Doctor Update: Insurance fraud not enough to dampen a doctor’s style

If the IRS fines you for not paying your taxes, it may have been the result of an honest mistake. Not all of us are good at math, and some of us have a habit of losing our receipts.

But it might also be a sign of a more fundamental problem. When you twin a tax fine with allegations of insurance fraud, a pattern starts to emerge.

Less than a year after Dr. Tomas Ballesteros Rios was fined by the IRS for cheating on his taxes to the tune of $72,000, he was sued by Allstate Insurance and the state of California for insurance fraud. I wrote about this at the time and described the scheme this way:

Chiropractors are not allowed to prescribe drugs to patients, and, as a result, are not allowed to bill insurance companies for those drugs. A group of chiropractors, including Dolphus Dwayne Pierce II of Lemoore and John Brent Arakelian of Fresno, allegedly worked with Dr. Tomas Ballesteros Rios of Bakersfield and Dr. Charles Orlando Lewis III of Hanford to create fake medical corporations that appeared to be run by doctors. Through the corporations, the chiropractors would buy and prescribe drugs, billing the insurance companies as if the drugs were being prescribed by physicians for medically diagnosed conditions.

Note the other doctor mentioned there: Dr. Charles Orlando Lewis. Lewis was later convicted of insurance fraud but failed to tell the Medical Board of California about it. When the board did find out, it reacted by taking Lewis’ license away in May 2016. It’s not the crime; it’s the cover-up, right?

Rios, too, was convicted of one count of conspiracy to commit insurance fraud in November 2014 in Kern County Superior Court. He was put on three years of probation, much longer than the 90 days he served for filing a false income tax return. He also was ordered to pay some fines and complete 350 hours of community service.

Like Lewis, Rios failed to tell the Medical Board of California, according to medical board records. Dr. Kimberly Kirchmeyer, the board’s executive director, brought an accusation against Rios on October 1, 2015 asking the board to revoke or suspend Rios’ license or take some other action. Perhaps betraying a case of the left hand not knowing what the right hand was doing, just 29 days later, Medical Board President David Sewell issued an order declaring that Rios had completed his probation from his earlier tax-related violation and would have his license fully restored.

Technically, Rios’ probation should have been completed in June 2014. He was put on three years of probation in June 2011. One of two things happened that could explain the fact that the board didn’t restore Rios’ license in 2014. 1) The Board just didn’t get around to filing the paperwork officially taking Rios off probation. 2) Rios did something that extended his probation. Board documents are often scant on details, and so we may never know.

What is clear is that, as of now, despite problems with medical boards in two states, convictions of filing a false tax return and insurance fraud, Rios still has a license in full effect. There is an argument to be made that purely financial misbehavior should not have an impact on a person’s ability to practice. The theory might be that one can be an excellent surgeon but dishonest with the insurance company paying for the surgeries.

The wrinkle here is that the doctor-patient relationship relies on trust. For that relationship to work, patients must believe that their doctors are telling them the truth, giving them honest assessments, and providing them straightforward guidance on how to care for themselves or to beat a life-threatening illness.

Dr. James F. Drane at the Edinboro University in Pennsylvania wrote an interesting piece about honesty in medicine that summed it up this way:

Now, more than ever, patients have to be able to trust their doctors and to be able to rely on the truth of what they are told. Since truthfulness and veracity are such critical medical virtues, doctors have to work to develop the virtue of truthfulness. This is not an easy task.

When doctors don’t do enough to develop such virtue, it’s up to medical boards to do a better job at holding them to account.

[Photo by Quinn Dombrowski via Flickr.]

Related posts

Doctor Update: Should tax cheating affect a doctor’s medical license?

Doctor Update: Slow wheels of justice finally turn up insurance fraud