Anyone familiar with privatized healthcare probably knows from experience that the Hippocratic Oath often gives way to hypocrisy in the form of surprisingly high medical bills for simple procedures. But sometimes, healthcare professionals also succumb to the temptation to sidestep government regulations and rake in millions of illegal dollars. And when exploitation becomes that profitable, it can inspire shockingly villainous levels of dishonesty—sometimes even blatant patient endangerment.
10Changing The Definition Of “Sick” To Admit More Patients
With the constant barrage of news stories about all the food additives and household objects that can give us cancer or otherwise damage our health, the last thing we need as a society is another excuse to descend into hypochondria. But even when we do succumb to the urge to treat every itch and hiccup as a symptom of the plague, we should still be able to trust nurses and physicians to set us straight with the proper diagnosis.
Florida-based Health Management Associates saw it differently. With the aid of complex software and a little old-fashioned strong-arming, the for-profit hospital admitted an excess of patients who needed little or no medical attention in order to bill Medicare. Hospital staffers were so eager to treat visitors that an infant whose body temperature registered at 37.1 degrees Celsius (98.7 °F)—one-tenth of a degree higher than the average temperature of 37 degrees (98.6 °F)—was documented as having a fever, resulting in needless and costly medical tests.
But not everyone involved in the hospital ruse was a willing participant. According to a whistle-blower lawsuit filed against the company, it was standard practice to fire physicians who refused to play ball, and administrators with ethical concerns about excessive hospital admissions suffered similar fates. Unfortunately, because of the increasingly convoluted financial affiliations and colossal scales that are coming to characterize groups like Health Management Associates, these kinds of abuses will likely be a persisting nightmare for regulators.
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9Delegating Medical Treatments To Unqualified Staffers
Dr. Ravi Sharma was a certified thoracic surgeon who sought to help people lose weight through his Florida-based Life’s Image weight-loss center. And while one might not think of a chest doctor as the first person to run to with a severe case of glut-gut, it’s perfectly reasonable to expect the clinic to at least be staffed with professionals who know how to treat weight-related medical problems.
Unfortunately, Dr. Sharma was too busy being courted by dollar bills to worry about whether the people tending to his patients had any real clue what they were doing. Instead of recruiting certified professionals to perform vein injections and other invasive procedures, Sharma relied on untrained staffers—including an office manager—to do the work. The thoracic surgeon not only didn’t perform the procedures, he wasn’t even present to oversee them. Instead, he often texted the instructions for performing ultrasounds and varicose vein injections to his staff, according to one complaint against him.
To make matters worse, many of the invasive procedures were unnecessary, performed only for the purpose of charging extra money. Sharma, who only saw a few patients himself, sought Medicare payments for the procedures that his untrained assistants performed as well. But everything fell apart when he fired office manager Patti Lovell, who repaid the gesture by exposing Sharma’s indiscretions in a whistle-blower lawsuit. Sharma, however, having learned that money is the best medicine, simply made his troubles disappear by paying the government $400,000 and has since continued to practice medicine without further punishment.
8Exploiting Workers’ Compensation Claims
For the average Joe just looking to make ends meet, a severe workplace injury offers little more than physical agony and the dire prospect of being unable to provide for your family, not to mention the crippling debt of hospital bills. Thankfully, society has provided an invaluable safety net in the form of workers’ compensation, which covers the cost of recuperation from job-related accidents.
However, for orthopedic hospital owner Michael Drobot, workers’ compensation insurance was the unwitting inspiration for a 16-year, $500 million fraud. Through a series of bribes issued to doctors, chiropractors, and other professionals, Drobot’s clinic pulled in scores of patients who were undergoing surgery for work-related spinal injuries. Thanks to this scheme, many injured workers were sometimes sent hundreds of miles away from their homes for their operations instead of being scheduled for surgeries at the most convenient locations.
To ensure that his chicanery went unchecked, Drobot ingratiated himself with California state senator Ronald S. Calderon with the help of $100,000 in blatant bribe money. But since being apprehended, the corrupt hospital owner has done nothing but talk in attempts to reduce his punishment, dragging down Calderon and others in the process.
