When it comes to journalism and health care prosecutions, today’s “papers” are so yellow that they could damage vision like a 580 nm laser. I have personally seen and suffered from this unbalanced approach to reporting and felt a need to provide a counternarrative based on reason instead of hyperbole. After studying hundreds of cases, I will argue that in roughly fifty percent of these, the government has paid hundreds of thousands and sometimes millions of dollars to convict a completely innocent person who had absolutely no criminal intent. On the other hand … sometimes, they get it right.
When they do, we need to acknowledge it and give them credit. It proves that they do know how to do the job right. If we can get them to focus on that instead of politically based persecutions, we’ll all be better off. Today, let’s look at one of the cases that makes it easier for the public to believe that doctors are greedy and just in it for the money. There is a common misconception that doctors are “rich.” In general, we are not. Oh, we get along much better than average and have no room to gripe, but very often, the prosecutor sneeringly deriding our salaries to the jury takes home as much as we do.
That being said, we don’t make nearly enough for the government to care about our rights and freedom. You will notice a great disparity between how the DEA deals with large corporations and how it treats independent health care providers. The Sacklers’ legal department receives a phone call explaining how there are going to be criminal charges brought against their company for intentionally misleading doctors and the public about the dangers of their medications. The Sacklers’ attorneys bargain on a payoff, $225 million in civil penalties for the feds, and an $8 billion settlement.
Not for the families who lost loved ones, of course; the government doesn’t truly care about them but for the state governments. Nothing will derail a righteous political crusade faster than the unrighteous distribution of large sums of cash. But wait? What happened to the U.S. attorney explaining how “medical drug money” will be seized? Why didn’t the Sacklers get their bank accounts frozen and their homes raided? Why weren’t machine guns pointed in their faces as they were forced to crawl out of their homes on their hands and knees? As has happened to independent physicians?
We know the answer to that, my friends. Money. Real money. Not the few hundred thousand in your life savings. If you are truly rich, the DEA politely points out that you lied and killed a few thousand people, and then, over a cup of tea probably, they discuss the required payoff, money changes hands, and you’re done. State politicians can then happily balance their budgets, making up for tax breaks they gave to the very wealthy, who are now giving that sweet kickback. The poor and untreated can still wander the streets, dying and getting arrested, providing the DEA’s raison d’être and filling local jails.
The Sackler family is worth around $11 billion, according to a document released by the House Committee in 2021. So now they are left with a pitiful $3 billion in blood money. How will they ever get by? But when it comes to independent physicians, pharmacists, and now chiropractors (yes, I’m going to write about it; he owned the building the MDs worked out of, off to prison for him), things are different. The DEA agents will tell the jury that a doctor owned a nice car! Perhaps a classic old, restored car like Dr. Henry’s ’63 Rolls, or a Mercedes, a Tesla, or even, heaven forbid, a Volvo! (Yes, they did—Dr. Anand.)
The stark contrast between perception and reality in health care prosecutions is a result of the government’s selective targeting in its quest for political control. It’s hard to ignore the fact that almost every physician and pharmacist prosecuted has been independent, running their own clinics or groups, as all providers used to. However, with corporations now dominating health care, the landscape has changed. Now, we have massive companies protected by their billions, competing with individual doctors or pharmacists who are trying to survive on the crumbs falling off the table.
That’s why independent pharmacies are more likely to fill controlled medication prescriptions. The big chains can afford to just not mess with it, issuing a rule for all their chain stores to stop filling prescriptions for chronic pain patients and sometimes even addiction medicines. This is smart for them because they can survive on the slimmer margin provided by non-controlled blood pressure medications and antibiotics. Indeed, since the pharmacy is just a small part of their business, it doesn’t hurt them at all. On the other hand, the independent clinic owner is always on the border of business failure.
So, the government makes the jury think the providers are rich by showing them the gross receipts. Gross income is all the money coming into a company; it is not what you get to keep. Most independent medical clinics operate on about a 40 percent net profit margin. That means if you pull in $300k, you end up with a salary of about $120k. That’s about the income of the average USDOJ attorney. This disparity, as well as distinct racial biases, is a clear indication of the need for a more balanced and fair approach to health care prosecutions. All that being said, a few doctors can make all the rest look bad.
Two of these appear to be Drs. Desi Barroga, age 51, and Deno Barroga, also age 51. In fact, the two were twins. These doctors had an office at 7515 Greenville Ave, and there, they chose, from all accounts, to break bad. Desi had over 23 years of experience, having graduated from the University of Hawaii at Manoa in 2000. He was board-certified in physical medicine and rehabilitation. Deno had 22 years of experience, having graduated from Tulane University in 2001. He was also PM&R. Both had received some board attention, but this is not uncommon for any physician after decades of practice.
Here seems to have been the scam, and that’s what it truly is. When a physician chooses to create false records and lie to get more money, it costs everyone: the other physicians trying to make a living, of course, but more importantly, the patients and the general public because scarce health care dollars are going for treatments never delivered. Independent medical practices get by on procedures, usually EKGs, minor surgeries, and, of course, injections. While the payment for a visit is marginal, a single shot of antibiotics or steroids can take a visit from red to black. So, most doctors do these when reasonable.
