“Why did I rob banks? Because I enjoyed it. I loved it. I was more alive when I was inside a bank, robbing it, than at any other time in my life… but to me the money was the chips, that’s all.” – Bank Robber, Willie Sutton
It was also Willie Sutton who said he robbed banks because that was where the money was. As a healthcare ethics keynote speaker, healthcare ethics consultant and book author, I often wonder if some of the recent fraudsters in the healthcare profession aren’t more like Willie Sutton and less like healers.
Medicare often represents a bank to some practices and taking from that bank is a rationalization despite its unethical nature. Rationalization becomes a secret code for “I was more alive when I was inside a bank, robbing it…”
A $31 million fraud
In Miami, Florida, Chiropractor Dean Zusmer and Orthopedic Surgeon Lawrence Alexander, were sentenced to eight years and one month in prison and two years and nine months respectively for committing Medicare fraud. Zusmer owes about $1.4 million in restitution and the courts have yet to determine the size of Alexander’s fine.
Zusmer was the owner of four clinics and he submitted claims to Medicare for $15 million worth of equipment that patients didn’t want or need. To be sure, he didn’t do it alone, but was assisted by a cadre of off-shore telemarketers and his stateside administrators and bookkeepers under the direction of Jeremy Waxman.
The braces that Zusmer deemed as medically necessary were done so under the prescription signature of Alexander. Allegedly, Zusmer and Alexander also owned one of the chiropractic practices in partnership. The third party, Jeremy Waxman, was the mastermind. He secured patient referrals from the two doctors’ orders and paid the marketers and doctors kickbacks once Medicare paid-off. Waxman began serving time in January 2023.
The organization of doctors, marketers and administrators was a well-thought-out scam that seemed almost foolproof. Patients came in for chiropractic work, then they were recruited by telemarketers and approved for the durable medical equipment under a physician’s signature.
But, why?
It is impossible to not wonder at the “why” of it all. Why would a successful chiropractor with four practices need to resort to fraud? Why would an orthopedic surgeon, a well-respected and lucrative profession to say the least, resort to fraud? As a healthcare ethics keynote speaker, healthcare ethics consultant and book author, this “why” question is the most common I receive.
As a society, we tend to place great value on “profession.” We might view the chair of an orthopedic surgery department to be more ethical than the hospital groundskeeper, however, that is merely perception, not reality.
One of the constants for the commission of fraud is need. Some have a need for power, others for money and still more for a deep-seated thrill. Using the above example, the chair of an orthopedic surgery department might want the thrill (Willie Sutton-style) of getting “one over” on the system, while the groundskeeper might be content to live an utterly moral life.
Remember that before he was caught, Sutton was a fairly wealthy man. The money only represented a way to keep count. Medicare is often viewed by the healthcare profession as a terrible and adversarial system. For some healthcare fraudsters, there is the thrill of paying the system back for its imagined insults.
Within that context, and another element of fraud, is that the construction of a scam by a physician, chiropractor and professional telemarketers is the perfect way to create an organization impervious to scrutiny. It is what we might term a lack of transparency behind a cloak that governmental examiners can’t penetrate with their oversight.
Regardless of the “why,” the breakdown that permits such fraud to occur is ethical. The orthopedic surgeon and the chiropractor felt responsible toward nothing ethical. Within that narrative, they felt no obligation to their professions.
Unless the profession demands ethical compliance then this type of fraud will keep repeating itself. As a national healthcare ethics keynote speaker and healthcare ethics consultant, I find that to be a tragic outcome.
