Not long ago, a friend of ours had to go to court to pay a hefty speeding ticket. She was going 80-m.p.h. in a 60-m.p.h. zone.
“Well, everyone does it,” she said.
“But were you speeding?” I asked.
“Sure, but everyone does it.”
She also noted that on the court date, approximately 75 other commuters (none too happy, I was told) assembled to make their guilty pleas and to pay up to the city.
Sometimes, we engage in illegal or unethical behaviors knowing full-well we are in error, but we like to push the envelope because we perceive that those around us are getting away with something too. Sometimes, as well, those around us engage in those illegal or unethical behaviors for so long, they assume it is perfectly legal and ethical.
The Fifth Circuit Court
I was thinking about my friend and her $167 ticket (and the officer said he was giving her a break!), as I read the proceedings of the Texas U.S. Court of Appeals for the Fifth Circuit in regard to a case of criminal healthcare fraud. The two situations may at first seem worlds apart, but they are surprisingly similar.
In late March 2022, the court affirmed the convictions of two individuals who were running a scam involving hospice and home healthcare facilities.
In the original case, it was found the two operated their businesses on what was described as a “reimburse-first-verify-later system.” They did so for about ten years. It was the equivalent of “I know I’m speeding, but I’ll worry about it when I get caught.” They knew they were scamming the system, and in fact, the prosecution determined that “an estimated 70 to 85 percent of patients were ineligible for the care they received.”
The egregious behavior was illustrated in the court citing the following examples (and others) of a supposed hospice patient who was holding down a job; a patient supposedly in dementia who recalled a family celebration only a few days before when he twisted his knee while dancing and a supposed home healthcare patient who was actually a boxing instructor!
Strangely, it was reported that the owners essentially gave their staff raises and bonuses to participate in the healthcare scam. They routinely threatened their staff with terminations if they objected.
Though the jailed healthcare providers at the top of the food chain maintained the equivalent of the fact that “everyone does it,” in this case, the court did not agree:
“Health care providers cannot immunize themselves from prosecution by cloaking fraud with a doctor’s note.”
In plain talk, if the guy next to you was also speeding and got away with it, it does not mean that you were somehow innocent of the charges when you were caught. Also, in the Fifth Circuit Court decision was not only the abundance of evidence of fraud that was found, but one of the physicians was clearly lying when talking about conditions of patients. It is well and good to have a medical opinion expressed on a Medicare form, but another thing to justify the claim to an experienced reviewer of that claim.
No debating the truth
Lying or even self-deception under the guise of “it’s all right unethical because we haven’t been caught,” is still lying and committing fraud. The hospice and at-home care organizations knew they were wrong but they had been committing such fraud for so long, they assumed it was no big deal.
According to the Department of Justice, the amount of healthcare fraud in 2021 alone exceeded $1.6 billion. It is a breathtaking number. However, numbers are not the people who are actually committing that fraud. The providers who commit those actions frequently rationalize that it is a common practice of little importance. In truth, it is very important. Many have legitimately died from lack of care because the unethical took funds for their own indulgence.
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