A Greedy and Dangerous Case of Healthcare Fraud

A fraud case involving an anesthesiologist in Dallas, Texas, U.S. is striking in its details. According to court filings, the physician – who was convicted on seven counts of fraud – was apparently greedy, negligent and, at times, just plain lazy in his approach to his work – to a degree that he endangered at least one of his patients.

Richard Ferdinand Toussaint Jr., MD, fraudulently collected $10 million from the government through bogus payment claims. His history might have been a tip-off – according to an article about his case in the Dallas Morning News, Toussaint was co-founder of a medical center that “had a history of paying physician kickbacks before it went bankrupt.”

Following that venture, he started Ascendant Anesthesia, where he made a lot of money plying his trade in local hospitals. He made a lot of money, some of it fraudulently, as it turns out.

His trial in a federal court lasted four days, and after hearing the evidence against Toussaint, the jury needed only 3 hours to convict him. Now he faces up to 10 years in federal prison and a mountain of fines.

But it is some of the details of his frauds that are really disturbing, and make clear that at least at some points, his criminal behavior put patients at risk. According to the Dallas Morning News article, “Dallas doctor who billed for services he didn't perform guilty in $10M fraud scheme”:

  • Toussaint submitted bogus claims in 2009 and 2010 to Blue Cross Blue Shield of Texas, United Healthcare, the Federal Employees Health Benefits Program and others, the U.S. attorney's office said.
  • In addition to submitting the claim for a procedure at a time when was really under the knife for surgery, Toussaint also filed claims for being present at procedures when he was out of state, at another hospital, flying in his private jet or "nowhere to be found."
  • In one case, a nurse anesthetist needed help from Toussaint but couldn't reach him because he was "asleep in bed," court records said. As a result, she "was forced to do a difficult and dangerous central line through the central artery in a patient's neck without needed assistance."

That’s not what we expect from the medical professionals that we entrust with our lives. Far from it.

There was more evidence stacked against him. According to prosecutors, there were times when his billings indicated that he was directing medical procedures – but instead was bragging to other doctors about his newly purchases luxury cars.

There is more:

The doctor also inflated the amount of time it took to perform the procedures, pre-signed patients' medical records to represent the services before the procedures took place and directed others to do the same.

It’s a scary situation concerning a doctor who has been in practice for more than 20 years. The problems embroiling his former business were probably a harbinger for what was to come. Forest Park Medical Center, the practice he co-founded, paid $215,000 in fines to settle charges of accepting kickbacks:

The government alleged that Forest Park paid the kickbacks in exchange for referrals of patients covered by the federal workers' compensation program, known as FECA.
FECA is a federal health care program that provides workers' compensation benefits to federal workers who suffer job-related injuries.
And in 2013, the hospital paid more than $258,000 to settle separate allegations that it paid kickbacks to area physicians for referrals of Tricare patients between 2008 and 2012.

One thing is for sure – investigators must be diligent in rooting out corrupt medical providers like Toussaint. It is through their fraudulent acts that the cost of healthcare continues to skyrocket. But even worse, arguably, is the negligent behavior that his greedy attitude brought to his practice. Patients could have been injured or killed, and losses would be measured not just in money – but in lives.