There is an issue of integrity with the whistleblower program as framed by the government--and here I'm referring particularly to Medicare whistleblowers, as they are the cause of my current predicament.
Medicare encourages whistleblowers to report doctors when there is suspicion of fraud. In and of itself, this should not be problematic. If a doctor or corporation is attempting, systematically, to defraud the government of money, it is in everyone's best interests to bring that to an end.
But by what means?
If there is a vandalism circuit in the neighborhood, does it make sense for law enforcement officials to use guns and brute power to raid every house, taking all valuables in sight--then tell the public it has "recovered" the vandalized goods because it confiscated the equivalent of the stolen goods? And is it fair, then, to block the owners whose houses have been robbed by the government from registering a complaint, or demanding their property back?
The government claims to have recovered $10 billion in Medicare fraud over the past three years. But is it really fraudulently acquired money that it has recovered? Or is it any money at all that the FBI and government prosecutors can bully out of doctors, through raids, threatening tactics, silent treatment, sealed affidavits, and a refusal to communicate in any substantive way with the doctors they raid or the lawyers who represent them?
There is something wrong with a system that has removed, preemptively, any right to appeal or for due process on the part of those who may have been falsely accused and punished. In fact, a system that operates in this manner is referred to as fascist.
Fascism: radical, authoritarian, nationalist, political policy, where the stated goal is to seize power and protect the interests of the proletariat.
Fascism is a pejorative term which is loosely used as an equivalent of "bully." Fascists take from those who have, and redistribute to those who don't.
The government recruits and uses Medicare whistleblowers as a starting-point for bullying doctors in their effort to recuperate money--per executive orders passed down to the Department of Justice--for a flagging United States economy. The stated objective is to protect taxpayers' money. The real aim is to take back money in the easiest way possible so that it looks as though government agents are doing their jobs, even though the real fraud-gangsters are not nuts-and-bolts doctors who are trying to make sense of abstruse Medicare coding and documentation guidelines--and who are being terrorized out of medicine by perpetual threats of take-backs, and by overzealous auditors--but racketeers who hack into Medicare portals, represent themselves as doctors, submit false claims, have large payments routed first into legitimate-looking bank accounts, and then into foreign bank vaults, and remain incognito throughout. Long after the government gets a whiff of what's going on, these large-scale criminals have moved on to newer grazing fields to start the process over again.
It's a billion-dollar industry, and I'm not part of it.
Neither, apparently, is the FBI.
"It's too hard to go after those guys," three different FBI agents told me two and a half years ago, when I explained to them what I thought was going.
Back then, the FBI had approached me to "review" lists of patients whose Medicare accounts had been billed for expensive pieces of home medical equipment. My license information had been registered on the line for the referring physician. Unless government agents were trying to entrap me at the time, the lists of Miami patients I was shown were people in whose names false claims had been submitted--and paid out--using Medicare claims-submissions software.
"Yeah, there's a whole lot of fraud going on out there, but we're not going to catch it," one FBI agent casually commented.
"Why not?" I asked. "Isn't that your job? Aren't you guys good at espionage stuff?"
"These people are professional crooks. They come from foreign countries and do a number on the system," he answered. "They're gone before we can say, 'Boo!'"
"Why can't you track them down?"
"They use false ID's, and have bank accounts under false names. It's an industry."
"How much do they wrangle out of Medicare?"
"Oh, millions a pop."
As for whistleblowers, it's possible that they might be able to identify small errors in billing.
For example, the patient may see a statement reporting that Medicare paid for a nebulizer treatment, but he knows he had to cut out of the doctor's office early, and never received the treatment. That's not 'fraud"--it's not even "abuse" of the system. It's an error. And there are likely to be as many errors going in the opposite direction--a patient who does receive a nebulizer treatment, but the nurse or provider forgot to circle it on the coding sheet, and it never gets billed to Medicare.
The integrity problem with the whistleblower system is that whistleblowers--like people pointing an accusatory finger at witches in the 1600's--get protection from authorities. In America, Medicare whistleblowers are allowed to remain anonymous. If they're wrong, they don't suffer ignominy, they aren't fined, there's no slap on the wrist--they don't lose a thing.
Why not be a whistleblower? If you report your doctor and the government "recuperates" money by any means, legitimate or not (plea-bargaining is not legitimate) you get up to 40% of the take-back.
Wow! That's like winning the lottery for most people. And you don't even have to buy a lottery ticket to enter into the gamble.
One of the first actions Pat McCullough took in the weeks after she purchased Hawthorne Medical Center from me was to call Bill Nelson, the U.S. Senator from Florida, and ask, "How does someone report a doctor for fraud?"
What did she have to lose?
She knew I hadn't committed fraud of any kind. But she also knew how to roust government officials out of their slumber and present the profits my office generated as illegitimate.
