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In August of 2011 I began journaling my day-to-day thoughts and feelings to help me work through what was sure to be a very rough and tumultuous next few years. Writing in my journal daily helped me work through periods of mixed emotions ranging from anger to anxiety. I was able to express my deepest thoughts on paper, those that I was unable to share with anyone else in person, and it helped me clear my mind every day.
Below are excerpts from my journal: bits and pieces from that difficult period. Looking over these has helped me realize I have the strength to take on and overcome anything, and I feel compelled to share my story.
Part I: The Fall Out
On December 15, 2009, an FBI search warrant was executed on my Bloomingdale facility, along with facilities owned by my former partners and their associates. After speaking to the FBI investigator, my corporate attorney determined the search had to do with diagnostic testing and likely an investigation into the practice management group my former partners had engaged with. My attorney assured me it did not have to do with my practice itself. I was further assured that the FBI had no interest in my current clinics, so I thought nothing more of it at that point.
Until Friday afternoon, August 11, 2011, when I received a phone call from my corporate attorney stating that the assistant U.S. attorney is requesting to interview me. My corporate attorney recommended I hire a white-collar criminal defense attorney for the meeting and interview. After interviewing five or six attorneys recommend by my corporate attorney, I hired the one that seemed best qualified to represent me.
Two weeks later, my attorney reached out to the U.S. attorney’s office to tell them we were ready to sit down for the interview. At that moment, we are told there is no point in meeting any longer, that within the next few days I will be indicted on charges of healthcare fraud.
On August 31, 2011, I am indicted on 15 counts of healthcare fraud with an intended loss amount of more than 18 million dollars to Blue Cross Blue Shield of Illinois (BCBSIL) alone. This is the culmination of a 5+ year investigation by BCBSIL, the FBI, the U.S. attorney’s office and multiple other government agencies, spanning from 1999 to 2008.
I come to learn the investigation included undercover agents posing as patients, a perspective witness wearing a wire, patients being interviewed, former and current staff members being interviewed and voluminous amounts of medical and billing records being seized. I was suddenly a part of the largest chiropractic healthcare fraud case in Illinois, and one of the largest nationally.
Within days of the indictment, my clinics all receive faxes from a Medicare CERT contractor stating that they are coming to conduct an audit. Clearly this is not a coincidence, to be so close on the heels of the indictment.
Part II: Three Years That Would Change Everything
The two weeks following the indictment had to have been the worst two weeks of my life that I can remember. I went from an arraignment hearing, to being processed by the FBI and the U.S. Marshals office, to being treated like a hardened criminal. I learned the hard way that in reality there is no such thing as innocent until proven guilty. In actuality, once charged you are seen as guilty until you can prove your innocence.
During this two-week process, I got the feeling the attorney I hired was not right for me, so I began interviewing every top notch white-collar criminal defense attorney I could find in downtown Chicago. After speaking to nearly a dozen of the most prestigious law firms, only one was willing to stand behind me, believe in me and fight for me. Every single one of the other firms told me that once you’re indicted, the U.S. attorney’s office has a conviction rate higher than 98%, and that they would be able to negotiate the best deal possible, but they saw no way of being able to defend and win my case. They determined this after reading the indictment and speaking with me for about an hour.
It was clear to the law firms that turned me down that there was likely one or two people that aided in the investigation and were likely going to be the government’s key witnesses if the case went to trial. This also meant they likely had a deal in place to plead guilty, which made defending me seem that much more impossible. The single law firm that was willing to defend me came with a very high price tag: the retainer alone was over seven figures.
At this point, it was up to me to do whatever it took to prove that I never had any criminal intent and was innocent of the charges that were filed against me. The battle my lead attorney, his two associates and I were up against was the battle of unlimited resources, manpower, data collection and witness testimony of the government. We were given box after box of paper evidence along with multiple terabytes of digital evidence to sift through and try to make sense out of.
The root of the charges came down to this: I stood accused of a scheme to defraud by means of over-utilization of services and diagnostic testing. I cannot speak on behalf of what was taking place prior to me joining my partners, or what was taking place in their clinics, but I knew the staff that I had hired, trained and worked alongside was utilizing good medical judgment with respect to treatment and diagnostic testing.
I knew going into it the hardest thing to embrace would be having patience over the course of the coming months. I wanted nothing more than to make all of this go away as quickly as possible. Unfortunately, that was not an option.
The government offered me a plea deal: if I plead guilty, I would serve 63 to 78 months in prison and pay a restitution fine of nearly $1,300,000.
I knew if the plea offer was rejected and a guilty verdict was reached at trial, the length of time served in prison would increase.
