TSGLI fraud

[Gastrapathy]

Feds Indict 2 Navy Medical Officers, Sailor in Alleged $2 Million Fraud Ring - USNI News

An active-duty Navy physician and a former medical officer were indicted Thursday by a federal grand jury in what prosecutors allege is a conspiracy to collect millions in fraudulent insurance benefits. Cmdr. Michael Villarroel and former Lt. Cmdr. Paul Craig are charged with conspiracy to...

news.usni.org

Yikes. I deployed with one of the docs involved. Nice guy. Go figure

---

Members don't see this ad.

 

[Cooperd0g]

Maybe too nice. "Yeah, sure, I'll sign off on that."

Like the civilian ortho doc who testified in an admin sep case my command had recently that said "oh no, that wasn't a staph aureus abscess from IM steroid use. That was a hematoma from a torn muscle" ... completely contrary to his own notes and lab records. I'll be talking to the state board about him shortly.

 

[Gastrapathy]

Yeah that’s my preferred interpretation too

 

[orbitsurgMD]

Imagine hearing about any of this from the perpetrators and really not wanting anything to do with any of it. Senior officers, chiefs, I can imagine it would be uncomfortable thinking of yourself as someone else's idea of a loose end in a multi-million-dollar fraud scheme the consequences of being caught being decades in prison and loss of all benefits and a felony record. I imagine heads must have rolled somewhere over this for just the bad publicity alone.

 

[DrMetal]

Was he Internal Medicine? NMCSD, circa 2012 or 2013, name sounds familiar.

And we're hell bent on closing down the medical school....jeeez

 

[Gastrapathy]

@DrMetal probably, he was an O4 GMO when I met him

 

[dwb8p]

The Making of A Navy Doc – Navy Medicine

navymedicine.navylive.dodlive.mil

 

[DrMetal]

The Making of A Navy Doc – Navy Medicine

navymedicine.navylive.dodlive.mil

What a winner. Apparently the making of a Navy Doc doesn't include training on the perils of fraudulent documentation. And I doubt this was a case of 'poor-doctor-just-signing-off-on-things'. Most prosecutors build a decent case before indicting, they're not stupid. It could be a case of gross negligence, but still, there's no excuse for it. It seems like it was happening on a large scale, with real money being exchanged.

 

[Cooperd0g]

What a winner. Apparently the making of a Navy Doc doesn't include training on the perils of fraudulent documentation. And I doubt this was a case of 'poor-doctor-just-signing-off-on-things'. Most prosecutors build a decent case before indicting, they're not stupid. It could be a case of gross negligence, but still, there's no excuse for it. It seems like it was happening on a large scale, with real money being exchanged.

I don’t know the guy, the circumstances or the details, but I do know lawyers. Specifically prosecutors as I was married to one for several years. Don’t overestimate them. Generally prosecutors were not top of their class and law schools pump out grads like a fat kid eats candy. They may have presented a compelling case, but that doesn’t mean it is a decent case. You don’t have to convince a room full of knowlegable federal agents and other lawyers, just the average schmo who ends up on the jury.

 

[DrMetal]

I don’t know the guy, the circumstances or the details, but I do know lawyers. Specifically prosecutors as I was married to one for several years. Don’t overestimate them. Generally prosecutors were not top of their class and law schools pump out grads like a fat kid eats candy. They may have presented a compelling case, but that doesn’t mean it is a decent case. You don’t have to convince a room full of knowlegable federal agents and other lawyers, just the average schmo who ends up on the jury.

Fair point.

I knew the guy very briefly. He was a nice guy, but he didn't seem all that interested in Medicine. I think he was roped into an Internal Medicine residency, for lack of anything else to do, after being a GMO for nearly a decade. He didn't seem like the strongest trainee. In fact, I don't know if he even finished the program, he's not BC. And yet, he made O-5, how bout that?

I do remember him being very hoo-rah about operational stuff. I think this may even be a case of "MC-officer decides he doesn't want to be a doctor any more, takes on only operational tours to thump his chest, does anything he can to help his line guys, but then crosses a line."

 

[orbitsurgMD]

Fair point.

I knew the guy very briefly. He was a nice guy, but he didn't seem all that interested in Medicine. I think he was roped into an Internal Medicine residency, for lack of anything else to do, after being a GMO for nearly a decade. He didn't seem like the strongest trainee. In fact, I don't know if he even finished the program, he's not BC. And yet, he made O-5, how bout that?

I do remember him being very hoo-rah about operational stuff. I think this may even be a case of "MC-officer decides he doesn't want to be a doctor any more, takes on only operational tours to thump his chest, does anything he can to help his line guys, but then crosses a line."

I came across people like that in the aviation medicine community. There were guys who put on O-5 never having done more than a squadron flight surgeon job. Some grandfathered into boards that previously had non-approved residency pathways to certification (EM was once like that, you could do a couple of years as a surgery resident and work in an ED for a couple of years and be eligible to sit their board; and in Canada, if you got in that way, you could get reciprocal certification by the ABEM, which was accepted equivalent to having done a full EM residency by the Navy.) There were people in my flight surgeon class who were civilian accessions looking to get away from civilian medical careers, to escape burnout or because they just didn't like clinical medicine and wanted a change.

