My husband works at an eye care facility. He’s been there for about nine years and he’s done the same work for over 20 years. He’s a dispensing optician; the person you see after your exam. He helps people select frames that will work with their prescription, shape of head and face, and also with the patient’s sense of esthetics. He adjusts the glasses so well that people come to him when others have failed. He’s very good at what he does.
The corporation for which he works is a small one by some standards. It encompasses eight offices throughout the state and employs a lot of people in various areas. The technicians that assist the various doctors in each of the offices with the exams are probably the most numerous of the employees. There is staff for the front desks in all the offices, at least one and sometimes two opticians for each office, and the billing staff is quite large. The main doctor who performs the cataract and eye lid surgeries (when the eye lid droops so much that it impairs vision) also employs surgical nurses and anesthesiologists. Plus there are all the people who manage the business.
There are a few employees who have been there longer than my husband, but not many. The company has a fairly high turnover rate. Partly this is due to the fact that often the technicians are studying to themselves become doctors. The corporation is known as an “institute” because it does provide internships.
On Thursday last week as my husband was taking some trash out to the dumpster, he saw the surgical physician being placed in handcuffs and loaded into a vehicle. The doctor hollered to my husband to have his second in command, the corporation’s general manager, call his lawyer. When my husband first told her, she thought he was joking. When he impressed upon her that he was not, she got very busy.
The doctor has been charged with insurance fraud. He is accused of defrauding Medicare and a state run health care cost containment system as well as several privately held insurance companies. It is alleged that he instructed 46 former and current subordinate employees to falsify patient records and maintain them in such a way that they would pass an audit.
It is also alleged that he performed medically unnecessary cataract surgeries. In short, a cataract lens that is not hard and ready to be removed cannot actually be removed. Many of their patients complain about having to wait for the lens to be ready for removal because they are having such difficulty seeing.
It is alleged that the fraud has been going on for nearly the last ten years and that hundreds of thousands of dollars have been defrauded. For a business that takes in several million a year, that seems unlikely and hardly worth the risk. My husband has said there have been times when a patient was pressing him to do something regarding the patient’s insurance and he has called his supervisor for permission and been told that he cannot because it is illegal and they could lose that insurer. The ability to accept all insurances is critical to the success of any medical practice.
A little less than a year ago, shortly after a certain employee was fired, the company was raided. Employees were told to step away from their computers. My husband reached down to close the page he was on because it’s a HIPAA violation to allow anyone to see patient information and was just about arrested for it. They did a deep audit and found nothing amiss. The whole thing was dismissed at the time. But now there is the new claim that they have somehow managed to make everything that is wrong look like it is okay.
The conjecture is that the disgruntled employee was thwarted in the first attempt at revenge and has now made another one. Whether the allegations are true or not, the doctor’s name has most likely been ruined.
Personally, knowing what I know about the corporation and its practices and the people who have been there a long time and their intolerance for illegal practices, I think the claims are baseless. Also, if my husband were even remotely aware of shady practices, he would have quit a long time ago.
Since the surgical physician is the main driving force behind the corporation, chances are good that even if he is acquitted, the entire corporation will suffer.
It employs a lot of people who are all affected by this. Right now. Conceivably, all the offices might have to be sold or closed. For sure, business will suffer and with a drop in business, people will have to be let go. I foresee many jobs being lost.
If this is indeed the work of a disgruntled former employee, does she not see the harm she is doing to all the very many completely innocent people the corporation employs. How can a person put a personal vendetta before the welfare of so many others?