Dr. Alvarez's Deal
The $9.13 Solution
Suppose someone offered you this deal: You go to jail for thirty years in a federal prison, and we'll pay you X amount. How large would X have to be?
In a federal prison you are told when to get up, when to go to bed, and what to eat. You're told where you can go. You're told what jobs you're going to do. You'll get three meals a day, many with meat labeled "Grade D but edible." You'll get access to free health care. You can't smoke. No alcohol is ever provided. And you'll have to do 29 years and six months before you can be released to a halfway house to be re-integrated into society. Your new friends will be drug dealers, bank robbers, and sometimes killers. Inmate on inmate violence is the norm. You'll get to see family maybe twice a month.
Now, how much would you want? Ten million dollars? Twenty? Five hundred million dollars? For me, no amount of money would be worth it. But one thing is for sure: I wouldn't take the deal for $9.13 a day.
Yet that's the deal that Dr. Ana Alvarez took when she went to work in a medical clinic run by three brothers who have since fled back to Cuba. Alvarez took a $100,000 a year salary as an endocrinologist and wrote treatment plans for patients with HIV. Except, the patients were false, the claims were false, the prescriptions were false. The scam cost Medicare more than $8 million, a small part of the $119 million scheme orchestrated by Medicare fraudsters in Miami.
Dr. Alvarez got 30 years in federal prison. At the time it was the longest sentence ever for Medicare fraud in Florida. Thirty years is 10,950 days behind bars for a woman who was 55 when sentenced and would be 85 when, or perhaps I should say if, she is ever released. That $100,000 salary works out to $9.13 for each day behind bars for the physician.
Although Alvarez's co-conspirators received sentences of four and seven years each, the judge threw the book at Dr. Alvarez in large part because of her status as a physician and her conduct during the trial. She took the stand in her own defense and it was the Judge's view that she lied on the stand and had falsified records. Although the maximum under the sentencing guidelines was 22 years, Judge Federico Moreno went outside the guidelines and sent her to prison for thirty years in part as a deterrent to others involved in Medicare fraud.
Dr. Alvarez did not helped her cause any. She took out a full page ad in the local Spanish-language newspaper proclaiming her innocence and stating that her liberty had been "incorrectly taken away." She claimed she did not know that the clinic was operating as a scam even though for five months she prescribed exactly the same therapy for every HIV patient she purportedly saw. She asked local physicians and patients to write to the judge for her to obtain a lighter sentence. It appears this plan backfired on her very badly.
Of course, the doctor appealed, and no less an authority that Sandra Day O'Connor, the retired Supreme Court judge, affirmed her sentence saying that physicians should be punished more severely because "the doctor is breaching a position of trust" when she commits Medicare Fraud. The opinion by the 11th Circuit Court of Appeals is here and it tells a very sad story of a doctor who knew what she was doing was wrong, and who kept doing it anyway.
From time to time health care practitioners are asked to look the other way. They're asked to "go along to get along." Sometimes the requests don't seem too awful. Chart a treatment that wasn't done. Say a patient had meals when they did not. Or perhaps, sign off on the narcotics log to prove that certain drugs were wasted when you didn't actually see it. It's not like someone's asking you to commit murder or anything. Right?
In Star Wars Luke Skywalker is warned that once you start down the path to the dark side, you cannot come back. The same is true for breaking the law. And the same is even more true for covering up the misdeeds of others. Would you spend even a year of your life in jail for $9.13 a day? That's the question you have to ask yourself.