Dr James Schaller
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Why Physicians Refuse Medicaid & Fire
Medicare: Want to Fight a Superpower?

The bottom line is that the state and federal government is out for blood, and much of it is physician blood. They think that they help patients by destroying doctor after doctor, with useless and trivial accountant evidence, and wonder why the pennies of Medicaid and the fraud hunts of Medicare are making physicians run from them their patients. Doctors are slow to care for themselves, but not stupid.

The Dark Side of Whistle-blowing

When the feds enlist whistleblowers to go after big companies, many firms pay up regardless of guilt, shareholders pick up the tab, and life goes on. But when prosecutors pursue individual doctors, the docs can be ruined over even minor transgressions.

George Krizek put in 25 years as a psychiatrist at Washington (D.C.) Hospital Center before learning, on Christmas Eve 1992, that the Justice Department was accusing him and his wife, Blanka, of fraudulent government billing. Prosecutors claimed $245,000 in overcharges--and demanded $81 million in fines and restitution under the False Claims Act. A federal appeals court later dismissed that demand as an "astronomical" sum. A lower court then cut the figure to $75,000, but prosecutors appealed the ruling in 1998. By then Krizek had retired and was fighting cancer.

"The government continues to relentlessly pursue Dr. Krizek, who is at this point a broken and sick man," U.S. District Judge Stanley Sporkin wrote. "There comes a point when a civilized society must say enough is enough. That point has been reached in this case." Undaunted, the feds went after Krizek for another three years until his daughter, Monika, borrowed money to meet prosecutors' demand for $315,000. "They ruined our lives. Nobody will know how much we suffered," says Blanka Krizek.

In Springfield, Ill. psychiatrist Robert Mitrione was sentenced to 23 months in jail over Medicaid bills that totaled all of $75.25. In California one doctor served five years in prison over $65,000 in disputed Medicare bills in a case in which a key witness was a fired office worker. Stripped of his medical license, he now does charity medical work overseas. "The government seized all of our savings, and we lost our home, too," says the physician, who requested anonymity. "This case has ripped the hearts out of my wife and my children, who have to live with this history. It eats away at them."

"These lawsuits are envy engines that bring out competitors, fired office workers, ex-spouses and mischievous patients," says Madeleine Cosman, a lawyer who has written extensively decrying the criminalization of American medicine. "I'm not interested in defending quacks or charlatans, but whistleblower suits are hobbling some of our best practitioners."

Docs must contend with 133,000 pages of federal medical regulations, and only the richest can afford to fight. Bradenton, Fla. orthopedic surgeon Owen McCarthy spent $3.5 million in legal fees after an estranged ex-partner told the government he was overcharging Medicare for office visits. He claims the FBI bugged his home and his wife's car and threatened to press criminal charges if he didn't settle. McCarthy paid $600,000 in 2002. "The government wanted to put me in jail for billing $45 for office visits for which it said I should have charged $25. It's all arbitrary," McCarthy says ...

Source: Forbes.com and excellently written by: Neil Weinberg, 03.14.05

My respect and thanks for this exceptional reporting and writing.

Dr. J

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