Part III: Defending My Innocence
My lawyers and I were given a spreadsheets containing hundreds of thousands of line items identifying every alleged fraudulent charge submitted to Blue Cross Blue Shield, Aetna and Humana. Our task was detailed analysis of every line item and separation by procedure code.
This became my second full-time job as we had set out to disapprove every charge in the indictment. Once the analysis was completed it needed to be reviewed and verified by billing and compliance experts. At the same time the medical decision-making had to be justified by experts in the medical and chiropractic profession. This involved complete dissection of each patient file from history to treatment outcome.
We were behind the eight ball so to speak, and playing catch-up on a 5+ year ongoing investigation. In addition to the statistical analysis, we needed to closely review every single interview conducted, from staff to patients to anyone we had associated with.
Over the years we had well over 200 employees. Given the opportunity, a former or disgruntled employee, when approached by the FBI or U.S. attorney’s office, would inevitably have a lot to say, much of which could become twisted and factually inaccurate. Our job was to prove through unbiased factual evidence what the truth was interview-by-interview and accusation-by-accusation. There were hours upon hours of me explaining the facts and my attorneys figuring out how to defend them from a legal perspective.
There was also the learning curve. My attorneys were tasked with learning every detail of my practice operation as well as the chiropractic and physical therapy industries as a whole. I was tasked with learning the details of how the law works when it came to motions being filed, discovery being presented and how specific rules become established based on decisions from preceding cases. Countless hours were spent explaining CPT procedures, ICD-9 codes and medical necessity.
During this 2.5 year process, things often seemed bleak. The amount of discovery evidence we had to go through was nothing short of overwhelming. I now understand why all of the other law firms were either unable or unwilling to put in the time and effort to defend such a complicated case.
There were many times that I came very close to giving up on the clinics that I was still running. It was very difficult trying to juggle running the clinics and working on my defense, both full time. I often considered selling or closing them down. Looking back, it would’ve been the worst decision I could’ve made. They kept me sharp and focused and gave me a well-needed distraction.
But the hardest time during this 2.5 year period came not at the hands of the government, but on November 23, 2013, when my 14-month-old son suffered a subdural hematoma and needed an emergency craniotomy. Going into surgery we didn’t know what to expect; coming out we knew even less. After the surgery, the neurosurgeon told us he was likely within 30 minutes of losing his life.
We wouldn’t know for weeks, months or even years if there was any brain damage, and if so to what extent. During the same time we were gearing up and prepping for an April 7, 2014 trial date.
There is nothing that could have tested my family and our strength quite like this event. In the weeks following, as I could see my son recovering, it gave me strength and a determination that I didn’t know I had.
Part IV: The Agreement
The following months were back to the grind of reviewing and analyzing the discovery evidence. Sixty days before trial we had to make the biggest strategic decision to date in the case. Would we present to the U.S. attorney’s office before the trial date in an effort to resolve the case and avoid the uncertainty of a trial?
By presenting to the U.S. attorney, we would essentially be showing our cards and giving them insight into how we planned on defending the case. The plus side was that if it went well we could avoid the trial. I made the decision that I wanted to present to the U.S. attorney to at least give the government some insight into the fact that they had misunderstood me and my role in their investigation. The countless hours everyone had poured into the case was going to be tested in a sixty minute presentation.
My attorneys presented to the U.S. attorney’s office, FBI and other government entities on Friday, February 14, 2014. After the presentation I received a phone call from my attorneys stating that they thought it had gone very well. Now we had to wait and see, but we continued to prepare for trial.
Monday and Tuesday went as they always did: many phone calls and emails back and forth clarifying details that were on that day’s agenda.
By late morning on Wednesday, February 19, the U.S. attorney’s office reached out and offered an unheralded deferred prosecution agreement. This meant the indictment and all charges against me would be dismissed based on the terms of the agreement. This was simply an unheard of victory in a healthcare fraud case, especially when the co-defendants had already plead guilty.
The terms of the agreement were such: I could not violate any federal, state or local law for the next twelve months, I was required to pay BCBSIL $87,852 in restitution, and I had to admit to improper billing of services under a provider that was not the one actually providing the services. All the services were actually rendered, but our billing company had billed them under the wrong provider.
The truth is that we could have turned down the U.S. attorney’s offer and moved ahead with the trial to seek a not guilty verdict. The trial would have lasted 4-6 weeks however, bringing on added stress and undue media attention. It also would have cost nearly half a million dollars.
It seemed like a no-brainer to have the indictment and charges dismissed and pay BCBSIL their requested restitution, and so that’s what we did.
