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Turning Point

My understanding of the events that shook my world last night is that they began before Hurricanes Katrina and Rita.   Although I am not certain of this, it seems that an investigation into Abide Home Health began prior to the storms but the evidence was washed out to sea.   I can’t say if that’s true or not but it adds a level of interest to the story knowing that the agency had a new chance to do things right and chose not to do so.

The case involved over 20 defendants, illicit sex, a dash of racism, the mother of a prominent football player (The Honey Badger), a large oil company and two Zulu Queens.  For those of you not from the South, Zulu is a Mardi Gras parade and they were Carnival Royalty. This is a big deal in New Orleans social circles.

To be sure, this case was juicy.

Imagine for a minute that you are one Lisa Crinel involved in a romantic relationship with your lawyer when a search warrant is executed relating to a fraud investigation involving your business.  Imagine if it was signed by a federal judge who was married to your lawyer.  Now imagine that you are the lawyer when Lisa Crinel files a lawsuit alleging that the lawyer ‘“never informed Ms. Crinel that it was a conflict of interest for him to represent her and her company while carrying on an extramarital affair with her….”   Yes, indeed.  How else could she have known?  I’m betting the judge was unaware of the affair when she signed the search warrant because it didn’t include a cavity search.

For some people, Medicare fraud isn’t enough.  The original press release from the US attorney’s office in Eastern Louisiana alleges that Lisa Crinel created false documentation to support claims for two employees and her daughter so that they could collect money from the funds provided by BP to compensate real victims of the Deepwater Horizon oil spill.  Classy.

Moving right along, Ms. Crinel had already lost 1M to the feds who seized her property even before she was indicted.  This was interpreted by Lisa Crinel as being racially motivated because they did not seize the property of another Medicare defendant accused of the same crime.    I believe there is a possibility that something, other than race motivated that decision.  Could there have been a previous overpayment?  How strong were her ties to the community?  I have to admit, a beach in a country without extradition might have appealed to me if I were in that position.   I sincerely hope that federal investigators did not simply seize her property and bank accounts with no good reason prior to the indictment because in spite of mountains of evidence, Ms. Crinel was innocent until proven guilty.

The Turning Point

In October of 2015, Lisa Crinel woke up with a newly calibrated moral compass.  In exchange for a lighter sentence of no more than 8 years and an agreement from the Assistant US Attorney that all felony charges be dropped against her daughter who served as CEO, she pleaded guilty.  She explained her decision, ‘because I am in fact guilty, and because I did not want to put the government through the unnecessary expense and trouble of proving this in court. I also pled guilty because I understand that accepting responsibility for the wrongs that I have done is the first step toward correcting them.”

Of course, she also agreed to provide the prosecutors with any truthful cooperation in any way she could.  According to Ms. Crinel, this was a genuine personal turning point for her, not just a legal one.  Yes.  That’s what she said.

The Sad Part

Last night, four doctors were convicted of multiple counts of Medicare fraud.  The longest possible sentence I saw was 170 years although the sentencing date has not been set. yet.  Are they guilty?  I think they are.  I still don’t know all of the details but the Feds don’t lose.   They knew this case was their’s for the winning when they took it on.  They turn away far more cases than they accept and the do not indict until they are certain they have a case.

Of the four, I know one mainly through his office staff.  I know that he was with his grandson who was receiving chemo when his office was raided.  I do not believe this was an accident because I’ve heard too many other stories about the feds arriving when the targets of their investigation were least available.  I have followed behind this doctor and another and read their clinic and hospital documentation for years.  The truth is that they are razor sharp physicians who are responsive to their patients and the nurses who call them for orders.

They are basically good men.

So, what happened? One doc received $3,500.00 a month from the agency – $1,000.00 more than would be allowed by law assuming he worked for the paycheck.  None of the doctors were poor and they all made more money than most people reading this blog.

My anger towards the owner of the agency is what I hang on to while these questions still linger.  Lisa Crinel owned Abide Home Health.  Her daughter was the CEO.  They wrote and signed checks that went to physicians.  They paid a physician’s wife an inflated salary so that her husband would refer patients.

