The Tragedy of Fraud!


by Bruce Strom

Thursday the United States Supreme Court issued an opinion in Universal Health Services, Inc v. Escobar.  The case may not get much attention but a unanimous court opened a door for victims of fraud.  The case is a prime example of Medicaid fraud – not by individuals but by big health companies.

Yarushka Rivera was a typical twelve year old girl struggling to fit in which led to acting out in school.  Her mom and stepdad took her for counseling at the local clinic in their low income neighborhood operated as a subsidiary of healthcare giant, Universal Health Services.  The doctors counseled and prescribed medication for what they diagnosed as a bipolar condition.  The clinic billed Medicaid.  That doesn’t sound so bad, except that the employees were not doctors or licensed in any way.  The medicine they prescribed had adverse side effects which led to seizures and the death of this young teenage girl.

Five different counselors treated Yarushka.  One claimed to be a Ph.D. but only had an online unaccredited college degree and was refused a license in psychology by the state.  The “psychiatrist” who wrote the prescription was a nurse with no licensing to act as a psychiatrist.  But the clinic made money from Medicaid while serving poor residents like Yarushka.  Other mental health clinics in high income areas owned by Universal Health Services had licensed doctors.  But this poor neighborhood had none.

When notified, Universal Health Services pulled out a barrage of attorneys to hide behind its interpretation of the False Claims Act.   That act imposes significant penalties on anyone who “knowingly presents… a false or fraudulent claim for payment or approval” to the Federal Government.  Yarushka’s mom and step-dad argued that there is an implied false certification when submitting payment request.  Universal Health argued the government paid so they approved the payment processing.  The parents argued the government would not have paid had they known the people submitting payment were not qualified to deliver the services for which they were seeking payment.  The court unanimously agreed with the “implied false certification” theory while limiting the circumstances in which it can be applied.

The case highlights the rampant fraud and abuse that takes place against the poor and vulnerable.  The assumption by the big health company is that poor minorities aren’t smart enough to figure out credentials and they save money by not having to pay for actual doctors and psychiatrist.  While this case involved the healthcare industry, fraud is certainly not limited to that industry.  Last year more than 2.5 million cases were reported to the FTC in areas like debt collection, imposter scams, phone scams, bank and lending abuses, credit bureaus and tax scams.  Those stats do not include housing abuses or employment abuses including wage theft.

But if you lack resources, where do you turn for help?  1 in 3 Americans cannot afford an attorney but without an attorney there is no power to address such injustices.  Justice to be fair must be fair for all, not just those who have money.  The first place we turn is to a God who warns, “Do not exploit the poor because they are poor and do not crush the needy in court, for the Lord will take up their case and will plunder those who plunder them.” Prov. 22:22.

God is our advocate, but He invites Christian lawyers to join Him in restoring people trapped in broken systems.  We seek to restore our neighbors in relationship with their Creator and their community.  We cry out, “Stop doing wrong, learn to do right!  Seek justice, encourage the oppressed.  Defend the cause of the fatherless, plead the case of the widow.”  Isa. 1:17.

Our neighbors need our help.  I invite lawyers to join us and use their gifts to make a difference.  We have the tools and systems to make this possible.  And I invite other justice minded believers to join with us.  Lawyers can’t do justice alone.  Together let’s provide help and hope for those oppressed by legal injustice.  Together let’s

Go and Do Likewise.