Does stealing from insurance carriers to keep an ailing medical practice afloat really classify as “Robin Hood”-type behavior? According to The Record, a judge who compared a New Jersey doctor to the English folk hero also sentenced the offender to multiple years in prison, after he was found to have fraudulently billed public and private insurance providers more than a quarter of a million dollars for patient office visits that never happened. (While the judge did not accuse him of acting solely out of greed, she did hold him accountable for actions that violated his position of trust as a physician.
In a medical service billing scheme that lasted more than a decade,
the Bergen County doctor submitted claims to Medicaid, Medicare and
private insurance carriers for medical tasks that could have involved
office visits, but did not. In addition to writing prescriptions and
authorizing refills that he later misrepresented to insurers, he
regularly inserted into patient records false information, like blood
pressure readings, to support claims of nonexistent office visits. Even
worse? He pressured staff members to do the same, even though at least
four of them warned him of the ethical and legal repercussions of such
actions. (Note to potential whistleblowers: you blew it.)
But one astute patient noticed that their insurer had been billed for
a prescription incorrectly listed as having been written during an
office visit. The patient tipped off the insurer, who then attempted to
audit the doctor’s records. But when the dodgy doctor realized what was
going on, he intentionally attempted to manipulate the audit’s results
by destroying patients’ original medical records and replacing them with
fake ones. (The cover up always makes the crime so much worse.)
Soon after, the doctor’s shady rule over Sherwood Forest came to an
abrupt end, in court. While the doctor’s defense attorney called him
“selfless with his time” and just a “bad business person,” the presiding
judge noted that he did not apologize or show remorse. She went on to
sentence him to 37 months in prison and ordered him to pay back $280,000
to the insurance carriers he defrauded.
Defrauding insurance carriers is wrong and illegal, but to do so by
falsifying patient records puts people’s lives at risk. What if another
doctor went on to base a critical medical decision on false information?
The legendary Robin Hood stole to help the masses. This doctor stole
his patient’s trust.