The Heavy Human Price of Health Care Fraud

It costs taxpayers and insurance companies billions every year, but fraud is too gentle a word when you consider the effects of this crime

Posted by Dawn Lomer in Healthcare on November 29th, 2011

Health care fraud is the worst kind of fraud. I came to this conclusion while listening to the fraud investigation team presenting the 2011 Investigation of the Year at the NHCAA Annual Training Conference. For not only did Drs. Arun and Kiran Sharma steal millions from taxpayers, private industry and innocent people, they betrayed the trust of those who have faith in the medical community.

The two doctors put the lives and health of innocent people at risk, and they diverted millions of dollars worth of health care from those who really need it. They also may have killed somebody. And they very likely caused grave harm to many others.

So it’s not just about money. It’s about physical and mental harm as well. And when I heard the stories of the complete disregard these two fraudsters had for people’s lives, I concluded that 15 and eight years in prison and the forfeiture of roughly a quarter of the money they took is an awfully light sentence.

Dangerous Deeds

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The investigation team related incidents in the Sharma case that put people in real danger. The medical supply kit Dr. A used to administer injections was inadequate for the kind of injections he was giving and kept in an unsterile container.

Dr. A used whatever space he had as a surgical suite and administered injections wherever the patient said it hurt. He actually injected a woman in the forehead for a headache – in the waiting room! He was even known to administer injections in the hallway by positioning patients over the photocopier.

Pill Mill

In one eight-month period, Dr. A had prescribed 615,671 tablets of hydrocodone (Vicodan), 66,000 tablets of alprazolam (Xanax), and 26,000 tablets of diazepam (Valium). Stories of patients who became addicted to the drugs Dr. A prescribed are backed up by the videotaped evidence of people lining up at 6:30am at the clinic that didn’t open until 9am.

During the investigation, one witness revealed that a family member had died from an overdose of the drugs prescribed by Dr. A. The patient had experienced several overdoses prior to her death and the patient’s daughter had confronted the doctor to ask him to stop prescribing the drugs to her mother.

There had been 14 previous claims against Dr. A filed with the Texas Medical Board. He had defeated all 14 using falsified references from other doctors on their letterhead, which he had copied. How this escaped further scrutiny is a mystery.

Do No Harm

In addition to drug overdoses and botched procedures, victims of health care fraud – the patients – simply don’t get the care they need. They may dismiss symptoms of something serious because a fraudulent doctor isn’t paying attention to any conditions that don’t fit their billing scheme. By falsifying records, doctors enter incorrect information about a person’s medical condition into public systems, so that in an emergency a patient may not receive the correct treatment because their record may show that they are being treated for a condition they don’t have. And in extreme cases, people die.

 


Dawn Lomer
Dawn Lomer

Managing Editor

Dawn Lomer is the managing editor at i-Sight Software and a Certified Fraud Examiner (CFE). She writes about topics related to workplace investigations, ethics and compliance, data security and e-discovery, and hosts i-Sight webinars.