According to an indictment filed against Texas doctor Dennis B. Barson, Jr., M.D., the doctor and his medical clinic administrator, Dario Juarez, fraudulently collected $2.1 million in payments from Medicare – in under two months! Barson actually claimed to have seen 156 patients in one, single day – July 13, 2009. On another 13 days during the two-month period, he claimed he saw more than 100 patients per day.
As a False Claims Act lawyer who represents whistleblowers, I just shake my head. I know that for every doctor the federal government catches, dozens, probably hundreds, get off scot free because the federal government never finds out about the fraud.
With Dr. Barsen, the federal government caught on because the numbers just didn’t add up. Dr. Barsen literally could not have seen as many patients as he claimed he had treated.
In theory, Dr. Barsen could have seen 156 patients on July 13th, if he had worked a solid, non-stop, 12 hours. Sure, he would have had to skip lunch, and eschew all breaks, even for the bathroom. And yes, he would have had only 4.6 minutes to spend with each of his patients. Probably his patients would have had some caustic things to say about his rushed bedside manner. Still, it would have been physically possible for Dr. Barsen to “lavish” 4.6 minutes on 156 patients in one day.
So Dr. Barson might have gotten away with his claims had he been billing for routine office procedures. But in this case, Dr. Barsen was billing Medicare for performing rectal sensation tests and electromyogram studies of the anal or urethral sphincter. According to medical-dictionary, each electromyogram procedure takes between 30 and 60 minutes. So Dr. Barson would have had to work 78 straight hours to cram in the 156 rectal sensation and electromyogram studies he claimed he performed in just 24 hours.
The government was not clear as to what tipped it off to the fraud, saying only that “the criminal charges are the result of a joint investigation” by the FBI, Department of Health and Human Services, and the Texas Medicaid Fraud Control Unit.
Dr. Barson has a medical practice in Houston, Texas. The indictment says that he billed for procedures performed on 429 patients, but he in fact did not perform the “rectal sensation tests and electromyogram (EMG) studies of the anal or urethral sphincter” which he claimed he was performing.
Unlike Dr. Barson, according to the indictment Juarez actually was seeing patients. The problem was that Juarez was the office administrator, and only pretended to be a doctor or a physician’s assistant. He had no medical training, yet actually saw and treated patients. Juarez is currently in jail for practicing medicine without a license.
In addition to being just plain wrong, left unchecked, this kind of fraud will absolutely break the Medicare system. Yet another reason why we need whistleblowers and the False Claims Act – to root out this sort of behavior before it crushes the U.S. taxpayers. The False Claims Act specifically addresses fraud in which someone “knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval” or uses “a false record or statement material to a false or fraudulent claim.” If doctors represent that they have performed procedures they did not perform, and create medical records to support those claims, clearly they are defrauding the government. Whistleblowers who report the fraud help protect the entire Medicare system. In order to incentivize the whistleblowers, federal law allows a whistleblower to collect between 15% and 30% of the amount recovered by the United States after it learns of the fraud. The whistleblower must file an appropriate lawsuit, following the requirements set out in 31 U.S.C. Â§ 3729, et seq.