I could see how someone who really didn't fit into clinical medicine but liked the operational camaraderie of a special forces unit (and EOD easily fits that description) doing "favors" for senior operational colleagues without asking too many questions and completely being duped. I really doubt anyone in this multiparty scheme sat him down and gave him the skinny on what was going on with these insurance claims, where the false records were obtained, how the records were altered, what was being claimed and paid or what was at stake for him and the others if found out. Somehow I suspect the whole of this was never presented. Sort of like the Fat Leonard bid rigging scheme, it was a dinner here and a weekend there and someone leaning over some evening and saying "we have a bid proposal that needs a signature by Friday, do you think you could help us out?" Slippery slope.

 

[orbitsurgMD]

I don’t know the guy, the circumstances or the details, but I do know lawyers. Specifically prosecutors as I was married to one for several years. Don’t overestimate them. Generally prosecutors were not top of their class and law schools pump out grads like a fat kid eats candy. They may have presented a compelling case, but that doesn’t mean it is a decent case. You don’t have to convince a room full of knowledgeable federal agents and other lawyers, just the average schmoe who ends up on the jury.

Even more so with a grand jury: there is no adversarial process, no scrutiny of evidence, no cross-examination of witnesses, and the grand jury only gets to see and hear what the state attorney puts in front of them.

 

[jurassicpark]

it was a dinner here and a weekend there and someone leaning over some evening and saying "we have a bid proposal that needs a signature by Friday, do you think you could help us out?" Slippery slope.

LOL. Crickey, thank God that doesn't translate to us civilians. That's essentially what pharmacy dinners are for! They take you to some place very fancy and hey, you want that Louis XIII on the shelf for dinner? Sure, make sure you order a lobster to go to take to your wife as well. The only saving grace is I already use their meds on their own merits regardless and they know it too.. just an excuse to eat and drink with us on the company dime.

 

[pgg]

The Making of A Navy Doc – Navy Medicine

navymedicine.navylive.dodlive.mil

My god, what kind of person actually agrees (or volunteers) to write something like that?

Oh.

 

[d2305]

Gross negligence vs extremely careless, where have I heard that before?

 

[ruiner]

Vaguely know the guy, was my senior resident one rotation when I was an intern. Nice guy, definitely graduated the IM program, hard to believe he would do this with any criminal intent, but as has already pointed out, negligence/ignorance is also not a great defense.

 

[DrMetal]

Navy doctor pleads guilty to $2 million military scheme

So how is this guy still in the Navy (is that not a court-martiable offense)? How did he get promoted, and how is he still licensed?

"Justice is lost / Justice is raped / Justice is gone / Pulling your strings / Justice is done
Seeking no truth Winning is all Find it so grim So true So real"

 

[orbitsurgMD]

Navy doctor pleads guilty to $2 million military scheme

So how is this guy still in the Navy (is that not a court-martiable offense)? How did he get promoted, and how is he still licensed?

"Justice is lost / Justice is raped / Justice is gone / Pulling your strings / Justice is done
Seeking no truth Winning is all Find it so grim So true So real"

The federal government likely chose a single civilian tribunal due to the large number of defendants, some of whom were not active duty and the greater resources available to conduct the complex prosecution required. They appear to have followed a common prosecutorial path of extracting plea agreements in exchange for cooperation in future prosecutions of other defendants. A court martial proceeding might still be possible to secure additional convictions that might apply additional penalties, but more likely for the purpose of loss of benefits. Now that there is a plea agreement, which here is a felony conviction, that will automatically trigger suspension and process for revocation of his medical license in most states.

As for promotion, the question is when that promotion occurred. The fraud crimes occurred in 2012-15. The charges came later after someone tipped the authorities.

 

[orbitsurgMD]

It wouldn't be surprising if the Navy elected the fastest and least public process, which would be administrative. Instead of prosecution and (probable) conviction resulting in dismissal (officer equivalent of dishonorable discharge) they will move to discharge on general/OTH terms and drop him from the roll, which might require an action at the level of the Secretary of the Navy. He would then be "de-commissioned" and, of course, still subject to the terms of his sentence, which has yet to be imposed. There will likely be fines imposed to the defendants in addition to prison terms and probable agreements to surrender assets to reimburse monies unlawfully taken from the government as well as interest. This avoids the inconvenience to the government of a civil suit against the defendant, which would probably be successful. The un-discussed question remains as to how the defendant treated his ill-gotten gains. If he did not declare it as income, then felony tax evasion is an additional avenue for future prosecution.

 

[DrMetal]

It wouldn't be surprising if the Navy elected the fastest and least public process, which would be administrative. Instead of prosecution and (probable) conviction resulting in dismissal (officer equivalent of dishonorable discharge) they will move to discharge on general/OTH terms and drop him from the roll, which might require an action at the level of the Secretary of the Navy. He would then be "de-commissioned" and, of course, still subject to the terms of his sentence, which has yet to be imposed. There will likely be fines imposed to the defendants in addition to prison terms and probable agreements to surrender assets to reimburse monies unlawfully taken from the government as well as interest. (This avoids the inconvenience to the government of a civil suit against the defendant, which would probably be successful. The un-discussed question remains as to how the defendant treated his ill-gotten gains. If he did not declare it as income, then felony tax evasion is an additional avenue for future prosecution.

It would be nice to see the hammer of USMJ come down for once, lest we've become a military that can't even prosecute or discipline the most egregious acts of waste/fraud/abuse.