But these two don’t seem to have been happy with reasonable. Drs. Deno Barroga and Desi Barroga have pleaded guilty to submitting claims for corticosteroid injections that were never given. In fact, some patients were billed for 80 injections in one day. Now, trigger point injections can help some conditions commonly treated by PM&R physicians, like myofascial pain syndrome and, to a lesser degree, fibromyalgia and tension headaches. Trigger points are sensitive areas in muscles that are painful when palpated, and these shots can help. Usually, the number of injections given is 2 to 10.
In their plea agreement papers, the brothers admitted to billing about $45 million and receiving $9 million. This may seem strange, but it’s not uncommon for doctors to only be paid a fraction of what they bill to Medicare or Medicaid, while commercial insurance usually pays more. This fraction is one of the things that make American health care completely unfair to any patient, even the insured ones. For example, let’s say you go to the ER with a cut hand. The ER receptionist will check you in, the nurse will do your vitals and check your vaccination history, and you’ll see the ER doctor, who’ll sew you up.
A few weeks later, you get a bill from the hospital and see that you were charged about $3,000 for the visit, including $50 for a Q-tip. Now you are furious! 50 bucks! For a Q-tip! The problem is that the insurance will only pay a small fee for the doctor’s time, but they will pay for supplies, so by increasing the price of the supplies, the hospital can get maybe $1,000 for the visit. The problem is that what the insurance doesn’t pay goes to you, and if you don’t have insurance, you must be billed the full amount. That’s because they can’t charge different fees for insured and uninsured patients (not legal).
You can, of course, bargain this down, which is allowed. The moral of the story is never paying retail, I guess, but when it comes to the brothers Barroga, the payout is only about 20 percent of what was billed. That’s probably because they maxed out the number of injections that would be paid for. I am told by software much smarter than me that the CPT codes for injections are 20552 for injections into one or two muscles and 20553 for injections into three or more muscles. The payment for 20552 is about $60-$70, and that for 20553 is $80-$90. These are flat fees for these shots, so how can the doctors get more?
Well, they can charge for the medications given. If they use bupivacaine, that’s up to $1.00 per milliliter given; the somewhat cheaper and shorter-acting lidocaine is only up to $0.25 per milliliter. That’s anesthetic or numbing medicine. Then, we have steroids for anti-inflammatory effects. Commonly used ones like methylprednisolone can be as much as $3 per 40 mg vial, and triamcinolone $2 per 10 mg vial. Now, for each of these visits, there’s also going to be an evaluation and management or E/M code; these are 99201-99215, depending on if this is a first visit or follow-up and how complex it is, etc.
The code for lidocaine is J2001; bupivacaine is J3490; methylprednisolone 20 mg is J1020, 40 mg is J1030, and 80 mg is J1040. If a nerve block was used, they could code 64450; if it went into a joint, it would be 20210 without guidance and 20611 for ultrasound guidance. A brief note here: do not trust me on these codes! I am not a professional biller; these could have changed, or I could get them wrong, and then any bill filed by you that is not correct can be considered fraud! Even if you did your best. That’s because they will say you “should have known.” And they routinely get convictions with that argument.
But these two doctors don’t say they made mistakes. They say they cheated. They admit to charging for injections that were never given and medications that never existed. So, looking back. Sure, they might have only gotten $80 to give the injections and perhaps $90 for a return 99213 visit, so $170, but then you add imaginary methylprednisolone at $3 and bupivacaine 3 cc at $3 times 80 … and there’s another $480 added to the $170, giving $650. Multiply that by six patients per hour, 8 hours a day, five days a week, 50 weeks a year, and you get $7,800,000. Do that for a few years, and there you go … $49 million.
It was also alleged that the doctors prescribed opiate medications just to keep the patients coming back, but this is what they say about everyone. I’m waiting to see oncologists get rolled up for “charging vulnerable patients for their health care!” and “giving them chemo just so they’d live to come back!” Anyway, these two guys were criminals, and both agreed to immediately surrender their DEA registrations and their medical licenses and to pay back whatever the court decided at sentencing. When sentenced, they could be looking at up to ten years for the one conspiracy to commit health care fraud.
And this brings up another point. The federal criminal system is designed to reward the guilty and absolutely destroy any defendant who dares to suggest that the government is not perfect in its choice of prosecution. Just like the CDC didn’t have time for evidence, the DOJ has no time for truth. But, if you shoot enough people, you’ll eventually hit one that deserved it, I suppose, and these two definitely did. Their actions are a true violation of the oath physicians take and a prime example of the office of the inspector general, as well as the DEA and the Texas Department of Insurance, doing their jobs.
So, in closing. If you are truly guilty of criminal medical behavior, do everyone a favor and retire now. That way, the rest of us won’t get thrown in with you when the media starts waxing bright yellow. On the other hand, if you are absolutely innocent and have no criminal intent, fight with every breath in your body, knowing that you will still probably lose in court but that you have stood for what is right and done the right thing. If you are guilty and caught, plead out and take your DOJ reward for being a good little criminal and making their job easier. Either way, get a good health care specialist defense attorney.
You’ll need them no matter who you are.
L. Joseph Parker is a distinguished professional with a diverse and accomplished career spanning the fields of science, military service, and medical practice. He currently serves as the chief science officer and operations officer, Advanced Research Concepts LLC, a pioneering company dedicated to propelling humanity into the realms of space exploration. At Advanced Research Concepts LLC, Dr. Parker leads a team of experts committed to developing innovative solutions for the complex challenges of space travel, including space transportation, energy storage, radiation shielding, artificial gravity, and space-related medical issues.
He can be reached on LinkedIn and YouTube.
