Third Degree (14 page)

“What do you think, Doc?”

The patient’s question penetrated Auster’s reverie. “I think you’re doing about as well as you’re going to do, Mr. Johnston. You’re not going to play ball for the Yankees, but you’re not going to drop dead anytime soon either. You’ll probably still be fishing when they bury me.”

Johnston gave a little laugh. “I hope so, no offense. But I was thinking, Doc, you know…. I might need some tests.”

Auster looked back in puzzlement. Johnston had the tone of a patient who’d read some article on preventive medicine in
Reader’s Digest.
He probably wanted a goddamn sixty-four-slice CAT scan of his heart. “What kind of tests?”

Johnston’s face looked blank as a baby’s. “Well, you’re the doctor. I thought maybe you could tell me.”

Auster’s financial antennae went on alert. He glanced at the upper-right corner of Mr. Johnston’s file, searching for a faint check mark in pencil. There was none, as he had suspected. If there had been, it would indicate that Mr. Johnston was a “special” patient, meaning that he’d undergone some tests that might have been unnecessary in a strictly medical sense, but which had proved lucrative for both doctor and patient. But there was no pencil mark. So what the hell was Johnston hinting at?

“What are your symptoms, Mr. Johnston?”

A sly grin now, minus three front teeth. “Well, Doc, I thought maybe you could tell me that, too.”

A few months ago, Auster would have been happy to oblige Mr. Johnston. Thorough lab work was good, sound medicine, and a chest X-ray never hurt anybody. But given the present state of affairs, Mr. Johnston’s not-so-subtle hints were like the blare of a fire alarm. Auster put on his soberest countenance, the face he used when telling people they had a disabling or deadly illness.

“Mr. Johnston, in the past, I’ve worked with patients to solve their health problems as creatively as I could, given the state of government regulations. But recently the government has taken a dim view of that kind of alternative medicine. It’s become very risky to do anything unconventional these days. Anyone who does could be subject to severe penalties. Abusing the Social Security disability program would be a good example.”

Mr. Johnston blanched.

“Am I being clear enough, sir?”

Johnston was already getting up. “You know, I think I’m doing fine, Doc, except for this back of mine. If you could just renew that prescription, I’ll be on my way.”

Auster stood and patted him on the shoulder. “Happy to do it.”

He wrote out another prescription for Vicodin, then, cursing under his breath, marched out of the exam room and down the hall to his private office. Things were spinning out of control. Vida was doing everything she could to erase all trace of questionable activity, but people kept crawling out of the woodwork with their hands out.

The patients weren’t even the main problem. The real threat was the state’s Medicaid Fraud Unit. Five attorneys, eleven investigators, and four specially trained auditors bird-dogging every medical practice in the state that accepted Medicaid patients. The injustice chapped Auster’s ass no end. Many doctors refused even to treat Medicaid patients, so pathetic was the level of reimbursement. It was the humanitarians who found it in their hearts to treat the poor and indigent who got raped by the government. It made you want to leave the damn country.

Auster knew the Fraud Unit was on his tail. Patrick Evans, his doubles partner on the high school tennis team, was an executive assistant to the governor. Pat was wired into every agency in the state, and a week ago he’d quietly informed Auster that Paul Biegler, the pit bull of the Fraud Unit, had begun investigating him, based on a tip called in to the attorney general’s office. The whistle-blower could have been anybody, but it was probably a disgruntled patient, someone who’d made a little extra money off Auster, then wanted more and got angry after being turned down. Or maybe it was a woman. Auster didn’t get many attractive female patients, but when he did, he wasn’t above a little horse-trading. An ER doc had taught him this racket during his residency. Five Mepergan could get you a hell of a blow job from a strung-out woman, and that beat seventy taxable dollars for an office visit any day of the week.

