I have hesitated for awhile to talk about how I left my career as a Paramedic and became a teacher. A recent story that has made the news in Central Florida has convinced me that it is time. A man from Connecticut who was being investigated for Medicare fraud decided to try to kill himself and his entire family here in Central Florida during the holidays. He only did the job halfway, killing his wife, three kids, and the family dog. After a few weeks, the Feds showed up to arrest him and found the bodies.
That brings me to my own story. I had retired from the fire department and was working as a Paramedic performing critical care transports for a Medicare contractor. I was supposed to be transporting only the very sickest people. Instead, I was mostly transporting people who were either not sick, or who could have been well, but there was too much money to be made in keeping them sick.
We were lying about the services we were performing, and I refused to play along. There were other patients who were sick, and we were purposely keeping them sick so we could make more money. One patient was supposed to be receiving physical therapy so he could learn to walk again. The only problem is that, once he could walk without assistance, we would no longer get paid for him. So they made sure that he never managed to walk far enough to be cured. The physical therapy team was told to stop teaching him to walk before he could walk 30 feet without assistance, because that would mean he was no longer disabled and we would no longer get paid for his disability care.
We used forged paperwork. We got doctors to sign blank orders that we later filled in as needed. My coworkers and I were expected to invent the paperwork to make it all billable- you weren’t allowed to go home at the end of your shift unless the paperwork was done, even if that paperwork was a complete fabrication. My employer wasn’t alone. Most of the people I know in the health field are expected to do at least a little of this.
I refused to lie on my medical reports, and my bosses hated it. There was no way that I was going to help those people victimize my patients so they could make themselves rich doing it. I sure wasn’t going to lie and risk my license and my freedom to make someone else a millionaire while I was left looking guilty for $17 an hour.
Six months after I began working there, I was approached by state and Federal investigators. I told them everything that I had seen and agreed to cooperate. At their request, I began saving and forwarding documentation to investigators. The company found out and terminated me for “corporate espionage.” I was blackballed from the medical field and my name was mud. I had to change careers and became a teacher.
Over the course of the following six years, I was interviewed by the FBI multiple times. I had to hire a pair of attorneys, because you don’t get interviewed by the FBI unless your attorney is there. A couple of the interviews included the Assistant US attorney. Five years after I was initially contacted, the Feds showed up at my former employers’ offices with a search warrant and some subpoenas and began interviewing my former coworkers.
The investigation could only go back 5 years, and even with that my former employer was suspected of receiving nearly $80 million in fraudulently obtained Medicare payments. My opinion is that it was even more than that, perhaps as much as $200 million in the past 10 years. Still, there was evidence that this one company stole $80 million in a ten year period.
The employer worked a settlement with the Feds. No criminal charges, no admission of guilt, they had to reimburse Medicare for less than $6 million of what they were accused of stealing, and had to sign a paper promising not to do it again.
I was declared to be the whistleblower, and the reward money was just under $1.2 million. My legal bills ate up nearly half a million of that. The IRS got $250K. I lost the career that I had done for most of my adult life in exchange for $500K.
So after nearly a decade of investigation by half a dozen agents, attorneys, and contractors, and the government recouped less than $4.7 million of the over $80 million that was stolen, no one went to jail, the company got to keep roughly $74 million of their ill gotten proceeds, and no one can charge them with any fraud for anything that happened before 2015. I heard that the CEO got a bonus.
The only loser here was the US taxpayer. This is why Medicare for all won’t work. There is so much fraud, so much profit, and so little oversight, that most health care providers are busy stealing the government blind.
As for me, some of my old friends and coworkers have called me a snitch. I am still blackballed from the medical field. I did what I thought was right. I was not about to let them victimize people to become rich. What is right is right. What is wrong is wrong. So, to paraphrase those stupid kneelers: Sometimes you have to do what is right, even if it means losing everything.
jwl · January 19, 2020 at 5:23 am
Thank you for having the courage to do what is right.
SiGraybeard · January 19, 2020 at 7:09 pm
As you said, what's right is right and what's wrong is wrong. You did what's right and it's a damned shame you have to have your life upended.
If anyone deserves the public scorn it's the Assistant US Attorney who settled for the $6 Million. My immediate suspicion is that US attorney is part of the system. I don't know what they get for their part, but what if it was another million or two under the table? That's certainly incentive to keep the system going. If this US attorney files a dozen suits, "wins" them enough to get some money to the treasury, some guilty pleas from the fraudsters, and a couple of million for themselves, that perpetuates the fraud.
The system becomes self-perpetuating because everyone involved in it benefits from it.
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