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Join us for a thought-provoking discussion with Jeffrey L. Fraser, a family physician who shares his experience of addiction and felony conviction, which led to his placement on the Office of the Inspector General exclusion list. We’ll explore the impact of the OIG exclusion on health care providers, underserved communities, and patients, and discuss the challenges of seeking reinstatement and accessing resources for addiction recovery. We’ll also examine the role of the legal system and politicians in supporting health care providers with addiction, and consider potential reforms to the OIG exclusion process.

Jeffrey L. Fraser is a family physician.

He shares his story and discusses his KevinMD article, “From addiction to exclusion: a physician’s struggle for redemption.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today’s show, we welcome Jeffrey Fraser. He’s a family physician. His KevinMD article is titled “From addiction to exclusion: a physician’s struggle for redemption.” Jeffrey, welcome to the show.

Jeffrey L. Fraser: Thanks, Kevin. Thanks for having me.

Kevin Pho: So we’re going to talk about your article, which also tells your story, and I know that you’ve shared your story on a prior episode of KevinMD. It’s titled “From addiction to exclusion: a physician’s struggle for redemption.” Now, tell us, how did this article come together, and how did your story start?

Jeffrey L. Fraser: Well, I think that physicians, as a whole, are a profession where the consequences we face from addiction, and from the behaviors while we’re addicted, are worse than in any other profession. The consequence that I face with an OIG exclusion is the worst that a physician can face. It’s basically career-ending. So what an OIG exclusion is, is that they prohibit you from prescribing or billing Medicare and Medicaid services.

Kevin Pho: All right, so for those who aren’t familiar with your story and didn’t listen to your episode, tell us about the events, or recap the events, that led up to your OIG exclusion.

Jeffrey L. Fraser: OK, so I’m a family doctor. I’m in an office. I became addicted to hydrocodone when I had prostate cancer. It was the first prescription I’d ever had, and that was part of my other story before. So I diverted the narcotics. That means I wrote prescriptions to my patients for pain, they brought it back to me, and I used it for about three years. So I diverted narcotics. I got caught, and my license was suspended for a year in Nebraska, because we don’t have a PHP, and that was a topic in my last article, which was talking about the need for a physician health program.

So I received a letter on August 3, 2021. I was practicing medicine in North Carolina after having been fully credentialed for both Medicare and Medicaid, with disclosure of my felony and my addiction history, practicing medicine in a small, underserved community. And on August 3, 2021, I got a letter in the mail, just regular mail, that said I was excluded from Medicare and Medicaid because of my history of the felony, not because of my addiction, just because I had the history of the felony. So when I got the letter, I informed my attorney and the hospital administration. They said, “Don’t worry about it. We’ll file for a waiver. We won’t appeal this. We’ll file a waiver. Just keep seeing patients, and we’ll get a waiver.”

The reason I wanted to write this article is that the OIG exclusion is career-ending, but there are ways to overcome it. I want to educate other physicians about that.

Kevin Pho: How common are OIG exclusions, and what are some things that physicians do to warrant getting on that list?

Jeffrey L. Fraser: There can be Medicare fraud, any history of felony. For me, it’s because I had a history of a felony for diverting narcotics. It’s not the disease itself, not the addiction, and it’s actually not the behavior. So many physicians that have done the same things that I did, divert narcotics, but were not faced with felonies, are not going to be placed on the OIG exclusion list.

Kevin Pho: Now, before you got that letter from the OIG, was it something that you would have expected?

Jeffrey L. Fraser: No, I did not expect that at all, especially, you know, when I applied for credentials for Medicare, Medicaid, and all the commercial ones like Blue Cross Blue Shield and UnitedHealthcare. On that form, it says history of felony, history of drug addiction, and I was fully credentialed and seeing patients. Now, the last time I diverted narcotics was December of 2017. So I did not expect it to happen. I thought I would have not been credentialed initially, Kevin, instead of 13 months after I pleaded guilty and nine months after I had been fully credentialed. So it just came out of the blue. I described it as a bombshell in my letter, in my article rather, because it was just unexpected.

Kevin Pho: So by the time you got this letter, you were re-credentialed, and you were seeing patients regularly as a family physician. Is that correct?

Jeffrey L. Fraser: Yeah, in a small town in North Carolina called Vanceboro. They had a doctor there for three years. I would say mostly Medicare and Medicaid patients, underserved, a very underserved community, and I was pulled out of that because of the Medicare exclusion.

