r/news • u/Easy-Goose1038 • 1d ago
AZ doctor sentenced for $36.5M Medicaid fraud case
https://ktar.com/arizona-news/az-doctor-sentenced-36-5m-medicaid-fraud-case145
u/Medical_Bartender 1d ago
As a doc, good. I'm glad they are seizing his assets and he is giving up his license. How evil do you have to be to defraud a system designed to help the poorest and most vulnerable in your care
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u/MountainFriend7473 1d ago
Ask Dr Oz he was the one saying people who don’t use their Medicaid enough are possibly causing fraud vs inappropriately billing services and making a good chunk of money off of it and using people’s Medicaid. 🤷🏻♀️
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u/Arizonagaragelifter9 1d ago
defrauded the state’s Medicaid program of more than $36.5 million in a six-month
It's crazy that someone can be smart enough to be a doctor, but at the same time is stupid enough to not spread the scam out more. They are obviously going to notice $36 million being billed in 6 months. It even says he billed one specific patient for 1700 xrays. How could he possibly think that that is something he'd get away with lol?
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u/Frodojj 1d ago
If he was smart, he wouldn’t have done the fraud in the first place. Being skilled enough to be a doctor doesn’t make them smart outside their subfield. Unfortunately many don’t realize that. Even Sir Isaac Newton, one of the greatest mathematicians and physicists of all time, was a financial idiot and not immune to pseudo-scientific alchemy.
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u/Competitive_Touch_86 1d ago
Meh. There are an absolutely insane number of medical practicioners participating in medicare/medicaid "fraud lite" - it's an entire industry, and it's effectively normalized.
If you ever go on a walk and see "we buy unused diabetic supplies for cash!" signs that's a great example. All those are is the tail-end of a medicaid/medicare fraud that the clinics are pushing - maxing out diabetic supplies for patients who do not need them with a wink and a nudge. Why make half the money when they can simply max out the benefits of the patient every cycle for stuff they will never use? The medical device industry is basically propped up by this sort of scam.
And that's just a really trivial easy relatively public example. It's endemic to the entire profession at this point.
That one idiot decided to go full idiot mode mostly just tells you that the behaviour is so normalized in the profession that he's surprised anyone at all is looking or cares.
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u/fall3nang3l 1d ago
No no, and I have receipts.
When medical marijuana first became legal in PA, doctors were courted by entities from other states who had run similar scams in their state.
They would have patients who wanted to get certified, which the state requires to get a license to purchase medical marijuana as a patient, come in to sweat shop, fly by night pop-ups. There the patients would have to provide blood, urine, and DNA swab samples before seeing the doctor. Who would ask some general questions and certify.
I went to one early on, not knowing any better, and there was a waiting area in a chiropractic office (first red flag), with dozens of others also waiting.
I got one of those "explanation of benefits" from my insurance company once saying that I could be responsible for $286,000 in fees for "testing".
I called the company that ran the scam and they said to ignore it.
Talked to a guy who ran a legit certification practice a few years later and he confirmed my suspicions.
These shady folks early on would do the specimen collection and then bill for literally everything they could to insurance and Medicaid.
Whatever was covered, they pocketed, whatever wasn't they wrote off.
I think in my case something like $30,000 was covered.
So the doctors, who were in on it, walked away with millions per year and the company that set it all up pocketed the rest.
To know knowledge, no one was ever charged in PA for this scam.
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u/VirginiaLuthier 1d ago
He is the very definition of a dumb thief. Charging for 1,600 x-rays under the same account and thinking no one would notice. They will probably let him be a doctor is prison, though
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u/onarainyafternoon 1d ago
My mother worked for him. She said he is the most greedy human being she’s ever met. She said he used to tell everyone in the office that he had “billions”. This didn’t surprise her at all. This is just a fraction of the money the guy made from this scheme.
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u/RainyDayColor 1d ago
Throughout history, time and time and time again, with the grifters and fraudsters it's not stupidity. It's greed. Not an intellectual failing, but a moral one.
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u/Different_Wolf_764 1d ago
Oh, there is no shortage of the greedy ones still out there. People associate it with stupidity because it is the stupid ones that get caught.