7Pretending Patients Are Terminally Ill To Get Medicare Funding
Hospices are essentially healthcare purgatories where the terminally ill wait out their final months under the care of staff trained to make their exit as painless as possible. They also happen to reduce hospital expenses and place a smaller financial burden on the Medicare program, which only covers expenses for hospice patients who are diagnosed with six or fewer months to live. Accordingly, hospitals and hospices have a large incentive to identify dying patients who no longer wish to extend their lives.
But between 2001 and 2013, Vistas Hospice Services, America’s largest privatized palliative care service, squandered millions of dollars in Medicare reimbursements on healthy and otherwise ineligible individuals. To promote these deceptive hospice enrollments, Vistas paid bonuses to staffers who played along, all while ignoring doctors’ and nurses’ concerns about the suitability of the care being administered. And in addition to this blatant subsidy abuse, Vistas also improperly identified some patients as suitable for crisis care, a highly expensive recourse reserved for patients who are severely impaired by illness. These bogus expenses were in turn passed off to taxpayers through Medicare reimbursements.
In one of the most telling cases, Vistas charged Medicare $170,000 to provide intensive nursing assistance to a woman who was not only not critically ill, but healthy enough to live on her own and perform household chores. Other patients who were supposedly knocking on death’s door were going to church and attending bingo halls. Because of such wholesale dishonesty, Vistas’s crisis care costs were almost six times that of the national average. These kinds of aberrations tend to attract the attention of the US government, which busted Vistas as part of a multibillion-dollar Medicare fraud investigation.
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6Profiting From Dying Patients And Then Abandoning Them To Avoid Associated Costs
As we just observed, the best interests of the sick and dying sometimes take a backseat to the appeal of extended Medicare reimbursements. However, rather than blatantly lying about the condition of their patients like Vistas, many for-profit hospices opt for the more subtle approach of enrolling disproportionately high numbers of dementia sufferers, who sometimes live years longer than expected and—on average—require less care than other typical hospice patients.
The US government attempted to clamp down on this clandestine corruption by setting a $25,000 limit on the amount of money that hospices can receive without having to repay the government. However, numerous for-profit hospices nonetheless exceed their reimbursement caps by 50 percent or more. If they’re still in hot water, they can simply declare bankruptcy to avoid paying large debts, leaving ailing patients and their families to scramble for new providers while taxpayers foot the bill.
In a particularly striking case of this systematic abuse, Sojourn Care Inc. chose to close down after accruing $27 million in debt, then turned around and reopened under a different name. Consequently, the company was able to relinquish all previous legal obligations—which remained with the now defunct Sojourn Care—and then recruited the healthiest patients from its former incarnation in order to profit off them a bit longer. As a result, 180 of Sojourn Care’s 280 former patients were left to struggle, some dying in uncomfortable conditions as a result. The only thing more dispiriting is the fact that all of this is technically legal, meaning that for scores of families, justice may never be served.
5Conning Drug Addicts Into Entering Psychiatric Lockdown
Hardcore drug addicts are among the most desperate souls one can encounter in any society. Whether you sympathize with their struggles or chide them as harbingers of crime and social decay, there’s no denying that they lead lives of physical and mental enslavement at the hands of often deadly substances. So any efforts to help them break the chains of drug dependence should, in theory, be hailed as laudable endeavors.
But in Broward County, Florida, a group of executives overseeing a psychiatric hospital saw fit to provide a different kind of help for substance abusers. Over the course of nine years, the executives paid bribes and doctored documents all in the name of luring drug addicts to their hospital, the Hollywood Pavilion, where the addicts remained locked for weeks on end. But despite the glamorous connotations of its name, the Hollywood Pavilion was far from posh. Instead, patients were stuffed into insect-ridden rooms where they received little or no treatment and were kicked out as soon as their Medicare benefits had been exhausted.
After racking up $67 million in bogus reimbursements by offering empty promises of rehabilitation, the owners, Karen Kallen-Zury and Christian Coloma, received jail terms ranging from 12 to 25 years and were forced to pay millions in restitution. While none of these consequences can undo the injustices wrought against their victims, one can take some comfort in knowing that others in need of rehabilitation can’t be roped in by this toxic deception.
4Performing Fake Surgeries
One of the truly nightmarish aspects of surgery is the abject vulnerability of it. A patient must submit to drug-induced slumber so that a group of strangers can slice them open and proceed to poke, prod, and jostle their delicate innards. Were it not for the fact that this task was left up to highly trained experts, the surgeries would seem like blatant felonies. Unfortunately, some highly trained experts aren’t above behaving like felons.
