Shelinder “Shaun” Aggarwal, MD, 48, a pain management specialist in the area of physical medicine and rehabilitation of Huntsville Alabama has accepted a plea agreement for supposed health care fraud. He has agreed for forfeit his home and pay $6.7 million for the supposed fraud involving urine testing. Medicare and Blue Cross Blue Shield of Alabama are the recipients of the reimbursement. He has also agreed to a 15 year prison sentence. However, all of this is still at the discretion of the judge, and his sentence could end up different than what he has agreed to.
This case gives me an opportunity to explain the reality of these types of charges and pleas that are going on across the country. First, just because the doctor agrees to the plea doesn’t mean he did anything willfully or intentionally illegal in his medical practice. I can testify to that from my own experience with my plea in 2008. Also, 25% of the people in prison are innocent victims of government attack where they took a plea because the fight was either fiscally out of their reach, or the potential sentence if convicted was something they didn’t want to face. With a 98% conviction rate, the federal government has a little more advantage on their side. But I can also say from personal experience, that their 98% conviction rate is because of prosecutorial misconduct, perjury, and sucking up all potential witnesses so that the doctor has no defense.
Back to the case at hand.
First, federal prosecutors claim Aggarwal ordered $9.5 million in unreasonable and unnecessary urine tests as part of a scheme against Medicare and Blue Cross Blue Shield of Alabama between 2011 and 2013; that the tests he ran depended not on patients’ treatment, but on how much he could bill for tests; and that he often ignored urine test results showing patients were using illegal drugs. Supposedly these urine drug tests accounted for about 80 percent of paid claims he submitted to Medicare and Blue Cross. The government stated “Aggarwal’s primary motivation for testing patients’ urine and submitting those claims for payment, was financial gain.”
Now all of this is really government propaganda expanded through magic and mirrors, throwing out big money amounts that are totally unrealistic. But since the average American doesn’t understand medical billing, when they see $9.5 million in print, the doc’s goose is cooked.
Here are the true facts:
- The doctor’s office does not do the testing of the urine specimens. All they do is collect the specimen. And it doesn’t matter how much you charge for the collection, Medicare only allows $3.00 per claim. So where is the $9.5 million they are claiming? On to step 2.
- Doctor Aggarwal supposedly did check the urine of patients at every visit. But then so does every other major pain clinic in the US, including the clinic of Dr. Marc Swanson, the “expert” witness used by the government in my case. Doctors are doing that as a CYA (cover you’re a__) measure, in order to prevent prosecution, not bring it on. It is considered standard of care to do UDS (urine drug screen). If a doctor doesn’t do them, he could more reasonably be charged with lack of medical scrutiny in his pain management practices.
- When Medicare does an audit of your records and they find the slightest thing that they consider “unnecessary”, the entire visit is held for reimbursement. It doesn’t matter if other parts of the visit were reasonable and necessary. They will even say something is not there when it is, and won’t even acknowledge it on appeal. In my case they said I billed for lab work not done, and when I sent them the lab results, they still said the lab work didn’t exist.
This is how they get the $9.5 million. The government is asking for reimbursement for, and declaring fraud for, every Medicare visit made to Dr. Aggarwal for 2 years. In other words, their patients received care and treatment for 2 years, and now they get reimbursed, so they actually make money in the deal. Because what they charge back on the doctor is what he charged, not what they paid. And part of that charge was paid by the patient. So the government is making money.
So when you see government charges against medical professionals of any sort for fraud, just understand that actual criminal intent was not there—this is just a way for government officials to reap back the money they have spent, plus a bonus. Great way to run a government and pay off the national debt, isn’t it? That’s why you are seeing more and more doctors and medical companies being charged with fraud. There is a lot of money being made by the Justice Department. It would be interesting to see where that money goes, and whose pockets get filled.
Reasons for an innocent person to take a plea
So why would anyone agree to a plea bargain admitting fraud when it wasn’t actually committed? I can answer that, because I did it in 2008. The reasons are:
- The government wins 98% of the cases that go to court. (And now I know how they do that as well—through prosecutorial misconduct that is accepted practice throughout the Justice Department.
