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Those acquainted with privatized healthcare are likely aware that the Hippocratic Oath can sometimes be overshadowed by hypocrisy, leading to exorbitant medical bills for routine procedures. However, there are instances where healthcare professionals bypass regulations to amass millions illegally. When exploitation becomes this lucrative, it can lead to astonishing levels of deceit—even endangering patients outright.
10. Redefining “Sick” to Admit More Patients
Amid the endless stream of news about food additives and household items potentially causing cancer or harming our health, society hardly needs another reason to spiral into hypochondria. Yet, even when we overreact to minor ailments, we should still rely on nurses and doctors to provide accurate diagnoses and reassure us.
Florida-based Health Management Associates took a different approach. Using sophisticated software and some traditional pressure tactics, the for-profit hospital admitted numerous patients requiring minimal or no medical care to charge Medicare. Staff were so enthusiastic about treating patients that even an infant with a body temperature of 37.1 degrees Celsius (98.7 °F)—just one-tenth of a degree above the average 37 degrees (98.6 °F)—was recorded as having a fever, leading to unnecessary and expensive medical tests.
Not everyone involved in the hospital’s scheme participated willingly. A whistle-blower lawsuit against the company revealed that doctors who refused to comply were routinely fired, and administrators who raised ethical concerns about excessive admissions faced the same fate. Unfortunately, due to the increasingly complex financial ties and massive scale of organizations like Health Management Associates, such abuses are likely to remain a persistent challenge for regulators.
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9. Assigning Medical Procedures to Unqualified Personnel
Dr. Ravi Sharma, a certified thoracic surgeon, aimed to assist individuals in losing weight through his Florida-based Life’s Image weight-loss center. While a chest specialist might not be the first choice for addressing obesity, it’s reasonable to expect the clinic to employ qualified professionals capable of managing weight-related health issues.
Unfortunately, Dr. Sharma was more focused on profits than ensuring his staff had the necessary expertise. Rather than hiring certified professionals for vein injections and other invasive procedures, Sharma delegated these tasks to untrained employees, including an office manager. The surgeon not only avoided performing the procedures himself but was often absent during their execution. According to a complaint, he frequently texted instructions for ultrasounds and varicose vein injections to his staff.
Compounding the issue, many of these invasive procedures were unnecessary, conducted solely to inflate costs. Sharma, who saw few patients personally, also billed Medicare for the procedures carried out by his unqualified staff. The scheme unraveled when he dismissed office manager Patti Lovell, who retaliated by exposing his misconduct in a whistle-blower lawsuit. Sharma resolved the matter by paying the government $400,000, allowing him to continue practicing medicine without further repercussions.
8. Manipulating Workers’ Compensation Claims
For the average person struggling to make ends meet, a severe workplace injury brings not only physical pain but also the fear of being unable to support their family, along with overwhelming medical debt. Fortunately, workers’ compensation exists as a crucial safety net, covering recovery costs for job-related injuries.
However, for Michael Drobot, owner of an orthopedic hospital, workers’ compensation insurance became the foundation of a 16-year, $500 million fraud. By bribing doctors, chiropractors, and other professionals, Drobot’s clinic attracted numerous patients requiring surgery for work-related spinal injuries. This scheme often sent injured workers hundreds of miles from home for operations, bypassing more convenient locations.
To keep his scheme under wraps, Drobot bribed California state senator Ronald S. Calderon with $100,000 in unmistakable bribe money. Since his arrest, the corrupt hospital owner has tried to reduce his sentence by implicating Calderon and others.
7. Falsely Diagnosing Patients as Terminally Ill to Secure Medicare Funds
Hospices serve as healthcare sanctuaries where terminally ill patients spend their final months under the care of professionals trained to ease their suffering. They also help reduce hospital costs and lessen the financial strain on Medicare, which only covers expenses for hospice patients with a prognosis of six months or less. This creates a strong incentive for hospitals and hospices to identify patients nearing the end of life who no longer seek aggressive treatment.
Between 2001 and 2013, Vistas Hospice Services, the largest private palliative care provider in the U.S., misused millions of dollars in Medicare reimbursements by enrolling healthy or ineligible individuals. To encourage these fraudulent enrollments, Vistas offered bonuses to compliant staff, disregarding concerns from doctors and nurses about the appropriateness of the care. Additionally, Vistas falsely classified some patients as needing crisis care, an expensive service meant for those severely affected by illness, passing these illegitimate costs to taxpayers through Medicare.
In a particularly egregious case, Vistas billed Medicare $170,000 for intensive nursing care for a woman who was not critically ill and was fully capable of living independently and performing household tasks. Other patients, supposedly near death, were seen attending church and playing bingo. Due to such widespread fraud, Vistas’ crisis care expenses were nearly six times the national average. These irregularities caught the attention of the U.S. government, leading to Vistas’ involvement in a multibillion-dollar Medicare fraud investigation.
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6. Exploiting Dying Patients and Abandoning Them to Avoid Costs
As previously noted, the welfare of the sick and dying often becomes secondary to the lure of prolonged Medicare reimbursements. Instead of outright falsifying patient conditions like Vistas, many for-profit hospices adopt a subtler strategy by enrolling a disproportionate number of dementia patients, who may live longer than anticipated and typically require less care than other hospice patients.
The U.S. government tried to curb this covert exploitation by imposing a $25,000 cap on hospice reimbursements without repayment obligations. However, many for-profit hospices still exceed these limits by 50 percent or more. If they face financial trouble, they can declare bankruptcy to evade large debts, leaving vulnerable patients and their families to find new care providers while taxpayers cover the costs.