Kevin Pho: All right, so you received this letter from the OIG. So tell us a story about what happened next and what your reaction was when you received this letter.

Jeffrey L. Fraser: Well, initially, you know, yeah, it’s a bad letter, but I thought, “OK, we can overcome that.” So I called my administration, I called my attorney, and they said, “Don’t worry about this. Since you’re working in an underserved area, we will file for a waiver of this exclusion. Just sit tight, keep seeing patients, don’t worry about it.” So that’s what I did.

Kevin Pho: So was that the lawyer who said that, or your administration?

Jeffrey L. Fraser: The administration and my attorney, yes.

Kevin Pho: OK. And what happened next?

Jeffrey L. Fraser: So three weeks later, the hospital administration for Carolina Health Systems in North Carolina fired me. They said that the CEO said he did not know I was a felon when they hired me, so even if they got the waiver, he couldn’t employ me, which is ridiculous. They knew my entire history. Involved in getting the waiver were a congressman in North Carolina and a state Medicaid director. All were lined up, ready to work on getting this waiver in a small town, until I was just fired. And I’ve been working to get back into medicine ever since.

Kevin Pho: And how long ago was that, when you got fired?

Jeffrey L. Fraser: It was August 26, 2021, and I’ve been fighting since 10:30 that morning, Kevin.

Kevin Pho: Now, in terms of your legal options after that, you talked to your attorney. What was some of your attorney’s counsel in terms of the options that you had?

Jeffrey L. Fraser: The options that I had were to file an appeal. You have 60 days from receipt of the letter to file an appeal. I was told specifically not to file an appeal, which I should have, because they were going to get this waiver. He said the easiest thing we can do is get a waiver of this exclusion, since you’re working in a small town.

Then it became complex, because a congressman got involved, community members got involved, and other physicians got involved. It went back and forth for a period of time, where they tried to convince the CEO to change his mind, to say, “Don’t do this to this doctor.” But regardless, by the time that they finally made their decision to let me go, the 60 days had expired. I contacted the OIG’s office and tried to file an appeal, and they said it was too late.

Kevin Pho: So the CEO could have just changed their mind, and you could have stayed employed? So this was solely on the CEO and their decision?

Jeffrey L. Fraser: It was solely on that decision, for him to say that he did not know I was a felon. It was just absolutely ludicrous. I mean, my attorney worked for them as well, a great guy, still my attorney. He knew my history when I was getting my North Carolina license. He told them about my entire history. I told the vice president, everybody, my history. They filled out the forms for me. My applications for all my credentials were filled out by that group. So they say they didn’t. Yeah, he could have just said everything was in place to work on getting this waiver done, if he would not have fired me. Yes.

Kevin Pho: So how have your last, you know, year, year and a half been, in terms of looking for employment, in terms of appealing the decision, and in terms of what you’ve been doing to get back on your feet after this? Tell us about that.

Jeffrey L. Fraser: Great question. So it’s interesting. In the interim, I’ve been hired by the government, helping with services. I now work for SAMHSA as a senior public health advisor analyst, and for HHS, but I’m still working to get back into the practice of medicine. So here’s how to work through this. State Medicaid directors in both North Carolina and Nebraska have agreed to try to find a place for me to work if I find a waiver. I also have a congressman, Greg Murphy in North Carolina, who has been great from the start. He’s still working on trying to help me.

So just to expand on that a little bit, to get past an OIG exclusion, you would still be at the exclusion office. You’re going to file for a Medicaid waiver and then also a Medicare waiver. So in a small town in Nebraska, Aurora, Nebraska, we got a Medicaid approval for the waiver, but Medicare denied that same appeal, looking at the same numbers. Same thing in North Carolina: In a small town of 200 people called Saratoga, North Carolina, they agreed to give me a waiver for Medicaid, but they denied it on Medicare, looking at the same numbers. If I can give some examples on that, if you’d like, Kevin.

Kevin Pho: Sure.

Jeffrey L. Fraser: So the town of Aurora, Nebraska, has four physicians. Two are retiring. One works part-time. They also cover two satellite clinics. That’s all they have there. There’s one group in the entire town, a small farm community in central Nebraska. So the Medicaid waiver was approved, but Medicare denied it, saying that there were 14 family doctors in the town, 49 doctors, 14 individual primary care offices in Aurora. They said within a 30-mile radius there were 348 physicians, family doctors, and 148 separate, unique family practice offices. We disputed that, and they said, “Well, we do not.” So I can guess at what Medicare provides.