There is a protective order on the case so I am not at liberty to discuss details, but I will share with you an excerpt from, Global Regulatory Enforcement Law Blog dated March 7, 2014: “Today, the United States Attorneys’ Office filed a Deferred Prosecution Agreement suspending all further criminal proceedings against Dr. Patel and effectively ending the prosecution. The Agreement was agreed to and entered by federal district court judge Ronald A. Guzman. Under the Agreement, Dr. Patel is required to pay $87,852 to Blue Cross Blue Shield of Illinois, refrain from any violations of law, and report as ordered to a pre-trial services officer. Upon successful completion of the terms of the Agreement, in twelve months all charges against him will be dismissed.
Steven A. Miller, lead counsel for Dr. Patel, stated “[t]oday’s resolution was the result of our two year analysis of very complicated statistical, medical, and witness evidence. After presenting our analysis to the government, it agreed that a Deferred Prosecution Agreement rather than further efforts to convict Dr. Patel was the appropriate outcome.” Mr. Miller added that he is “very pleased with the manner in which the United States Attorneys’ Office acted once our view of the evidence was brought to its attention,” and he commended its decision as “consistent with the highest traditions of the Office.”
Part V: The Experience
Looking back, the experience was priceless: I literally received a million dollar education. It sounds cliché, but I wouldn’t change anything that transpired over the entire thirteen-year span. I had the opportunity to learn about the business of healthcare, how an investigation starts, the process of developing the merits to pursue it, what investigators and auditors are looking for and what and who to avoid and stay away from.
The most important thing I took away from the experience is realizing how little people from all walks of life know about chiropractic care. And of the little knowledge they have, much is negative and inaccurate.
The reality of it was as much as I was on trial, many of the the principles of chiropractic care were also on trial. Many times I would have to tell my attorneys that it is simply the practice of chiropractic medicine that is being questioned.
Today the entire experience has allowed me to help chiropractors and other healthcare practitioners in private practices, and for that I am grateful.
Part VI: The Ultimate Result
I learned more about myself in 2.5 years than most people will in their entire lives. There was not a single moment that went by where the thought didn’t cross my mind – “What if this doesn’t end well?” Those thoughts changed my thinking pattern and affected how I functioned, and ultimately they made me stronger and helped me appreciate everything more.
I learned that I married the greatest woman in the world and without her strength I could have never made it through the experience. I treasure the fact that I will get to see my boys grow up. I get to go to their sports practices and coach their games. I learned what people really thought about me and who my real friends are.
The ultimate result is that I have a zest and passion for life today that I would have otherwise never realized. This zest and passion carries through into everything I do both professionally and personally.
Unfortunately, the fight is not over.
These days I have a new battle. The Department of Regulation wants to suspend my license indefinitely. I am still figuring out if this is a battle worth fighting. Whether I have a license or a title doesn’t mean as much to me today, because I will still make a difference. It may not be in the lives of patients directly, but it will be through the profession that gave my family and me everything we have today.
I will reach innumerable patients by sharing my experiences with fellow chiropractors and helping to create unity in a profession that desperately needs it.
Part VII: The Next Chapter
My experiences, both good and bad, are my driving force today, and they have lit a fire inside of me to create a movement that will make a difference – no matter what.
Stay tuned – the final chapter is coming up next.
Prologue: Where It All Began
I was born in Evanston, Illinois, and with the exception of five years when I was young, I have lived in the northern suburbs of Chicago all my life.
I attended Maine East High School and did my undergraduate work at the University of Illinois at Chicago and California State University Long Beach before attending the National College of Chiropractic and graduating in 2001.
Upon graduation, a classmate and I opened a clinic in Vernon Hills, Ill. It was a rough start: we had no formal business training and we were putting everything we had into getting our clinic up and running. After 9/11, business became increasingly difficult and we both opted to take on other jobs to supplement our income until we were able to get going.
My uncle suggested I speak to his chiropractor that had helped him a great deal. His clinic was busy, he had an MD on staff and he had multiple locations. I called my uncle’s chiropractor and met with him, and he offered me an associate position on the spot and told me he’d mentor me. I asked to speak to some of his staff at the other locations, coincidentally chiropractors that I knew, before committing. Upon speaking to them I was assured everything was on the up and up and I accepted the position.
This chiropractor had a partner and they were aware that I had a struggling clinic, and they were okay with me working in both places. Within six weeks of working as an associate, the chiropractor suggested that we partner up and make my struggling clinic part of his group.
My job would be just to see the patients, and he would supply all the trained staff and assign someone to do the marketing. At the time it seemed like a dream situation: I have a successful chiropractor 14 years my senior telling me he wanted to take me under his wing and offer me an opportunity to be his partner.
