Thursday, January 20, 2005


Medicare Fraud---More Bogus Claims

More Prosecution Misstatements
Bad Math, Bad Analysis-More Enron

The prosecution continues to make misstatements and exaggerated claims against Dr. Dhafir. Yesterday they presented inflated numbers taken out of context when claiming he was guilty of Medicare fraud.

The Post Standard reported today ( ) that "Dr. Dhafir is accused of defrauding Medicare out of $274,000 from 1998 to 2002 by billing for 26 chemotherapy treatments as if he were in the office when he was not…. "
"He's accused of billing Medicare at the 100 percent reimbursement rate if a physician is present for the treatment instead of at the 85 percent rate for nurse practitioners, even when he wasn't in the office. His nurse practitioners and a laboratory technician have testified they administered chemo and other treatments when Dhafir wasn't around."

When we examine the numbers, the "supposed" $274,000 that Dr. Dhafir bilked from Medicare is actually $41,100 or 15% of that amount($274.000). What the prosecution is doing is claiming that the gross amount Dr. Dhafir billed Medicare for as the 'supposed" amount he ripped them off for. Instead the actual claim, if Dr. Dhafir is guilty, is 15% of the gross amount. ($274, 000).

Lets put the government's claim in perspective. Dr. Dhafir billed Medicare for approximately $1,000,000 annually. For the period of five years the government is talking about he would have billed them for a total of about $5 Million. Then consider Dr. Dhafir's take home pay of about $500,000 annually. Do you think he would intentionally steal $8,220 ($41,100 divided by 5) from Medicare annually?

This is just another example of the prosecutions bad math, bogus claims and misstatements--they could teach the Enron accountants a thing or two. As we have already learned the prosecution admitted that some of the money it claimed Dr. Dhafir took from the charity was actually his--so he stole from himself? We also learned that the lead FBI agent has almost no accounting education. We learned…..the list goes on and on……

Let's not forget that the Medicare fraud charges were introduced after Dr. Dhafir was arrested. The charges are the culmination of several FBI going over his records with a fine tooth-comb--and this is what they came up with?

What happened to "evil-doer terrorist" original charge against Dr. Dhafir? Let's hope that the Medicare fraud claim disappears the same way the original charge disappeared.

But then I am sure that the government will conjure up some other claim.

After all the head office, justice department, desperately wants to convict Dr. Dhafir to help in the war on terror….OOOPPSS that was another bogus claim that is no longer being put forth by the prosecution!!!

Recieved from Roselynn Kingsbury, Nurse Practitioner

Probably if you go into many medical practices in the country you will find similar Medcare problems. A cardiology group got in trouble a few years ago for billing for NPs like that. The rules and regulations are extremely confusing. And the government insists on calling mistaken interpretation fraud. At the office where I work, a memo was posted to not print things off the Internet that were not work related, because the cost of the paper is in our cost of doing business, and Medicare could consider that fraud!

As a nurse practitioner myself, our profession is trying to change the practice of only allowing physicians the right to bill at 100%, since our practice is just as responsible for diagnosis and treatment as the MDs. NPs in private practice are at an economic disadvantage because of such regulations.

Roselynn Kingsbury, RN, MSN, FNP
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