Medicaid investigations typically lasted months before an indictment, but Auster sensed imminent danger. He felt like a rebel village waiting to be hit by government troops. The blow could fall at any hour of the day or night. The IRS was already auditing the partnership’s Schedule Cs for the past five years, and probably his personal returns, too. God knows what they’d found already. His gambling income was the problem there, although lately all he’d had to report were losses. Auster was a good gambler; he just didn’t always know when to stop. That was why he’d spent a lot of weekends working seventy-two-hour shifts in emergency rooms. Doctors were so reluctant to move to Mississippi that rural hospitals would pay large sums for ER coverage. But Auster was too old to be scrounging extra money that way. His colleagues thought it unseemly, and worse, the work itself was becoming a lot more technical. The standard of ER care was higher. Auster didn’t have time for the continuing-education classes he needed to stay competent in that arena, so that extra income had faded away.

It was Vida who’d helped him replace it. They’d started small, sliding a little cash off the books, for example. What smart businessman didn’t do that? But they’d quickly moved on from there, and soon Auster had found himself making serious misrepresentations of fact. Up-coding Medicaid claims—charging for a Level 4 exam when you’d only spent five minutes with the patient, that kind of thing. But it was the collusion with patients that had really kicked up the cash flow. Vida got the idea from an Internet story about some Korean doctors in New York City. They’d persuaded members of the Korean immigrant community to pretend to have various ailments, then had done loads of tests and procedures on those patients and paid them a fee for their trouble. Vida figured the poorer African-American patients would jump on a chance like that, if Auster put it to them right. But she’d been wrong.
Everybody
jumped on it in a big way. Not one patient Auster had ever pitched had turned him down. It was a no-brainer. Everyone felt dehumanized by the health-care system and thus eminently justified in screwing it back—just as Auster did. When he thought about how many hours he’d spent with indigent patients for no pay, he had no qualms about finding another way to get compensated for his time.

The Medicaid Fraud Unit wouldn’t see it quite the same way, of course. Guys like Paul Biegler were congenitally blind to the color gray.
If I hadn’t pushed it so far so fast,
Auster thought uselessly. But he knew enough psychiatry to diagnose his own problem: poor impulse control. Nature had combined with nurture to make him the kind of man who, confronted with a hundred grand in blackjack losses, would double down rather than walk away from the table. He had the same habit with women. Two were better than one, and three better still. Ideally, you had several available at various hours of the day, every day of the week, including Sundays. That way, you moved so fast from woman to woman that you never had to focus on the complications with any particular one. Nevertheless, Auster had somehow acquired two wives along the way, probably because he tended to tell people what they wanted to hear, regardless of his true feelings.

Just now he was managing three women full-time: wife number two, Vida, and a drug rep from Hoche. He had a backup stable of part-timers, but lately he’d been unable to do much there. His problem was Vida. She was the classic double-edged sword: an asset and a liability rolled into one. For an ex-waitress with a year of junior college, she was a whiz at accounting. And she gave great head, no question. But she had some very unrealistic expectations about the future. She’d cling to him like a terrier biting his leg, or in her case, his prick. Vida definitely didn’t fit into any of the scenarios he saw in his future. She probably wouldn’t cause much of a stir in Vegas, but they’d laugh her out of the clubs he liked to frequent in L.A., or even Atlanta.

Auster was thinking of taking out the bottle of Diaka vodka he kept in his bottom drawer when his phone buzzed. He put his hand on the drawer handle, dreaming of the transparent fluid that dedicated Poles filtered through diamonds before bottling it in crystal. One sip could erase an hour’s worth of stress—

“I have a phone call for you, Doctor,” Nell said through the phone’s staticky speaker. “An Agent Paul Biegler, from the Medicaid office in Jackson?”

Auster let his hand fall from the handle. He had the sensation of a sailor who has stared for days over threatening seas finally seeing an enemy periscope rise in front of him. At least it wasn’t a complete surprise. For the hundredth time he congratulated himself on making the right political donations over the years. That was how you stayed wired in this state—in any state, for that matter—and staying wired was how you protected yourself. “Ah, is Vida up there, Nell?”

“No, sir. I think she went out for a smoke break. You want me to try to find her?”

He thought about it. The last thing he wanted was Vida standing at his shoulder trying to coach him through a phone call. This couldn’t be too bad. If it were, Biegler would have shown up at the clinic door with a search warrant, not called him on the telephone from Jackson.

“Did the guy say he was in Jackson, Nell?”

“No, but the caller ID shows a state-of-Mississippi number.”

