When a $30 charge leads to 10 years in prison, no one wins

"Medicare is not a person," Ona Colasante, M.D., wrote in a post on her blog "Solo Docs, So Long."

"Think of it as a whole lot of money sequestered behind a bunch of computers. It's an advantage that the Medicare system is enormous, because it's as slow as a bunch of hippos. You can steal a lot before the system catches up with you, and by that time you're gone."

The post, dated July 20, 2012, was written a year after Colasante's Hawthorne, Florida clinic was raided by FBI agents. The post, titled "How to Defraud Medicare and Get Rich Quick" was an odd topic for any physician, let alone one being investigated for fraud.

Last week, Colasante was convicted of 162 counts of healthcare fraud, each of which carries a 10-year prison sentence. In the indictment, state prosecutors argued that between March 2010 and January 2013, Colasante "knowingly and willfully" defrauded Medicare, Medicaid and Blue Cross Blue Shield of Florida by performing unnecessary tests and procedures, including hearing and breathing tests, urinalysis drug screens, X-rays, stress tests and B-12 injections. The government also charged Colasante with billing healthcare programs for substance abuse counseling, tobacco cessation counseling, non-FDA-approved drugs, and self-care management training without ever rendering those services to patients.

But a closer look at the indictment revealed dollar amounts you might find crumpled at the bottom of your pants pocket, with most charges ranging from $30 to $67, and some as high $2,230. All told, the 162 counts added up to less than $55,000, hardly more than the minimum annual salary of just one of the two Assistant U.S. Attorneys who prosecuted the case.

The sheer volume of charges conjures up an image of a fraud mastermind, but the indictment itself reveals a doctor who targeted the lowest cost procedures--sort like robbing a bank and demanding all the pennies. If she was really pulling the strings on a complex scheme, she was either so good the government couldn't uncover her more lucrative indiscretions--even after a multi-year investigation--or she was shockingly ineffective at committing fraud.

Why, then, did the government devote four enforcement agencies--and nearly seven years--toward one doctor who may have improperly billed what amounted to the price of a new luxury car?

For the life of me, I can't figure it out, and it doesn't seem Colasante ever did either. While reporting the verdict, several media outlets linked to Colasante's ominously titled post with the title that sounds like a fraudster's manifesto. But a closer read revealed a post oozing with satire, clearly an outlet for the physician's bubbling frustration.

Perhaps Colasante's stubbornness was her downfall. During the investigation, she balked at the idea of cutting a deal with federal prosecutors, and refused to stop blogging about the case, even after the government issued its indictment, ignoring the pleas of her attorneys and her billing clerk. She demanded an apology from the feds, even as her lawyers insisted she won't get one. She wondered if she could bring herself to treat the FBI agent who raided her facility, imagining a hypothetical scenario in which he falls off the roof and she is his only available lifeline. She filed a petition on Change.org, calling on Attorney General Eric Holder and the Department of Justice to show cause for the FBI raid on her medical clinic. It receives 193 of the 10,000 votes necessary.

A spokesperson at the U.S Attorney's Office for the Northern District of Florida did not respond to questions about why prosecutors pursued this case so vigorously, instead forwarding a copy of the indictment. Colasante's lawyer, Paul Sisco, at Jung and Sisco PA in Tampa, declined to comment. Her other attorney, Eduardo Suarez, did not return calls or emails.

I don't know Colasante. I don't know if she intentionally billed for services she never performed, or provided drugs that weren't approved by the FDA, although a jury was apparently convinced she did. I don't konw if she was using her clinical practice to lay the foundation of a fraud empire.

What I do know is the government's allegations don't pass the sniff test. I know she practices in a state where prosecutors are scrambling to keep up with an industry overrun with fraud schemes of every variety. I also know that bullheadedness is not evidence of fraud, nor is a sarcastic blog post evidence of her guilt.

I think we can all unanimously agree that healthcare fraud is bad. But prosecuting physicians over ticky-tack billing errors does little to address multi-million dollar fraud schemes that still permeate the industry, and does almost nothing to prevent future schemes from emerging. If you want to see a true fraud mastermind, look at the Farid Fatas, the Jacques Roys and Michael Drobots of the world--physicians who did quantifiable human and monetary damage. 

Yes, fraud schemes that steal any amount of money are illegal and wrong. But ultimately, this kind of unapologetic, heavy-handed enforcement leaves everyone--physicians, taxpayers and proscutors--empty-handed. - Evan (@HealthPayer)