- If you are convicted of just one charge of fraud (and they usually file multiple charges), you can be sentenced to 20 years in prison per charge.
- The plea agreement, since they just want to steal money from the doctor, is usually a lot lower in prison time.
- The cost of the trial is prohibitive for most of the doctors they attack, because they are solo practice physicians scraping by in their business.
Real reason for the attack–MONEY
Aggarwal was a pain management doctor who was supposedly the highest Medicare prescriber of schedule II controlled substances in the United States. So Medicare could get back a lot of money by charging him with fraud. But this only shows that he was a doctor with a heart and compassion for his patients. Most of the big pain management physicians (like Dr. Marc Swanson, the government witness against me) don’t bother treating Medicaid/Medicare patients. As Dr. Swanson stated at my trial “They are too onerous”, when what he was really saying was “I don’t make enough money for them to be worth my time.”
The usual statement to make the Controlled Substance Act apply was stated by US Attorney Joyce Vance: “Shelinder Aggarwal treated his medical license like a license to deal opiate drugs. He directly contributed to the opioid drug epidemic which is plaguing our nation, and potentially endangered the lives of his patients. Thanks to this prosecution, Aggarwal is no longer a drug dealer masquerading as a doctor.”
By adulterating the language of the CSA, stating that the doctor was “like a drug dealer”, the government has the legal right to confiscate any and all assets that the doctor accrued through his medical practice. It is by this, what should be considered illegal, action that the government has decided to routinely charge doctors across the country.
Involvement of State Medical Boards
The medical profession is supposed to be governed by other doctors. In other words, we take responsibility for keeping our own ranks straight, not the government or law enforcement. But in reality, the state medical boards are simply an arm of the government. They work in league with State attorneys, US Attorneys, and DHHS to crucify doctors of their choice. And their choice is usually the independent, solo practice physician who is working for the patient, and not some hospital in league with government authorities.
It was reported that Dr. Agarwal’s problems began with an investigation by his state medical board because state officials said they had probable cause to believe Dr. Aggarwal excessively dispensed controlled substances to many of his patients. Larry Dixon, The Executive Director of the Board of Medical Examiners says the office began an investigation after several issues came to light; one being that he is the top prescriber in the state when it comes to pills like OxyContin.
Now that information could only have come from state authorities who have the right to query the state prescription monitoring program. Usually the doctors on the Medical Board do not have access themselves to that information.
From there, the medical board attacked Dr. Aggarwal with the usual complaints:
- Excessively dispensing controlled substances for many of his patients
- Dispensed controlled substances in amounts not reasonably related to proper medical management of his patients’ illnesses or conditions.
- Dispensed controlled substances not for legitimate medical purpose
This use of “not for legitimate medical purpose” is an adulteration of the CSA which the government has turned against doctors, when the original intent of the legislature was to exempt physicians from prosecution with this law. This shows that the Medical Board is simply an extension of the government, not a separate entity of peers. And so, in their usual course of action, the Medical Board cited probable cause to believe there was imminent danger to the public or safety if Aggarwal’s Alabama Controlled Substances Certificate was not immediately suspended. We have gotten into a time now where non-medical people are deciding what medical care should be, not the doctors. Non-high school graduates answer phones of insurance companies and deny doctor’s pharmaceutical choices, for example. And now law enforcement is decided what amount of medication is appropriate. What is wrong with this picture? I’m afraid doctors have been more interested in patient care to get politically involved, and they have worked with their head in the sand thinking bad things are only going to happen to bad people. But that is not the case. With the new laws coming up, every doctor in the country is a mark.
And the government is, as usual, short-sighted. Thinking only about how much money they can make charging innocent, hard-working, compassionate doctors for fraud and breaches of the CSA, they are forgetting about the 100 million people with pain, most of whom are able to work, make a living, and pay taxes only because of having their pain controlled with opiates. We will see the costs of disability (or the inhumane refusal of the government to issue disability to those who need it) go up astronomically, along with the unemployment rate, and a resulting decrease in tax income and support of our economics, with more Americans bedridden.