Fake Doc Takes Physicians For A Ride

Riding on the train last week, I talked with a fellow passenger about "fakes." That's because my traveling companion is a business consultant who specializes in uncovering fraud, especially related to counterfeit money. Our conversation turned to the 2002 movie, Catch Me if You Can, with Leonardo DiCaprio playing the role of Frank Abagnale Jr., who for years posed as a pilot, a prosecutor and a Georgia physician, scamming millions of dollars along the way, before he became a law-abiding citizen.

"The fraud," he said, "is relentless. It keeps coming."

I was thinking about that conversation after I read this news story about "fake" doctor who treated more than 1,000 people in 2 states, collected $1.2 million for the "care" he provided, and then tried to sell their health information.

The guy who didn't have a license to practice medicine is Matthew Paul Brown, 30, formerly of Atlanta, GA and Nashville, TN, who eventually pleaded guilty in federal court in Atlanta to healthcare fraud and wrongful disclosure of individually identifiable health information.

As Commins' reported, prosecutors said Brown worked with licensed physicians in both states from November 2009 to April 2011 and used their provider numbers to collect about $1.2 million in false claims with Medicare andMedicaid and private insurance companies. He would administer the care in the physicians' offices and at health fairs, with physicians agreeing to pay Brown between 50% and 85% of their take.

Those docs who agreed to pay Brown were really taken for a ride, which ended up being costly for everyone involved, physicians and patients included.

If the doctors who worked closely with Brown paid more attention, however, they could have halted the scheme quickly, and that's a lesson in itself.

"Brown tricked the physicians into believing that he was also a doctor," says Patrick Crosby, spokesman for the U.S. Attorney. "These techniques would not have been successful if the physicians had verified his credentials."

Brown purported to provide allergy testing and immunotherapy for patients at more than 20 health fairs and various work sites, according to the grand jury indictment I reviewed. Although the U.S. Attorney's Office says they are not aware of anyone seriously injured by Brown's actions, "because of the number of patients, it is possible that some victims have suffered injuries we are not aware of," says Crosby.

Brown convinced at least six physicians to pay him loads of money for his work. Not only didn't they check who he was, they left him alone for much of the time while he was reviewing patients' conditions at job fairs or offices. The physicians also agreed to Brown's proposal to allow him to perform allergy and immunotherapy testing in their offices, bill the services to healthcare benefits programs under the host physicians' provider numbers, and pay Brown half of the ill-gained fees from the benefit programs, prosecutors say.

Maybe the real physicians and their fake colleague were in a hurried environment. Maybe the real docs were thrown off by the white coat Brown wore, embroidered with the words "Dr. Matthew Brown," court records show.

And maybe because Brown said he was an "expert" on allergies, the licensed physicians simply took his word for it, especially since they weren't in the field he had claimed as a specialty. Finally, the young "doctor" never asked for any supervision or assistance when he was with patients, nor, apparently, was any offered.

One other tidbit in the indictment: Although he was seen wearing the "Dr. Brown" pin, he told one fellow physician that he was a nurse practitioner.

Too bad the doctors didn't get a chance to talk about their new colleague sooner at the water cooler, and trade some notes. It might have saved everyone a lot of grief.

Indeed, while Brown was with patients, none of the licensed doctors had seen him work, the indictment states. Brown gave "physicians the impression that he was a qualified allergist who needed no supervision," the indictment states.

In a cadence that read like Dr. Suess's The Cat In The Hat,  the indictment notes: "The physicians did not supervise Brown when performing allergy testing in their offices and they did not supervise Brown when he interpreted results of the allergy tests." After Brown interpreted the allergy tests, he sometimes prescribed immunotherapy to the patients. As he carried out his supposed specialty, he purchased needles and allergy medicine from a pharmacy and created a spreadsheet with information about patients he treated.

Eventually, and predictably, Brown's quest for money did him in. He sent the spreadsheet to an undercover FBI agent who Brown believed was "an investor considering a large investment in Brown's business," authorities said.

So what was Brown's take? "The exact amount has not yet been made public," says Crosby. What is known, is that "Brown caused over $2.9 million to be billed to healthcare benefit programs, and over $1.2 million to be paid out by them."

Brian D. Lamkin, the special agent in charge of the FBI's Atlanta field office, said in a statement that Brown's conduct "not only displayed a total disregard for the patients that he was improperly and illegally treating, but also for those individuals who could have legitimately benefitted from the federal Medicaid/Medicare funds."

Brown' was finally apprehended in an undercover sting that resulted from his own quest for even more money, authorities say. He pleaded guilty to 17 counts of healthcare fraud, each with a maximum sentence of 10 years and a fine of $250,000. And he also pleaded guilty to wrongful disclosure of individually identifiable health information, in violation of the Health Insurance Portability and Accountability Act (HIPAA).

Real physicians, especially those in the allergy field, are upset by the scam. "I find it particularly disturbing that any physician would allow someone with questionable medical credentials to provide care, much less specialist level care, for their patients," John Overholt, MD, of the Allergy & Asthma Associates of Middle Tennessee wrote on his web site.

"This is a clear case of greed outweighing the best interest of the patients."