So we’re still working on that. I have a lot of good people working on it: a congressman, an ex-attorney general for Nebraska, and the state Medicaid directors. When I finish this call, I will be talking to the state Medicaid director for Nebraska and trying to ask Medicare to relook at these numbers, because if they granted it for Medicaid, we’re not sure why they won’t do it for Medicare.

Kevin Pho: Now, historically, just because I’m not familiar with the numbers, physicians who are on the OIG exclusion list, is there a percentage of them that eventually can start practicing again?

Jeffrey L. Fraser: I don’t know what the percentage is. In Nebraska, I’m the only one, the first one that’s ever happened to, so it’s unique. The state Medicaid director said, “We’d love to help you. We’ve never had to do this before.” And the same thing in North Carolina. It’s a very rare thing. I do not know the percentage of doctors that actually are able to overcome this.

Kevin Pho: Have you heard stories of any successful cases?

Jeffrey L. Fraser: Rare cases. Like, if I could speak another language, like maybe Portuguese or another language, they’d say perhaps I would help. But to get the waiver, they ideally say you have to be the sole provider in a community. Well, there’s not any community, even in remote Nebraska or remote Alaska, where you’re going to be the only doctor. So Medicare did not approve them, knowing that I would not be the only doctor, but I’d be one of a few doctors. So I don’t know the statistics. It’s a really complex thing, and it’s actually very unique that it happens in Nebraska.

Kevin Pho: Now, short of this waiver, are there any other options that would have you practice again?

Jeffrey L. Fraser: Yes. So going back, past the appeal stage, the only way to do it is to get a presidential pardon, and I have sent a letter to Biden requesting a presidential pardon. Initially, I had a congressman in Nebraska that was advocating for me on that, and he’s not in office anymore. So I was told that it’s sitting in the office of presidential pardons, which is in the Department of Justice, just sitting there. So initially, this looks like a very good case. So if you get a presidential pardon, the OIG exclusion goes away, and I can give my life back to medicine.

Kevin Pho: Now, in terms of, this applies to Medicare and Medicaid. Now, again, if you don’t get this waiver, would you be able to accept cash-only patients? You know, what about commercial insurers? What about patients outside of Medicare and Medicaid?

Jeffrey L. Fraser: It’s a good question. You can own a direct primary care practice, and I have looked into that, but it’s hard to make money for at least several years doing a direct primary care practice. It can be lucrative, but in the meantime, you have to have a salary coming in and, you know, revenue coming in.

What tends to happen is if Medicare and Medicaid exclude you, then the other commercial insurance companies follow that lead. When I was credentialed for Medicare and Medicaid, they came on really quick. The first insurance company that approved me was UnitedHealthcare, when I initially did this, Kevin, and then Medicare and Medicaid, and then everybody else, just like that. So you can have a direct primary care practice where you do a cash-only basis, if you have enough funds to support yourself during the three years or so that it takes to establish a practice.

Kevin Pho: Now, if a physician is in the unfortunate circumstance of getting on the OIG exclusion list, what kind of advice do you have for that physician?

Jeffrey L. Fraser: My attorneys did not know, and I did not know, the ramifications of what happened when I pleaded guilty to my felony. I would say that if you don’t accept the plea deal, I think that a jury would have been more understanding of my situation, and my actions were based on my addiction, not just on immoral behavior, which is how I think the medical system can look at us. So I would not accept the plea deal. I’d rather go to trial.

Kevin Pho: And when you did accept the plea deal, you had no idea of this potential ramification, correct?

Jeffrey L. Fraser: I did not know this. It didn’t occur to me. My attorneys did not warn me about this. Actually, the assistant U.S. attorney who was prosecuting said, “We want to do everything we can to get you back into practice and medicine,” and prosecuted. Yeah, not knowing what would happen if you did have a felony, it’s not good. I did not get good advice.

Kevin Pho: We’re talking to Jeffrey Fraser. He’s a family physician. His KevinMD article is titled “From addiction to exclusion: a physician’s struggle for redemption.” Jeffrey, tell us some of your take-home messages that you want to leave with the KevinMD audience.

Jeffrey L. Fraser: My message would be that if you get charged with a felony for diverting narcotics, a federal felony, do everything you can not to accept the plea deal. Do not. A felony is career-ending. So do everything you can to negotiate with the prosecutor. I would have rather gone to trial.

Kevin Pho: Jeffrey, thank you so much for sharing your story, time, and insight. Thanks again for being on the show.

Jeffrey L. Fraser: Thanks, Kevin. Thank you.