It's likely that this was part of her grand plan, which would assure her a source of "income" long after she had seized the assets of the medical center, sold equipment, re-routed the money, and declared "bankruptcy" for $12 million. She knew, perhaps, how greedy government agents are for tips that might lead to easy monetary take-backs. After all, a goodly percentage of those take-backs end up in the FBI's coffers, and are necessary to flesh out the FBI's operating budget. And a solo woman doctor is pretty defenseless in the face of a SWAT team.
Pat McCullough's identity as the initial whistleblower was supposed to be protected. The affidavits containing information that justified, supposedly, the government's intrusion into my affairs, remain sealed. Magistrate Judge Jones refused to order the unsealing of these affidavits because he believed the prosecutors when they said they wanted to assure the anonymity and protection of the witnesses. He wouldn't even allow information propping up the raid on my clinic to be released if all identifying elements were redacted.
That didn't matter. Information like this has a way of leaking out. Pat McCullough appeared almost immediately under Justia.com as the initial whistleblower; afterwards, several ex-employees hopped into the fray--why not? Nothing to lose. They had no fear about identifying themselves.
"I called the FBI," one of my ex-billing clerks--a woman perpetually in arrears--said, proudly.
She couldn't have been proud because there was actually something fraudulent to report. She was proud, I believe, because this is America, and if someone can get big money in any way at all--even by lying to the government--that person is an idol. She was prepared to wait for the payout.
I hope the government doesn't play into the hands of these false whistleblowers. It doesn't look good for America. If we don't operate with integrity in this country, we're headed down the tubes fast.
But the national economy is insolvent, and its agents are under duress. Take back money for Medicare! We're running out of cash! We can't print it fast enough at the Federal Reserve! Therefore--go after doctors! These are the marching orders given to government prosecutors and their FBI underlings.
And I'm one of their cash cows, I guess. They've come into my clinic with their guns and puffed up facades, with the power of undemocratic statutes behind them, and they've taken whatever they could find.
Now they are able to claim they've "taken back" $10 billion plus my $400,000 for the American people. What a way to solve the country's indebtedness issue.
The problem is, government vandalism isn't going to solve anything. If you take it from the people, are you really taking it for the people?
Medicare encourages whistleblowers to report doctors when there is suspicion of fraud. In and of itself, this should not be problematic. If a doctor or corporation is attempting, systematically, to defraud the government of money, it is in everyone's best interests to bring that to an end.
But by what means?
If there is a vandalism circuit in the neighborhood, does it make sense for law enforcement officials to use guns and brute power to raid every house, taking all valuables in sight--then tell the public it has "recovered" the vandalized goods because it confiscated the equivalent of the stolen goods? And is it fair, then, to block the owners whose houses have been robbed by the government from registering a complaint, or demanding their property back?
The government claims to have recovered $10 billion in Medicare fraud over the past three years. But is it really fraudulently acquired money that it has recovered? Or is it any money at all that the FBI and government prosecutors can bully out of doctors, through raids, threatening tactics, silent treatment, sealed affidavits, and a refusal to communicate in any substantive way with the doctors they raid or the lawyers who represent them?
There is something wrong with a system that has removed, preemptively, any right to appeal or for due process on the part of those who may have been falsely accused and punished. In fact, a system that operates in this manner is referred to as fascist.
Fascism: radical, authoritarian, nationalist, political policy, where the stated goal is to seize power and protect the interests of the proletariat.
Fascism is a pejorative term which is loosely used as an equivalent of "bully." Fascists take from those who have, and redistribute to those who don't.
The government recruits and uses Medicare whistleblowers as a starting-point for bullying doctors in their effort to recuperate money--per executive orders passed down to the Department of Justice--for a flagging United States economy. The stated objective is to protect taxpayers' money. The real aim is to take back money in the easiest way possible so that it looks as though government agents are doing their jobs, even though the real fraud-gangsters are not nuts-and-bolts doctors who are trying to make sense of abstruse Medicare coding and documentation guidelines--and who are being terrorized out of medicine by perpetual threats of take-backs, and by overzealous auditors--but racketeers who hack into Medicare portals, represent themselves as doctors, submit false claims, have large payments routed first into legitimate-looking bank accounts, and then into foreign bank vaults, and remain incognito throughout. Long after the government gets a whiff of what's going on, these large-scale criminals have moved on to newer grazing fields to start the process over again.
It's a billion-dollar industry, and I'm not part of it.
Neither, apparently, is the FBI.
"It's too hard to go after those guys," three different FBI agents told me two and a half years ago, when I explained to them what I thought was going.
Back then, the FBI had approached me to "review" lists of patients whose Medicare accounts had been billed for expensive pieces of home medical equipment. My license information had been registered on the line for the referring physician. Unless government agents were trying to entrap me at the time, the lists of Miami patients I was shown were people in whose names false claims had been submitted--and paid out--using Medicare claims-submissions software.
"Yeah, there's a whole lot of fraud going on out there, but we're not going to catch it," one FBI agent casually commented.
"Why not?" I asked. "Isn't that your job? Aren't you guys good at espionage stuff?"
"These people are professional crooks. They come from foreign countries and do a number on the system," he answered. "They're gone before we can say, 'Boo!'"