Auster suddenly had visions of a government surveillance van parked outside his office, a convoy of black cars filled with agents ready to tear his office apart. “Could it be a cell phone?”

“Looks like a landline prefix to me. But I can’t be sure. You want me to take a message?”

Auster didn’t want Biegler thinking he could be intimidated by a phone call. He’d been expecting a surprise search for the past few days. That was the government’s style. They’d show up with a search warrant, a stack of subpoenas, and a team of agents. They’d confiscate your files, your computers, every damn thing you needed to run your practice. They’d act friendly and have “informal” chats with you and your staff, every word of which would be recorded and used against you later. Then they’d stop all Medicaid payments to your business, before you’d had a chance to say one word in your defense. In short, they would ruin you, months before you ever saw a courtroom. Sometimes they even denied you a jury trial. Auster’s lawyer had given him careful instructions on how to respond in the event of a surprise search, but no advice on how to deal with an informal phone call. He would just have to wing it.

“That’s all right, Nell,” he said expansively. “I’ll take the call.” He pressed the button that transferred the caller. “This is Dr. Auster. What can I do for you, Agent Biegler?”

“Hello, Doctor. Nothing today, actually. This is an informal call, for your benefit more than mine.”

Right…

“I’m calling as a courtesy, to let you know that you’ve been the subject of a Medicaid fraud investigation for some weeks now. Were you aware of that?”

“How could I be aware of that?”

A pregnant silence. “Are you one of those people who answers every question with a question, Doctor?”

This might actually be fun,
Auster thought. “That depends on the question.”

“Well, up to this point, we’ve mostly been conducting interviews. I wanted to let you know that we’re about to move to the more proactive phase of the investigation, and that’s likely to disrupt your normal business affairs for a short time.”

Jesus Christ. How would an innocent person react?
“I’m not sure I understand. Who have you been interviewing? And why?”

“Patients of yours, sir.”

Sir
always sounded bad in the mouth of a cop. “Patients? Why have you been talking to my patients?”

The answering silence felt smug somehow. “Do I really need to explain that to you, Doctor?”

Fear and anger rippled through Auster’s gut. “I’m afraid you do.”

He heard paper shuffling. Notebook pages? “Do the names Esther Whitlow, George Green, Rafael Gutierrez, Quinesha Washington, or Sanford Williams mean anything to you?”

Auster swallowed hard against a geyser of gastric acid rushing up his esophagus. Pulling open his top drawer, he took out a half-empty bottle of Maalox and chugged it. “They’re all patients of mine,” he coughed.

“I’m glad we can agree on that, at least. That’s probably all I should say at this time. I just wanted you to know that we’re moving to the next phase of our investigation. We’ve sometimes been criticized in the past for conducting surprise searches. I’ve even heard the phrase ‘storm trooper tactics’ used. In your case, I want to make sure that you have every opportunity to prepare your staff for the disruption. I don’t want you to feel we’ve made our investigation unduly burdensome in any way.”

What the hell is this guy up to?

“In my experience, you need to take certain steps if you want to be able to continue practicing medicine during the investigative process. You’ll probably want to make copies of your business software. I would also suggest purchasing some new computers, since we almost always remove the on-site computers from the practice.”

Auster’s head was spinning. He opened his bottom drawer and unscrewed the cap from the Diaka bottle. A hundred dollars’ worth of vodka slid down his throat as Biegler continued.

“You should photocopy any and all documents necessary for the running of your business, since we’ll probably be taking those away as well. It could be months before you see them again.”

“And when are you moving to this next phase?”

“Eight a.m. tomorrow.”

Tomorrow!
“Agent Beagle, I—”

“Biegler,” the agent cut in, his irritation plain.

“Right, listen, I couldn’t do the things you just suggested by tomorrow if I kept the staff working overnight.”

“You’re getting eighteen hours more notice than most people do, Dr. Auster.”

Stay calm, be courteous and professional at all times
—his lawyer’s voice in his ear. “Be that as it may, sir, tomorrow presents real problems. My partner, Dr. Warren Shields, is out due to illness, and consequently I have an especially heavy patient load tomorrow. It would be a huge help if you could delay your search until after the weekend.”