambitious--with too much money in the bank?
      The government is focused on seizures, not criminal convictions.  The war on healthcare fraud--like the "war on drugs"--is not, in my opinion, the motivating factor in such seizures, it's the financial gain for the government.  Such gain is almost guaranteed, because most seizures by government officials are not challenged--not because they are supported by evidence, and not because the victims have something to hide.  It just costs too much in civil litigation for the targets of these forfeitures to get the money back, and legal fees are not usually covered, even when a defendant is exonerated.
     Consider the high-profile case of Volusia County Sheriff Robert Vogel in the mid-1980's.  He was celebrated by some for his "unique talent" for arresting drug couriers on I-95, the highway thought to be most popular for drug trafficking.  He instructed his "drug squad" to look for large, late-model, rental cars with tinted glass, radar detectors and lots of antennas, driven by black or Hispanic men.  These vehicles were selectively pulled over for speeding--as little as 3 mph above the limit.  Drug-sniffing dogs were used to sniff out cocaine and marijuana (which, it is now said, is present on all denominations of bills in Florida) and an average of $5,000 per day in cash was seized.
     What was Vogel's unique talent, if not racial profiling?  Many troopers across the country imitated his "methods."  A Denver federal judge in 1990 ruled that the profiling being used to justify seizure of money from suspected couriers violates the rights of blacks and Hispanics.  In a televised program about this controversial system for catching criminals, Florida patrols said "drug couriers wear large amounts of gold and look out of place in the car."  When did highway patrolmen rewrite the Constitution, determining guilt and exacting punishment before the accused even has a chance to speak, let alone attend a trial?  Since Vogel didn't pull over an equivalent number of non-rented vehicles driven people of other races, no one knows how successful his profiling really was--there wasn't a control group. 
     Americans need to be protected against unreasonable searches.  Confiscating cash from suspected drug couriers--or physicians suspected of Medicare fraud--and requiring them to prove their innocence before they can get their money and rights back, is a backward way of exercising justice.  Is this country turning into a police state?  When will people with power stop acting as though their personal prejudice is a substitute for truth, and can supersede the rights of citizens?
     The traffic stops and forfeitures made by Vogel were controversial, and went to the higher courts of Florida, and even to the the Supreme Court.  Some cases were ruled in favor of Vogel and the methods he used for identifying drug dealers.  But it seems to me that the stops were unconstitutional--even though the seizures (like mine) have been legalized under the State of Florida's "assets seizure law."  A lot of money was stolen from innocent victims.  Seventy-five percent of these people did not pursue civil litigation to get their money back.  The money confiscated by Vogel was kept by the police, even in cases where the seizure was challenged, where no proof of wrongdoing existed, the accused had no criminal record, and the money was proven to be legitimate.  "The sheriff appointed a forfeiture attorney to handle 'settlement negotiations,'" says an editorial on The Free Man Online--link below: (  
     "Only four out of 199 got money back, and many settled for 50 to 90% after promising not to sue the department.  No one knows how many were drug traffickers because there were not charges, no trials..."
     If the crime du jour is now medical billing fraud, and there are (invisible) quotas for "recovery" in place, and stressed-out federal agents and prosecutors are under pressure to "find crime" and "refund the taxpayers"--or face reprimands by their superiors in the Department of Justice, someone's got to pay.  I understand:  it's just too hard to find the real scam artists--they're sly, and they move around, and they don't even have medical offices.  Maybe I ought to be willing to make a sacrifice for the feds, rendering unto Caesar and all that, helping them to pay the bills--those trillions of dollars we keep hearing about.  Some of my friends say, Just make the case go away, even if it costs you.  Really?  What case?  Is it so crazy for me to want to know?


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