Curious to hear opinions on this case

[Josh0731]

This got forwarded to me recently.

When I read it I was really curious what opinions might be out there on this person's case.  I'm really split.  On the one hand I believe this guy did do something dumb but not dangerous and probably doesn't deserve the severity of the punishment he may be facing.  But on the other hand I keep asking myself: how did this not seem shady at any point? nothing about their financial situation that seemed to provoke his seeking out this side-gig is unique at all (certainly not to anyone on this forum), so how necessary was seeking out these funds compared to following the sound but boring financial advice people on this site try to live by?  did he not realize the simple fact that what we physicians document and sign is legally and ethically very consequential and important?

What do you guys think?

[jfoxcpacfp]

Are you sure this is not a hoax? It says they had their first child in 2009 at the beginning and that they have 4 children ranging in age from 4 - 9 at the end. Besides the math, it just seems a little odd to keep having kids while you are undergoing federal prosecution. Maybe the children were added to engender sympathy...

Actually, found one (and only one) story on the net that said the physicians were key to the case because they had to sign off on all reimbursements. Wouldn't this have been a tip-off if they didn't already have a clue? They were in strip malls, for goodness sake.

[Zaphod]

The Go Fund Me is strange in those ages, but who knows their details. The practice of chart review isnt strange, but agree the settings and after going through a few charts you should have seen that things were not on the up and up. I was able to find 3 articles from different papers on it, all with the same superficial info.

You must remember something when dealing with CMS, you are guilty until proven innocent. This has played out time and time again, you are almost always assumed guilty, charged and have to defend it yourself at your cost. Its ruined people due to the severity of penalties, costs. Sometimes for dumb, non paying errors. They do like to make examples.

Idk anything about this particular cases details. It sounds early and could be part of the governments plan to get their desired outcome, who knows.

[jfoxcpacfp]

Zaphod wrote:

You must remember something when dealing with CMS, you are guilty until proven innocent.

Click to expand...

CM = Case Management?

[DarrVao777]

jfoxcpacfp wrote:

Zaphod wrote:

You must remember something when dealing with CMS, you are guilty until proven innocent. 

Click to expand…

CM = Case Management?

Click to expand...

CMS = Centers for Medicare & Medicaid Services

[DarrVao777]

Call me a cynic, but I think he's guilty.

Unfortunately, he won't (and didn't apparently) get much sympathy from a jury because the expectation is that someone as well-educated as a physician shouldn't be duped this badly. Or at least participate in something so stupid.

I cannot verify the accuracy of the article: http://www.chron.com/news/houston-texas/article/Three-doctors-convicted-in-3-1-million-scheme-to-8330633.php

"Each of the doctors responded to an ad for a clinic director on Craigslist."

Who in their right mind utilizes Craigslist as a job hunting site? (He should be sent to prison for this kind of stupidity alone)

How much were they paying that it would make flying to Houston (from his residency and presumed home in Dallas) for moonlighting worthwhile? They don't offer moonlighting gigs in Dallas?

 

[Zaphod]

DarrVao777 wrote:

Call me a cynic, but I think he’s guilty.

Unfortunately, he won’t (and didn’t apparently) get much sympathy from a jury because the expectation is that someone as well-educated as a physician shouldn’t be duped this badly. Or at least participate in something so stupid.

I cannot verify the accuracy of the article: http://www.chron.com/news/houston-texas/article/Three-doctors-convicted-in-3-1-million-scheme-to-8330633.php

“Each of the doctors responded to an ad for a clinic director on Craigslist.”

Who in their right mind utilizes Craigslist as a job hunting site? (He should be sent to prison for this kind of stupidity alone)

How much were they paying that it would make flying to Houston (from his residency and presumed home in Dallas) for moonlighting worthwhile? They don’t offer moonlighting gigs in Dallas?

 

Click to expand...

I agree he should have known given the complaints, "pts come in for low back pain and basically receive every test possible", he should have caught that asap in his first shift and noticed something was off and quit.

I also didnt understand why he flew to Houston instead of driving, its not that far (did residency in texas) and time/money wise makes no sense. I would drive that far almost any weekend I had off while racing bikes and I did a surgical residency.

[pulmdoc]

If someone wanted me, as a resident, to sign off on supposedly practicing physician charts, it would be a massive red flag. That they were willing to make it financially lucrative enough to travel from Dallas to Houston to do so is a massive red flag. That said, CMS likes to make examples out of doctors and has repeatedly ruined docs in the court of public opinion when the provable facts were much more ambiguous than presented.

[nolamd84]

It's unclear exactly how much he got paid but one of the other physicians reportedly was paid about $180,000 over 18 months and somewhere else it mentions $40,000 for 4 hours of work. No one thinks they're worth that much money - perhaps it was willful ignorance  and assuming plausible deniability?

[DarrVao777]

nolamd84 wrote:

It’s unclear exactly how much he got paid but one of the other physicians reportedly was paid about $180,000 over 18 months and somewhere else it mentions $40,000 for 4 hours of work. No one thinks they’re worth that much money – perhaps it was willful ignorance  and assuming plausible deniability?

Click to expand...

https://www.justice.gov/usao-sdtx/pr/four-convicted-health-care-fraud-scheme -> "The court also heard that Simmons had admitted being paid $40,000 for reviewing 20-30 patient files in less than four hours."

Oh that's not suspicious at all.

"Honey I'm back from my moonlighting shift. The work wasn't too bad but you wouldn't believe the attitude I got from the airline attendant in first class. I think I should fly private the next time I moonlight. It's OK because I got paid more this weekend than what I get paid all year as a resident. Now, let's go have another kid before they send me to federal prison for 10 years."

[nolamd84]

Yea that was the one @DarrVao777. To be fair, no where does it absolutely say that Martinez also had the same deal but I'm skeptical.

[VagabondMD]

Martinez might have made even more money as a whistleblower. Disastrous turn of events for someone who might have had a promising career, my inclination is to feel sorry for him, based on the information provided.

 

[Zaphod]

wow. yeah, theres no defense for that kind of money. How dumb.

[Hatton]

If it is too good to be true........run

[RadDoc6876]

I have a Texas medical license and receive their Board newsletter--apparently this is true, if it's the same person listed on page 8 and again on 9:

http://www.tmb.state.tx.us/dl/D3B7EF21-39EC-EF15-EB7C-52F4FA7D2139