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u/MrPBH 1d ago
Here I am billing Medicare for actual medical services rendered, like a fool. If only I committed massive billing fraud, I might actually be able to afford a new car. By doing it the legit way, I earn about $92 from Medicare for taking care of a complicated medical emergency that needs admission to the hospital. I paid my HVAC guy more than that for just diagnosing the problem with my heat pump.
I find it funny how Medicare pays so little to doctors providing necessary medical care and will claw back money they paid out for medical care, but it's so easy for fraudsters to make literal millions of dollars by scamming the program. By funny, I mean an absolute tragedy.
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u/A_Refill_of_Mr_Pibb 1d ago
We’re going down the path that if you’re not running a scam you’re doing it wrong.
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u/machsmit 1d ago
If only I committed massive billing fraud, I might actually be able to afford a new car
hell you might even get elected senator from Florida
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u/MountainFriend7473 1d ago
Right and according to Oz inappropriately billing Medicaid means your using it and that’s good vs not having a claim and not needing medical services is wasteful or fraud because you’re not using it enough 🙃🫠 where’s the line Dr Oz.
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u/KaliLineaux 5h ago
That's what really infuriates me, is people need medical care they can't get, or can't get by someone qualified, because the reimbursement is so low. None of the home health agencies/nurses in my area will provide the care my dad needs because it includes manual disimpaction along with wound care. He will die without the bowel care. They refuse to do it. I have to just find my own nurse and pay whatever it takes. And there are biologic dressings that significantly helped his sacral wound a year ago (which he got due to 3 weeks in a SNF and 3 more in a hospital). But I can't find a home wound care provider to do them. When he got the dressings a year ago I got fed up with getting the runaround and called for nonemergency transportation and had him taken to a wound care clinic to get them. They DEFINITELY helped! But he needs more because the wounds have stalled, and now several months after the fact this ambulance company decides he owes them over $35,000. Even though CMS says he doesn't owe it, he won't be transported now. It's maddening!
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u/SargeUnited 1d ago
But why do you need to punch down on the HVAC guy though? You think you’re better than them?
How much more than the HVAC guy do you think you’re worth? Per unit of time.
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u/walkingjogging 1d ago
Be real a doctor is absolutely worth more than some HVAC guy, they both provide a necessary service but the doctor takes many more years and arguably more intelligence and grit to provide their service than HVAC. I guarantee most hardworking people could learn how to be an excellent HVAC guy in much less than one year
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u/Wide__Stance 1d ago
There are roughly 444,000 HVAC technicians in the US. There are roughly 1,010,000 medical doctors.
So maybe if the insurance reimbursement rates are so bad and the schooling is so difficult, they should go to HVAC school? If it’s easier than being a doctor and more financially lucrative, maybe those doctors should just demonstrate their grit and show what hard work’s all about, right?
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u/walkingjogging 1d ago
Even though this isn't always how it works in reality, no doctor should be going into their field strictly for the money.
I'd imagine those who are truly passionate about being a doctor wouldn't suddenly want to become HVAC because it's easier or pays better? One of my grandfather's closest friend sold his HVAC business for over 50 million, certainly more than most doctors will ever see, but that's besides the point for any good doctor.
What point are you making?
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u/Competitive_Touch_86 1d ago edited 1d ago
If you are capable of becoming a doctor but instead go chase HVAC or whatever other career because you want to chase the money or easier life it's a sub-optimal outcome for society which should be discourged. Hence more money and prestige for the more selective profession.
HVAC is difficult in many ways that differ from a medical doctor. There are certainly some HVAC techs who could have become doctors, but pretty much every single doctor is capable of becoming a HVAC tech short of physical disabilities. Your best, brightest, most motivated people in society are not best utilized being HVAC techs, electricians, or other skilled trades.
This of course is not a major problem at this time. The major problem is many of the best and brightest minds are being utilized in adtech and finance or otherwise unproductive professions such as that.
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u/MrPBH 1d ago
I didn't say anything derogatory about HVAC technicians, though. In some ways, I am envious.
