"I Think You're Trying to Guilt Me": Why a Doctor Who Paid Back Medicare Got More Time

A physician told a federal judge he paid back all of the money. He'd scratched a check to Medicare. His wife, he said, has significant health issues.

The judge told him, "I think you're trying to guilt me," and sentenced him above the guidelines.

A lot of people in our community were confused. What is wrong with what the physician said? Paying the money back is a good thing, right? And a wife with health issues is certainly a mitigating factor. It's worth noting in the probation report, and addressing it at sentencing makes sense.

So why did this judge go above the guidelines? I think it came down to how the physician told his story.

Look at it from the judge's chair

If you're preparing for a sentencing hearing, approach it from the eyes of a judge or a probation officer. What do they hear routinely? I didn't have bad intentions. They're fixated on the result.

If you talk about all of the money you paid back, it would be easy for a cynical judge to deduce you paid it back because you want to avoid prison and you have the money.

I'm of the opinion your lawyer sells the great stuff: the cooperation, paying all of the money back. Let them sell that. If you pled guilty, especially if you're in a position of power and prestige like a doctor, I believe you need to convey a slightly different message.

That's the first exercise. These videos are of no use if you don't leave with some critical thinking about what you're going to do next. Approach everything from their perspective.

Why did you become a doctor?

This judge has values like community, commitment, and public service. Judges chose to become judges for a reason.

I would argue this physician chose to become a physician for a reason. God knows how hard he worked to get through high school, college, medical school, the boards, the testing. For a very long time, he did it the right way.

Then he went rogue. He billed improperly, got reimbursed fraudulently, got indicted, and paid the money back. Fine.

Beyond the money, he told the judge my wife is sick. That feels like manipulation. A judge could say, if you were so concerned about her health, you wouldn't have broken the law.

It would have made more sense to share some similar values. Why I chose to become a physician and help people. That I did it the right way for a very long time, and when things went south and I made some bad financial decisions, I chose to take shortcuts. I got away with those shortcuts. I concealed them, and I continued and continued, and eventually they caught up with me. I became the person I never thought I could be.

When you tell the story effectively, which he did not do, you can ask the judge without telling the judge. It's the beauty of storytelling. You're asking the judge to look at the totality of your life. Now he's a physician in his 60s who otherwise led a law-abiding life, with a two-year window where he made really bad choices.

Federal law asks the judge to weigh "the history and characteristics of the defendant" along with the nature of the offense (18 U.S.C. § 3553(a)(1)). When you tell the judge why you became a doctor and how long you did it the right way, you're giving him that history.

So ask yourself. Have you conveyed your values to the probation officer and judge? Do they understand when you began to work? Why you contribute to your community?

If you can embrace that they are cynical, that they expect you to say one thing and do another, or cooperate to avoid prison, or give money back to avoid prison, you can begin to engineer a different plan.

You had an obligation to do better

When I came home from prison, I was begging lawyers to take my book. Nobody wanted it. The phone never rang. I'd get passes from the halfway house and go listen to judges criticize and condemn defendants, primarily white-collar defendants. I was one of those dudes.

I've attended 1,500 sentencing hearings. That's the treasure trove I share with you.

I heard some version of the same thing from Judge Wilson, Judge Blumenfeld, Judge Gee, Judge Carter. You really didn't have any excuse to be here. I just sentenced a drug dealer. He's been in and out of prison his entire life. His mother is in prison. His father was murdered. I can't justify what he did, but he kind of has a better reason than you.

If you are a physician who went to good schools and made money, own it. You had an opportunity and an obligation to do better. You were raised to know right from wrong.

He didn't do any of that. It was a singular fixation on: I paid the money back, what's the big deal?

Here's the big deal. You rob a bank, you give the money back, you've still robbed a bank.

Fix the window

A federal judge told our community in a video: if you break my window, I don't want to hear I'm sorry. How are you going to fix the window?

There was no fixing of the window here. There was no assurance he would never return to another courtroom and do this again. I paid the money back. My wife is sick.

It surprises me how many people were okay with him simply saying, what's the big deal, your honor, here's the money.

Two exercises before you write a word to the court

First, if you created a victim, how well do you identify with your victim? Perceptible or not. It could be a person, us taxpayers, or Medicare.

Second, on a scale of 1 to 10, are you just issuing happy talk? I'm sorry. Brighter future. It will never happen again. I'm committed to making amends. A lot of the ChatGPT AI talk.

Or, on a scale of 1 to 10, are you following through on that commitment? What would that follow-through look like? Something like this:

Your honor, I'm not going to just scratch a check because I have the money. I want you to know how this will never happen again. I'm still a physician. I've created a compliance program. I've put in new protocols so this can't happen again. I've begun to volunteer in my community and use some of this privilege, which I agree I have, to pass my skills and insights to people who didn't have the same opportunities I had.

That's fixing the window. A judge is more likely to believe those lines when you've done the work and can show when you started.

Had he done that, he was still going to prison. This is a judge who loathes the entitled doctor. But I don't think it would have been a sentence above the guidelines, and I don't think he would have reached out to me afterward, blaming me.

He copied our free content without knowing what to copy

We give everything away through Prison Professors, which I proudly support. This physician looked at some of our copy and content, mimicked a lot of it, didn't know what to mimic, and figured it read well. He focused on some good things he did, and the judge crushed it.

I couldn't do it on my own. I went to federal prison after three and a half years of doing nothing to prepare. I got there, found Michael Santos, and he became my mentor. I hired him to help me create.

If you are going to use our free resources, you have got to use them correctly. You've got to invest hundreds and hundreds of hours to understand how to create a narrative for a probation officer and judge. A release plan without implementation and follow-through is simply a promise. That's exactly what happened here.

Or, and here's where I absolutely agree with lawyers, don't turn in anything at all. Remember the movie WarGames? At the end, the strongest play is not to play at all.

Watch the Youtube video here.