PBI Success Story: From successful physician to serving time in jail

PBI Success Story: From successful physician to serving time in jail

October 2015

One moment I was a successful physician; the next, I was in jail.

I was in shock. The judge had just told me I was being sentenced to one year and one day in prison. I had arrived at the courthouse that morning ready to plead guilty to eight counts of medical fraud, but my lawyer had told me that I would not have to serve any jail time and that my license would therefore not be in jeopardy. That’s what I had told my ex-wife, my friends and most importantly, my teenage daughter.

I tried to talk to the judge, but he wouldn’t listen. The fact was that he was being lenient, giving me the shortest possible prison term under federal sentencing guidelines. It didn’t matter what my lawyer had told me; the law was the law. If I had been convicted of all 146 counts of medical and wire fraud that I had originally been indicted for, I could have gone to jail for more than 20 years.

I started that day a free man, a respected physician with a nice house, who had never been in trouble with the law. By nightfall, I had been taken off to prison, where I was humiliated in ways I will never forget, and locked in a cell. It was a week before I could get out of bed and even talk to anyone.

As the weeks passed I kept going over how I had ended up where I was. The first hint of trouble had come three years earlier when my practice had been “red-flagged” by a health insurance company for billing more than other comparable practices in the area. Surprised and concerned, I agreed to attend a meeting with the companies.

At that point, I was proud of the practice I had built up over the years. Alternating between two offices, I had highly qualified physician assistants seeing patients in both locations. My patient list had grown extraordinarily fast, which I took as a sign of my success in caring for people. Realizing that I could no longer handle the enormous amount of paperwork involved in billing, I had contracted out the work to a well-regarded company in the area.

A representative from the billing company agreed to come with me when I met with the insurance company, but assured me that there was nothing to worry about and that he would make sure there were no further problems. At the meeting itself, the focus quickly became an expensive piece of equipment which I was told insurance would not cover. The financial impact of that decision distracted me from what seemed at the time less important billing problems.

A year later, the insurance company audited my practice, and a year and a half after that they called me in for another meeting. I was more annoyed than worried until the FBI contacted me a month before the meeting and said they wanted copies of billing sheets and patient charts.

Up to that point all I ever saw from the billing company was a monthly summary of the bills that had been sent out—so many office visits, x-rays, lab tests, that kind of thing. What I did not realize was that all of the practitioners at both offices had been billing under my name, which made it look like I was billing for services I could not possibly have provided. And there were other billing mistakes as well, none of which I discovered until I got out of prison. By that point, the billing company had dropped me as a client and sold me a software key so that I could get access to all the billing they had done.

Once the FBI got involved, the snowball started rolling downhill pretty fast. The attorney general got involved, a grand jury indicted me on all those counts of fraud, and I started meeting with a lawyer who, like the billing company, had come highly recommended. He told me that “we” were totally unprepared for a trial, presented me with the plea bargain and left me just one day to decide what to do. He put nothing in writing.

I was lucky. I served less time than I expected before being released to a halfway house, where I worked for minimum wage so I could go home on weekends to see my daughter. I was lucky, too, if you can call it that, when I was called before the medical board. The board only took away my license for six months and told me I had to take two classes in professional ethics.

I enrolled in an ethics course with PBI Education, which is one of the best things I ever did. It was an enormous relief to hear from other physicians, who had made serious mistakes. At least I knew I wasn’t the only one in the world to make such bad decisions. And the work I did in the PBI class helped me prepare for my second appearance before the board.

I went into that meeting humbled by what I had done, rather than angry about what the board had done to me. I had learned that my practice was my responsibility and that I had to accept the consequences of what I had allowed to happen. If I had understood what was at stake and done more early on, perhaps I could have avoided the problems that overwhelmed me. But once I was facing felony charges, the time for holding others accountable was long past.

I also went into my second hearing before the board with a Protection Plan that I had developed with PBI’s help. It clearly laid out my understanding of what I had done wrong and how I was going to avoid making the same mistakes again.

This time the board reinstated my license to practice, with no restrictions, and I was able to get back my Oklahoma controlled substance license. I expect to have my DEA number back within the next few weeks and I have a job offer from a local clinic. While I was able to get malpractice insurance, I will no longer be able to get reimbursed by health insurance companies, which means I cannot accept any patients who rely on health insurance.

Still, I am grateful to have gotten the help I needed and looking forward to continuing the career I am still passionate about.