I talked it over with my parents and decided to accept the opportunity. I was assured that his attorneys and multiple practice management groups had vetted the entire operation. We worked out a deal with my classmate who was my partner at the location, as we were losing money every month on rent and overhead.
June of 2002 we re-established the clinic and the first week I had 30+ new patients. Within three months I had an associate doctor and within eight months we were seeing 300+ patients per week and I had a second associate doctor. By the end of the first couple of years, I was only seeing new patients and the associate doctors were doing all the treatment. The clinic would peak at seeing more than 500 patients per week.
By late 2003 the clinic was stable and marketing was bringing in 20-30 new patients per week consistently. We decided to open another clinic in Schaumburg, Ill., and in March 2004 we opened the doors with an even stronger start than the first clinic.
We created a structured formula that allowed us to open a clinic within 2-3 weeks from start to finish. With the addition of the second clinic and the three clinics that my partners had on their own, we had created a marketing machine generating limitless new patients.
We had gone from grassroots marketing to being one of the leaders in corporate health and wellness. Corporations were now reaching out to us to run their health fairs. It became easy to continue to grow the marketing by scaling it. We were able to secure marketing at a fraction of what it would cost any independent clinic, and we had the staff across numerous clinics to back it.
It wasn’t long before we opened two more clinics, one in Bloomingdale, Ill., in March 2005 and the next in Algonquin, Ill., in August 2005. We had the next few locations already scouted out and there was no telling how many we would eventually have.
With tremendous success and fast growth came internal turmoil. The faster a company grows, the more responsibilities there are that fall on the owners, and more scrutiny comes from the inside and out.
Through the process of opening more clinics I began to learn more and more about the industry, and I began questioning some of the practices that had been established before I joined. This further fueled the turmoil, as I wanted to start making changes to add full-service physical therapy. It would be seen as an expense that would cut into profits.
That was the breaking point. My partner that brought me on and I bought out our other partner in June 2006. By October of the same year we had added our first full-time physical therapist and were set to bring on two more. In November of that same year we opened our next clinic in Gurnee, Ill. Everything appeared to be running well and things were getting cleaned up and better organized.
In late 2006 it was brought to my attention that we may want to consider changing some of our billing procedures with the addition of the physical therapists. One of my associate doctors had heard of a clinic that had nearly $10,000 recouped by BCBSIL based on specific CPT coding practices. In early 2007 I ordered an internal audit be conducted by a highly respected firm to review all billing and coding procedures.
The report was shocking: we needed a complete revamp of our back office procedures. The billing staff we had in place was the staff that was trained under my partners’ original structure, based on what they were told by practice management groups. I opted to discontinue doing our own billing and hired an outside billing company to take over and follow the recommended changes from the audit report. These changes were not going to happen overnight, so a timeline was established and followed meticulously.
During 2007 we also added interventional pain management to our service line. We hired an anesthesiologist board certified in pain management who would perform epidural and other joint injections under C-arm. With the addition of pain management treatment and the changes to billing procedures, 2007 was a financial disaster, but we had turned the corner and cleaned up the entire operation.
When all was said and done, the gross income filed on my taxes in 2007 was just over $12,000. As long as we stuck by the changes we made, 2008 would be better and the following years would continue to improve. But my partner did not see it that way. His other clinics that I was not a part of did not make any changes and continued to be very profitable in 2007.
In early 2008, he said we were going to revert back to the “old system”, that he was not going to have another down year. Things came to a boiling point and separation was the only option. We would eventually close three of the clinics. He would take the clinic in Vernon Hills and I would take the one in Bloomingdale. By March 2008 our partnership had ended.
In February 2008 I started TRU Rehabilitation & Wellness Centers with a location in Arlington Heights, Ill. Eventually I converted the Bloomingdale location to a TRU facility and opened TRU’s Glenview, Ill., facility in July of 2011. All three facilities are still open and seeing patients.
Why I Feel Compelled to Share
I wouldn’t wish what I have gone through on anyone. The toll it takes both personally and professionally is crushing. If my experience can help even one person avoid having to go through any of this, then it’s worth it.
Today, I work with people in healthcare from various specialties and I want there to be full disclosure as to what my background is and what I’ve been through. I want to set the facts straight. Much has been said and written from August 31, 2011, up to the present, and I’m sure more will be written in the future, but here I have voice and can set the record straight.
Anyone that is reading this and wants to reach out to me, has questions or feels that I may be able to help them, feel free to contact me.
My personal email address is email@example.com.