A healthcare fraud case ripped straight from 'Goodfellas'

My favorite scene from "Goodfellas" (among many) is when Tommy DeVito (played by Joe Pesci) is regaling his fellow gangsters with a barroom story and suddenly shifts his mood from jovial to threatening, leaving a laughing Henry Hill (played by Ray Liotta) suddenly uneasy.

"You're funny," Hill says, innocuously.

"I'm funny how? Funny like I'm a clown? I amuse you? I make you laugh?" DeVito asks, menacingly. Liotta's face suddenly drops.

Eventually Pesci's character relents.

"I almost had him," he says, cackling in between profanities.

Pesci perfected the mentally unstable gangster--his character thinks nothing of shooting someone in the chest for a perceived slight. What makes that particular scene funny is that the threat is real. Liotta's character knows DeVito is completely unhinged, and would think nothing of killing him over a misinterpreted compliment.

That scene came to mind several weeks ago when I was reading a story about Ira Bernstein, a Rockland, New York, podiatrist charged with conspiring to kill his wife and paying a hit man to beat up two insurance investigators from UnitedHealthcare.  

Bernstein was arrested May 3, along with his girlfriend, Kelly Gribelukafter, after the person allegedly hired to beat up the UnitedHealthcare investigators reported the conspiracy to police, according to LoHud.com. Using that information, law enforcement officials contacted the investigators and got a makeup artist to make it appear as if they had been assaulted. Police officers acted as the assailants and sent pictures to Bernstein as evidence of a successful assault. It unraveled from there.

During Bernstein's arraignment, prosecutors argued that their case against him is "extremely strong," with evidence of his plot captured on tape and video. Bernstein and Gribeluk targeted the two insurance investigators because they were about to refer fraud charges to the Rockland County District Attorney, according to LoHud.com. Both have pleaded not guilty to the initial charges against them.

At this point, we don't know what kind of scheme Bernstein may have been involved in, but apparently it was good enough to allegedly put out a hit on a couple of fraud investigators. We do know that he was the highest paid podiatrists in the state. According to ProPublica's database, in 2013 Bernstein ranked first among New York podiatrists in services performed, payments from Medicare ($669,000), average payment per patient and average services per patient. Updated 2014 figures collected by the Wall Street Journal showed Bernstein's Medicare payment rose to $748,000 in 2014, a 73 percent increase from 2012 despite the fact that he saw fewer patients.

Bernstein could hardly be described as a gangster, but his story is a stark reminder of the volatile and sometimes potentially violent characters who are attracted to healthcare fraud for the massive payout. Rather than dealing in narcotics or orchestrating a jewelry heist at JFK airport, for some Medicare offers a much less dangerous and easier source of income.

Several years ago, there were multiple media reports that the mafia had begun dabbling in Medicare fraud. According to an Associated Press article in 2009, federal fraud investigators were threatened, and woman was discovered dead at a pharmacy that was under investigation, "her throat slit with a piece of broken toilet seat."

An ABC News story several months later told of exotic weapons (a machine gun pistol, for example) collected by Department of Health and Human Services investigators. In 2011, Inspector General Daniel Levinson testified that a recent 73-person fraud bust involving $163 million in fraudulent claims had been orchestrated by the Mirzoyan-Terdjanian Organization, an Armenian-American gang.

Medicare fraud comes across as a non-violent crime in which fraudsters lurk in nondescript medical clinics quietly licking envelopes and cashing checks from HHS. But like any lucrative scheme, it's bound to attract a few Tommy DeVitos. - Evan (@HealthPayer)

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