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nitude of support from the people I love — my patients, family, and friends. I gained strength and determination from my support system, and I’m grateful for that,” Dr. Jabboury said. Dr. Jabboury’s problems began be- cause his billing for the cancer drug Her- ceptin — widely used to treat aggressive HER-positive breast cancer — caught Aetna’s attention. The insurer discovered in 2007 that he’d billed for Herceptin in- correctly for several years as though it came in a single-dose vial instead of a multidose vial. Dr. Jabboury incorrectly billed insurers for all 44 units of the vial but administered less than the whole vial. His attorney, Joel Androphy, says Dr. Jabboury thought the drug lasted only 24 hours (typical at the time for similar cancer drugs), requiring him to throw away any remaining portion. Before Aetna detected the billing problem, Dr. Jabboury filed prompt pay


54 TEXAS MEDICINE September 2012


complaints against the insurer with the Texas Department of Insurance (TDI) for delayed reimbursement. Mr. Androphy says Aetna and the doctor agreed to a civil settlement of the billing dispute and the prompt pay concerns. But just when Dr. Jabboury thought the matter was resolved, he received a visit from a TDI Fraud Unit investigator. Unknown to Dr. Jabboury, Aetna had filed a complaint against him with TDI, and the department began investigating him in 2006. Once TDI began looking into the physician’s billing of Herceptin more closely, Humana, United, and Blue Cross and Blue Shield of Texas — along with Aetna — levied charges of insur- ance fraud against him. The physician faced criminal charges and the possibil- ity of jail time.


The insurance companies claimed Dr.


Jabboury owed them $1.13 million in fraudulent charges. He and his attorneys


contended the billing error was uninten- tional, not fraudulent activity. TDI spokesperson Jerry Hagins says


the agency wouldn’t comment on the case, but the department’s Fraud Unit re- ceives few health care fraud complaints. For instance, he says only 3 percent of the 11,124 fraud reports received in 2011 involved health care fraud. “Less than 1 percent of cases referred


for prosecution involved physicians ac- cused of health care fraud. Over the past three years, one physician was convict- ed on a second-degree felony related to workers’ compensation fraud,” Mr. Hag- ins said.


Not guilty At trial, the state had to prove to the jury that Dr. Jabboury orchestrated a scheme to defraud insurance companies. In his closing statement, Mr. Androphy asked the jury to look into Dr. Jabboury’s heart


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