The biggest difference between us (doctors and HVAC techs) is that I cannot adjust my prices to account for inflation. The $92 Medicare pays me for a level 4 ED visit is actually less than what they paid doctors in 2000 (~$99). When you account for inflation since that time, they are paying me ~$46 in 2000s money. Private payers set their reimbursement based on Medicare rates as well (like 1.5x or 2.0x), if you are wondering.
The HVAC guy, on the other hand, increases his fees as inflation increases and is making more than he did in 2000 (or more than his dad did in 2000).
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u/FlyEaglesFlyauggie 1d ago
“Arizona seized cash, gold bars, multiple aircraft and other luxury items from Yuma doctor Irfan Fazil after he was caught defrauding our state's Medicaid program of $36.5 million.”
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u/rking0122 1d ago
I see lots of “Trump will pardon him.” He probably would (based on his pardon history) if this was a federal prosecution. But, this was a state prosecution. Trump can’t do anything about it. The AZ governor could, but there’s no way the current governor would do that.
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u/carlosdangermouse 1d ago
tRump pardon incoming in 3…2…1…
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u/onarainyafternoon 1d ago
My mother worked for him. He was a huge Trump guy and donated millions to Trump’s campaign. So that wouldn’t surprise me.
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u/KathyJaneway 1d ago
Congrats, he's the next Republican governor or Senator of some state in 4 years.
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u/thesupportplatform 1d ago
This illustrates that insurance reviews claims in the aggregate. Could he had gotten away with billing 1 X-ray that wasn’t performed? Sure. But 1,700 is going to set off alarms because of the total billed and the dramatic increase in services. This is the easy fraud to catch, assuming it’s not the empty store front, identify theft Florida variety of rapid charging.
Then you have corporate fraud where questionable charges are piled on, the government says it’s fraud, and then the corporation settles for less without admitting any wrong doing, aka The Rick Scott Method.
In the middle are small to medium sized practices intentionally or unintentionally billing for services that may or may not be accurate because the coding system is a mess.
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u/PresentImmediate5989 1d ago
Even though this seems awful, he’ll get around this. Guarantee you after this guy is done serving his time. He gets a licensed somewhere else and practices and make a lot of money elsewhere. I’ve seen this before.
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u/network_dude 16h ago
One guy stole $36.5 million? He has accomplices. Nobody can steal that much without help.
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u/DeweyDecimator020 13h ago
Always check everything you get in the mail that's related to Medicare/Medicaid -- doesn't matter if you have those or use private/employer provided insurance.
Both my mom and I were targets of fraud. She got a Medicare bill for medical equipment from a doctor in a nearby town that she'd never seen. Instead of paying it, she called Medicare. It was fraud. They said they'd had an eye on that doctor for a while and her case was another one to add to the stack.
I have insurance through my husband's work, but I got a letter from our state medicaid program AND an insurance card! I never applied. I called the insurance that our state program uses and as soon as I said I never applied, they became extremely hostile and did not want to talk to me. They told me to call the state medicaid program. So I did...they were VERY interested in what I had to say because they were familiar with the scam (and so is the insurer, which is why they didn't want to touch it). Anyway they took all the information down and took care of it.
This happens all the time. Even if you hate making phone calls as much as I do...call them. Question it before you pay it. You won't get the runaround. These people will hang on your every word when you report fraud.
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u/Stompanee 1d ago
Waiting for trump ti pardon him…
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u/MiserableSkill4 1d ago
People really dont understand how the republicans treachery works.....Trump will use this to attack medicaid more
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u/caliboy559 1d ago
Let me guess probation
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u/Modern_Bear 1d ago edited 1d ago
You don't have to guess. You can read the article to see the terms of the plea deal. It's in the second paragraph, with additional punishment listed in the fourth paragraph. It shouldn't take too much time to find out your guess was way off.
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u/PigFarmer1 1d ago
But, but reading those 9 paragraphs with 13 sentences would have taken several seconds of valuable time. lol
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u/its_yer_dad 1d ago
Pretty sure this qualifies him to be Governor of Florida