Did the docs approach her asking for a Medical Director position?  I bet they were approached by Lisa Crinel.  And what they saw was a successful business woman in New Orleans – an economic nightmare since the storms in 2006.  They saw someone who had overcome the odds and lived well.  They signed orders because she or her agents asked.  Did they trust that the orders were legitimate?

Did they get a little greedy rationalizing that the dollar amount of money may be technically fraud but they deserved it?

These physicians could not have realized they were risking what may amount to life sentences for the relatively small amount of money they received.  But that doesn’t matter.  The standard isn’t what you know but rather what a reasonable person in the same position has the responsibility to know.

Lisa Crinel had the jewels and cash paid for by the proceeds of the fraud.  She was a New Orleans socialite; queen of Zulu.  She was a leader of the community and she lead dozens of her followers to the jailhouse.  While the physicians earned most of their money providing care to patients, she stole all her money by committing fraud.  And when she ran out of lawyers available for affairs and the BP scheme fell flat and nobody would believe that her African American heritage was the reason the feds were picking on her, she turned on the very people she recruited to participate in her fraud scheme.  I’m not sure I have any respect for her.

And New Orleans has lost two great physicians and two more that may or may not be great.  I’m not disagreeing with the verdict but I still find it sad.   The jury found them guilty and I trust the jury.  But they are guilty of fraud; not of being scumbags who systematically scheme to steal as much as they can from the government.   Sometimes good people break the law.

4 Comments Post a comment
  1. Mary #

    Unlike you, I do NOT feel bad for the physicians. This is precisely the reason we are grappling with nonsensical regulations to combat fraud and abuse. I would bet my last dollar Lisa Crinel could work her way around any regulation thrown at her without blinking an eye. And, unfortunately, I believe there are many others out there just like her that continue to operate. Shame on all of them.

    May 11, 2017

    • I would be a horrible lawyer and a worse judge! I think most people feel like you and a worse judge. I think a lot of people feel like you and I certainly understand. Again, I do not dispute the verdict and I hope that agencies and referral sources read this and understand the consequences of buying referrals. And in the grand scheme of things, how I feel does not matter.

      May 11, 2017
      • revdanielpclarkrn #

        I have seen Drs sign orders and other things without reading them because they trusted the person holding them. It’s terrible practice. I have also seen Drs that read every little thing and corrected spelling and grammar (that has improved with the onset of EMR). Good people do stupid things. My concern is that the DA, because they want to look good by getting the most convictions, likely cut a deal to let the worst criminals off with lighter sentences. I imagine the Drs are still guilty and needed some correction, but it sounds like the owner and CEO needed much more correction.

        May 11, 2017

        • I agree. Of course, we don’t know what actual sentences will be yet but Lisa Crinel’s is capped at 96 months while two of the docs are capped at greater than one hundred years. (When I write the number using digits, people think it’s just another of my many typos.)

          Nobody hates fraud more than a good agency. Nobody. How do you compete with competitors who play dirty? My most successful clients over the years are the ones who do things right. After a company grows beyond a certain size, mistakes are made. Bad hires happen in spite of your best efforts. Big boys and girls fix them – the right way. Being smart means returning payment to Medicare for claims that were billed in error instead of hoping they are never found.

          I don’t know how much Ms. Crinel’s testimony helped the prosecution in this case. If it saved them years of investigation or plugged a hole in their case that might have resulted in losing, maybe it was worth it but I have no idea what her ‘truthful’ contributions added. I know that her daughter, the CEO, got off with a misdemeanor.

          Anyone who provides services for Medicare signs a provider agreement and a certification statement on the enrollment application. The providers (or those who have the authority to sign for a facility) agree in writing to bill only according to Medicare rules. In writing at least, they take responsibility. Medicare never instructs providers to drop claims and pray you are not caught. So, the doctors involved, whether they read these documents prior to signing or not, are guilty. The question I have is whether or not they should receive sentences that are longer than many violent criminals.

          May 11, 2017

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