Me Against the Mob
You Gotta Be Making This Up
It was the mid 1980’s, and I was on the faculty at Brown University in Providence, RI when I was approached by investigators from the US Treasury Department. I know that the FBI usually investigates Medicare fraud, but I think it was Treasury that called me. They wanted me to review some records at Kent County Hospital, a small hospital, in Warwick, RI. Kent County, and specifically a cardiologist named Felix Balasco, was placing almost as many cardiac pacemakers as Rhode Island Hospital and Miriam Hospital, both of which were major cardiac centers. The feds wanted to know if the pacemakers were justified. I agreed to do it. So, after I finished my day at the Miriam Hospital, I would go home for dinner and then to Kent to review records. My pile for each night was waiting for me on a table in the record room.
I started about 7 PM and would work for a few hours. Several nights a man in a long black leather coat opened the door and stared at me. He never said anything, and he did not stay long enough for me to talk to him. I began to get concerned, so I called my friend, Renn Olenn, since deceased. (I wish I could stop saying that about my friends.) Renn was a lawyer who knew everything that was going on in Rhode Island. I told Renn my story, and he promised to get back to me.
Renn called about 2 days later and said, "You are in deep XXXX. Felix Belasco is Raymond Patriaca’s bother-in-law.” For those of you not familiar with the former New England crime scene, Raymond Patriaca was THE boss of the New England mob
I was now worried. I had visions of my house being machine gunned like Sonny Corleone’s car in the 1972 film, “The Godfather.” I called the folks at Treasury and told them I wanted out. They refused. I was their star witness and the case could not succeed without me. I think they threatened a subpoena, but I do not remember any of this clearly. I do remember that I could not sleep. Two days later Renn called again, and this time he said something like, “I have great news. Felix is screwing some coke head in Newport. Raymond is pissed. You are OK.”
So, I call the feds to tell them that I was back on the case. But several months later they called and said that they were dropping the case because it was too hard to prove Medicare fraud. Now I’m upset because I had not found a single case where I thought the patient needed a pacemaker. In addition, many of these patients got a temporary pacemaker the night before the permanent pacer was placed. This was also at a time when you could see patients every two weeks for six months after the implant for a pacer check. This meant you could charge for an office visit and an EKG. This was a fraud factory, and the product was money. I didn’t think someone should get away with it. Remember, I was in my 30’s, so pretty naive.
My blog on March 26, 2024 (1) was on the importance of saying good things about other clinicians “when appropriate”, and not saying anything bad, but the piece did include the line: “Obviously, my advice to avoid saying something negative does not apply to real incompetence where you have a duty to speak to the appropriate people.”
So, I knew a reporter for the Providence Journal named Irene Wielawski. I told Irene the story, which she detailed in a front page article for the Journal. That put the case back on track. I prohibited use of my name in the Journal article, but did testify. Felix was sentenced to 10 years in prison and fined $70,000.(2) The government charged that Balasco was paid between $250 and $400 per cardiac pacemaker by Pacesetter Systems Inc. of Sylmar, CA as inducements to implant the devices. (3) He did not go to jail for medical fraud because that is “hard to prove”, but because he received kickbacks from the pacemaker company. Irene was a finalist for a 1987 Pulitzer Prize in Specialized Reporting (4) and subsequently moved to the Los Angeles Times.
That is a story of serious medical fraud and a clinician’s waste of resources. My ultimate intent is to discuss what we all can do to reduce medical costs, but this blog is long enough already. We’ll pick up on the theme in the next installment.
2. https://www.latimes.com/archives/la-xpm-1986-04-06-me-25126-story.html
3. https://www.upi.com/Archives/1986/01/18/Convicted-cardiologist-faces-up-to-35-years-in-prison/3781506408400
4. https://www.pulitzer.org/finalists/irene-wielawski
#mafia # Felix Balasco # Irene Wielawski #medicine #cardiology #medical costs #medical fraud #pacemaker #Pulitzer
Dan: Thank you for reading the story, and for keeping in touch. Paul
What a story. Must have been scary. Congratulations on what you were able to do!