MUST BE ABLE TO PASS ALL ORIGINALITY TESTS.
Dr. Robert Smith owned his family practice for over 20
years. He came from a family of success. His father was a brain surgeon and his
mother a well-known author. His younger brother, Saul, owned his own accounting
firm for several years, but came to work with Dr. Smith after he sold it for a
After graduating at the top of
his class from Johns Hopkins University, Dr. Smith was awarded a cardiothoracic
surgery fellowship in New York. He spent a few years there and was well on his
way to fulfilling his dream of becoming a heart surgeon. During this time,
however, his father became ill. Dr. Smith decided to return to his hometown of
Zoar, Ohio, to take care of him. Under Dr. Smith’s care, his father started
showing signs of improvement. He was glad not only for his father, but that he
could go back and continue his pursuit of becoming a heart surgeon. On the day
he was set to leave, his mother became ill and died a few days later from a
rare form of cancer that showed no symptoms. The devastation hit the family
hard. Saul was still in college, and Dr. Smith’s father needed someone to be
with him at all times. Dr. Smith decided to stay in Zoar to take care of his
father. He opened up a family practice in the town, thus putting his dream of
becoming a heart surgeon on hold indefinitely.
Over the years, Dr. Smith
sometimes felt regret that he never achieved his dream, but his job as the town
doctor had been fulfilling. Now Saul was working with him, helping with the
business. This made things significantly easier for Dr. Smith, who haphazardly
kept his own books and patient files. One day, as Saul organized Dr. Smith’s
piles of paperwork, he noticed there were charges to Medicaid that must be a
mistake. While most of the population of Zoar, Ohio, was considered low-level
income and qualified for Medicaid, this was not the case for all patients.
There were several elderly middle- and higher-income families who regularly
visited the office and usually paid with a check or cash. Saul assumed his
brother’s administrative office skills were poor and aimed to fix it. However,
as Saul organized the paperwork and checked files, these charges to Medicaid
appeared to increase, dating back at least five years.
Saul approached his brother.
“Robert, are you aware you charged Medicaid for Mr. and Mrs. Bennett’s visits?”
“Hmmm. Let me see the paperwork,”
Dr. Smith asked. Saul handed it to him. Dr. Smith glanced at the document and
said, “Yes, they are over age 65, so I made a bill for Medicaid.”
“But we have records they paid
you with cash,” Saul replied. He handed Dr. Smith an old receipt. “And there
are similar instances with some of your other patients. Besides, Medicaid is
for low-income patients, not the elderly. Mr. and Mrs. Bennett are clearly not
Looking a little bit flustered,
Dr. Smith replied, “Saul, you know how I am with details. I’m no good at it.
That’s why I hired you. Thanks for catching my mistake.” Dr. Smith walked back
into his office and shut the door, leaving Saul standing in the hallway with a
stack of files.
Saul knew what his brother gave
up for their family and the good he did for the families in this small town,
but he was convinced these charges were not accidental. There were too many of
them and the amount of money charged exceeded $ 75,000.
“What happened to all that
money?” Saul wondered. He also wondered how to handle the situation. He thought
to himself, “How can I report this without sending Robert to jail? If I don’t
report it and Medicaid finds out, I could go to jail and lose my accounting
license. This is such a small town. If anybody finds out, we’ll never live it
down.” At that moment, the phone rang, and Saul was the only one there to
Saul’s ethical dilemma.
would Medicare fraud be a white-collar crime?
should Saul approach the situation?