In a particularly egregious example, Sojourn Care Inc. shut down after accumulating $27 million in debt, only to reopen under a new name. This allowed the company to shed its previous legal obligations tied to the defunct Sojourn Care and selectively recruit healthier patients from its former roster to continue profiting. As a result, 180 of Sojourn Care’s 280 former patients were left in distress, with some dying in poor conditions. What’s even more disheartening is that such practices are technically legal, leaving many families without justice.
5. Deceiving Drug Addicts into Psychiatric Confinement
Hardcore drug addicts are among the most vulnerable individuals in society. Whether you empathize with their struggles or view them as contributors to crime and societal decline, their lives are undeniably dominated by the physical and mental grip of often lethal substances. In theory, any initiative to help them overcome addiction should be celebrated as a noble effort.
However, in Broward County, Florida, executives running a psychiatric hospital took a different approach. Over nine years, they bribed officials and falsified records to lure drug addicts to their facility, Hollywood Pavilion, where patients were confined for weeks. Despite its name, the hospital was far from luxurious. Patients were housed in insect-infested rooms, received minimal or no treatment, and were discharged once their Medicare benefits ran out.
After fraudulently claiming $67 million in reimbursements with false promises of rehabilitation, owners Karen Kallen-Zury and Christian Coloma were sentenced to 12 to 25 years in prison and ordered to pay millions in restitution. While these penalties can’t undo the harm done to their victims, they ensure that others seeking help won’t fall prey to this cruel scheme.
4. Conducting Sham Surgeries
One of the most unsettling aspects of surgery is the complete vulnerability it entails. Patients must trust a team of strangers to anesthetize them, cut them open, and manipulate their internal organs. Without the assurance of highly skilled professionals, such procedures would seem like outright crimes. Sadly, some of these professionals are not above committing such acts.
Consider Dr. Spyros Panos, an orthopedic surgeon at Saint Francis Hospital in Poughkeepsie, New York. Despite his qualifications, Panos allegedly faked surgeries or performed them with substandard skill. Over 250 lawsuits from former patients reveal that he conducted unnecessary surgeries on some and botched operations on others. In certain cases, he sedated patients, made incisions to simulate surgery, and then stitched them up without performing any actual procedure.
Panos’s practices allowed him to schedule up to 22 surgeries daily, far exceeding his colleagues’ monthly averages. At least one of his questionable procedures resulted in a patient’s death. While Panos has remained silent about the allegations, his social media and blog ironically portray him as a dedicated physician. Fortunately, he has been convicted and has fully confessed to his actions.
3. Conducting Unnecessary, High-Risk Surgeries on Elderly Patients
Like other facilities on this list, Sacred Heart engaged in systematic Medicare fraud at patients’ expense. To carry out this multimillion-dollar scheme, hospital administrators paid kickbacks for patient referrals and used ambulances to bring patients to the emergency room, triggering automatic Medicare billing. They also prolonged hospital stays unnecessarily and performed risky surgeries on elderly patients, sometimes with deadly outcomes.
One of the most egregious offenders, Dr. Vittorio Guerriero, allegedly caused breathing complications in at least 28 patients, necessitating tracheotomies. During these invasive procedures, which involved drilling holes into patients’ throats, five individuals died. The corruption was so rampant that Sacred Heart was forced to close after authorities seized its financial assets.
2. Unnecessary Chemotherapy Treatments
Anyone familiar with chemotherapy knows two key facts: it’s designed to combat cancer, and its side effects include hair loss and significant physical discomfort. Given that some chemo drugs can lead to severe issues like lung damage and permanent hearing loss, it’s crucial that the treatment is only used when absolutely necessary.
Unfortunately, the world is full of preventable suffering, partly due to oncologist Farid Fata, who infamously administered cancer drugs to individuals without cancer. Following an FBI investigation, the U.S. government filed a complaint revealing that Dr. Fata fraudulently billed Medicare for $150 million over three years. His deceitful practices included treating patients for incorrect conditions and concealing cheaper treatment options. A nurse working under Fata reviewed 40 patient charts and found that 95 percent were receiving inappropriate care.
In some instances, Fata prescribed lifelong drug treatments even when surgeries could have cured the condition. Most shockingly, he falsely diagnosed patients with cancer to profit from the resulting tests and chemotherapy. After being arrested in 2013, Fata now faces hefty fines and a potential 10-year prison sentence.
1. Exploiting the Homeless for Unnecessary Medical Procedures
It’s now evident that some medical professionals will go to extreme lengths of dishonesty for financial gain. While we hope those dedicated to saving lives have moral limits, this wasn’t the case in California, where vulnerable individuals were exploited as human ATMs by hospital administrators.
A network of Los Angeles medical facilities was exposed for luring homeless individuals into undergoing unnecessary medical tests. Using small bribes, homeless people were transported to hospitals for subpar or nonexistent treatment, only to be dumped in the notorious Skid Row area. These fraudulent treatments were billed to Medicaid. In one alarming case, a homeless woman was given a nitroglycerin patch for a fabricated condition, causing a dangerous drop in her blood pressure.
This scheme relied on paid recruiters who gathered and returned homeless “patients.” These orchestrated hospital visits generated over $16 million for the hospital chain. However, Scott Johnson, an employee of Union Rescue Mission, noticed the suspicious shuttle activity and alerted the police. A thorough investigation uncovered the scam, resulting in a $16.5 million settlement.