"Why can't you track them down?"
"They use false ID's, and have bank accounts under false names. It's an industry."
"How much do they wrangle out of Medicare?"
"Oh, millions a pop."
As for whistleblowers, it's possible that they might be able to identify small errors in billing.
For example, the patient may see a statement reporting that Medicare paid for a nebulizer treatment, but he knows he had to cut out of the doctor's office early, and never received the treatment. That's not 'fraud"--it's not even "abuse" of the system. It's an error. And there are likely to be as many errors going in the opposite direction--a patient who does receive a nebulizer treatment, but the nurse or provider forgot to circle it on the coding sheet, and it never gets billed to Medicare.
The integrity problem with the whistleblower system is that whistleblowers--like people pointing an accusatory finger at witches in the 1600's--get protection from authorities. In America, Medicare whistleblowers are allowed to remain anonymous. If they're wrong, they don't suffer ignominy, they aren't fined, there's no slap on the wrist--they don't lose a thing.
Why not be a whistleblower? If you report your doctor and the government "recuperates" money by any means, legitimate or not (plea-bargaining is not legitimate) you get up to 40% of the take-back.
Wow! That's like winning the lottery for most people. And you don't even have to buy a lottery ticket to enter into the gamble.
One of the first actions Pat McCullough took in the weeks after she purchased Hawthorne Medical Center from me was to call Bill Nelson, the U.S. Senator from Florida, and ask, "How does someone report a doctor for fraud?"
What did she have to lose?
She knew I hadn't committed fraud of any kind. But she also knew how to roust government officials out of their slumber and present the profits my office generated as illegitimate.
It's likely that this was part of her grand plan, which would assure her a source of "income" long after she had seized the assets of the medical center, sold equipment, re-routed the money, and declared "bankruptcy" for $12 million. She knew, perhaps, how greedy government agents are for tips that might lead to easy monetary take-backs. After all, a goodly percentage of those take-backs end up in the FBI's coffers, and are necessary to flesh out the FBI's operating budget. And a solo woman doctor is pretty defenseless in the face of a SWAT team.
Pat McCullough's identity as the initial whistleblower was supposed to be protected. The affidavits containing information that justified, supposedly, the government's intrusion into my affairs, remain sealed. Magistrate Judge Jones refused to order the unsealing of these affidavits because he believed the prosecutors when they said they wanted to assure the anonymity and protection of the witnesses. He wouldn't even allow information propping up the raid on my clinic to be released if all identifying elements were redacted.
That didn't matter. Information like this has a way of leaking out. Pat McCullough appeared almost immediately under Justia.com as the initial whistleblower; afterwards, several ex-employees hopped into the fray--why not? Nothing to lose. They had no fear about identifying themselves.
"I called the FBI," one of my ex-billing clerks--a woman perpetually in arrears--said, proudly.
She couldn't have been proud because there was actually something fraudulent to report. She was proud, I believe, because this is America, and if someone can get big money in any way at all--even by lying to the government--that person is an idol. She was prepared to wait for the payout.
I hope the government doesn't play into the hands of these false whistleblowers. It doesn't look good for America. If we don't operate with integrity in this country, we're headed down the tubes fast.
But the national economy is insolvent, and its agents are under duress. Take back money for Medicare! We're running out of cash! We can't print it fast enough at the Federal Reserve! Therefore--go after doctors! These are the marching orders given to government prosecutors and their FBI underlings.
And I'm one of their cash cows, I guess. They've come into my clinic with their guns and puffed up facades, with the power of undemocratic statutes behind them, and they've taken whatever they could find.
Now they are able to claim they've "taken back" $10 billion plus my $400,000 for the American people. What a way to solve the country's indebtedness issue.
The problem is, government vandalism isn't going to solve anything. If you take it from the people, are you really taking it for the people?
Was there any scrutiny of your practice by federal agencies before you sold your clinic in Hawthorne? Could the investigations that are happening be separate from the whistle-blower lawsuit that you have described? Could somebody be using your credentials?
ReplyDeleteFor one and a half years before my Hawthorne practice was sold, Pat McCullough had access to all the records, including billing and accounting information, and patient data.
ReplyDeleteThis is why I believe her motive in purchasing the medical facility was not to run a clinic but to take assets and "report" me to the government. The clinic provided a lot of services and therefore generated more income than the average family practice. It's possible that Pat thought she could represent the office as fraudulent and get government officials to pursue a whistleblower suit because I was an "outlier," therefore a suspect, and a possible source of take-back money. Could someone be using my credentials? That's possible, but it seems likely that the government would have figured that out by now. I requested a list of all the charges billed out in my name to Medicare, from First Coast Services in Jacksonville--the office that manages Medicare claims in north central Florida. I knew I would be able to identify codes for charges I would never have billed, which might have suggested that my Medicare number was used by an outside scam artist. But First Coast never sent the requested list. It would have been long--charges for the past five or six years could number in the thousands of pages. Without such a document, however, I can only know what I billed out, not what was billed out in my name in the form of illicit submissions.