Take, for example, Dr. Spyros Panos, an orthopedic surgeon at Saint Francis Hospital in Poughkeepsie, New York. Despite supposedly being fully capable of performing legitimate surgeries on his patients, it appears that the doctor opted to feign operations or perform them with the shoddiest of workmanship. A collection of 250 lawsuits filed by Panos’s former patients details how the surgeon performed excessive surgeries on some patients while not properly completing operations on others. In some cases, he sedated and opened up patients to give the illusion of surgery before sealing them right back up without making a single alteration.
Spanos’s exploits allowed him to schedule up to 22 surgeries per day, nearly 20 times the monthly average of his colleagues. And at least one of his dubious undertakings appears to have led to the death of a patient. While Panos has remained reticent about charges against him, his social media posts and personal blog ironically paint the picture of a doctor who takes patient care seriously. Fortunately for everyone, Spanos has since been convicted and has made a full confession.
3Recruiting The Homeless For Unnecessary Medical Treatment
By now, it’s abundantly clear that medical practitioners will sometimes travel great lengths down the path of dishonesty to make a few extra bucks. But we often expect that people who have dedicated themselves to saving lives will only go so far before succumbing to the pull of the angels on their shoulders. But if such a thing does occur, it certainly didn’t happen in California, where some of its most vulnerable citizens have been turned into fleshly ATM cards by hospital administrators.
A chain of Los Angeles-based medical facilities was caught enticing homeless people to submit to unnecessary medical testing. Lassoed in with miniscule bribes, homeless people were carted off to the hospital to receive second-rate treatment—or no treatment at all—before being loaded into ambulances and dumped in the famously seedy Skid Row. The bogus treatments were in turn billed to Medicaid. In one particularly horrifying instance, a homeless woman received a nitroglycerin patch for a fabricated illness, resulting in a dangerous drop in blood pressure.
All of this was made possible through a series of paid runners who collected and redeposited the homeless “patients.” The impromptu hospital visits accrued more than $16 million for the hospital chain. But the observant eye of Scott Johnson, an employee of Union Rescue Mission, caught on to the bizarre back-and-forth of makeshift homeless shuttles. After Johnson informed the police of the suspicious activity, a lengthy investigation busted the scheme wide open and led to a $16.5 million settlement.
2Unnecessary Chemo Treatments
Anyone with a passing knowledge of chemotherapy probably understands two things: It’s supposed to kill cancer, and the treatment’s side effects include hair loss and general anatomical misery. Because some chemo drugs can cause problems as severe as lung damage and permanent deafness, it’s imperative that the treatment only be administered when necessary.
But we live in a world rife with avoidable suffering, thanks in no small part to oncologist Farid Fata, whose litany of lies includes administering cancer drugs to people who didn’t have cancer. According to a complaint filed by the US government after a thorough FBI investigation, Dr. Fata issued $150 million worth of partially fraudulent Medicare bills over a three-year period. His chosen method of deception was to simply treat patients for the wrong illness or withhold valuable information about less costly alternatives. A nurse employed under Fata reported examining a chart of 40 of his patients and discovering that 95 percent of them were being improperly treated.
In some cases, Fata would write prescriptions for lifelong drug treatment even though curative surgeries were available. But the most shocking infractions involved his willingness to falsely diagnose patients with cancer in order to profit off the ensuing tests and chemotherapy. After finally being apprehended by authorities in 2013, Fata faces massive fines and a decade-long prison sentence.
1Performing Unnecessary, Life-Threatening Surgeries On The Elderly
Like all of the other facilities on this list, Sacred Heart was the site of systematic Medicare fraud at the expense of patients. To perpetrate this multimillion-dollar fraud, hospital administrators not only paid kickbacks to have patients artificially referred to them, but also had ambulances deliver patients to the emergency room to force automatic Medicare billing. They also artificially extended hospital stays and subjected elderly patients to unnecessary operations—sometimes with fatal results.
One of the hospital’s most wanton offenders, Dr. Vittorio Guerriero, reportedly induced breathing complications in at least 28 patients, at which point tracheotomies were required. In the course of performing these invasive procedures, which required holes to be drilled into the victims’ throats, five people died. The entire operation was so corrupt that Sacred Heart was forced to shut down after the authorities seized its financial assets.