Dr. Muhamad Aly Rifai is a psychiatrist in rural Pennsylvania that I have written about before. He practices medicine as an internist and psychiatrist in the Greater Lehigh Valley area of Pennsylvania. The Lenape Indians called this area home until they were forced out, after which it was settled by German immigrants in the 1700s who were fleeing religious persecution and war. Allentown is famous for being the hiding place of the Liberty Bell during the Revolutionary War, as well as being in a song by Billy Joel.
This area of Pennsylvania is not wealthy, having ascended with the rise of Bethlehem Steel in the early 20th century and fallen since, but it has a natural beauty that persists. Dr. Rifai was the CEO and Chief Psychiatrist and Internist of Blue Mountain Psychiatry, and a clinical professor of psychiatry and medicine at the Gelsinger Commonwealth School of Medicine and also the Philadelphia College of Osteopathic Medicine, and is board certified in Internal medicine, Psychiatry, Psychosomatic Medicine, and Addiction Medicine.
He was, in fact, a fellow of the American Psychiatric Association and the Academy of Psychosomatic Medicine, as well as President of the Lehigh Valley Psychiatric Society. Luckily for America, the DEA’s vaunted AI, called “The Beast,” stepped in to protect citizens from this ne’er do well, pointing its digital finger at him back in 2022. The algorithm had apparently decided that Dr. Rifai, like so many other doctors of color, was not doing things right. I’m not saying they tried to make it racist, just that they succeeded either way.
It claimed that there were four cases of psychotherapy worth $43.59 each that it did not think had been performed. Extrapolating this back for seven years and assuming that this unproven charge was an example of his entire practice, it calculated that he had cheated the federal government out of $1.3 million. The prosecutor quickly went into headline-grabbing mode, telling the media that more than 24 hours a day were billed for 2015 and that deceased patients were billed after their deaths, devastating the doctor’s reputation.
Usually, in these cases, the crushing weight of federal power, combined with the complete destruction of a doctor’s practice and name, is enough to make physicians fold and plead guilty, not seeing much left worth fighting for and fearing the loss of liberty and family. Dr. Rifai, however, had legal experience and was more familiar than most with expert witness testimony. Expert witnesses, at their best, can be an invaluable service to the process of justice in any court.
As long as they objectively state the true standard of care and not extreme opinions, they may personally hold. At their worst, they destroy any semblance of fairness. Accepting large payments to send colleagues to prison for decades or even life for the crime of not agreeing with the government’s opinions on the practice of medicine. Quite often, these opinions are sincerely held as not being trained in medicine, the prosecutors do not understand the role of the general physician or specialist.
They routinely lambast doctors for treating patients under thirty or over fifty, those with a criminal record, or even, those who “look like junkies.” Ignoring that fact that young people and old people get hurt and sick, that we don’t have access to accurate databases of criminal history and cannot discriminate based on that status anyway, and that no one agrees on what “junkie” looks like or even if the term should be used at all. I say it should not.
Dehumanizing our patients in this way should be anathema to any compassionate physician worthy of the label. You will also see them tell juries that “the doctor did not even order an MRI!” when these studies are documented in the history and prove to the medical eye injuries from which no patient ever truly heals. Why get another one? Just so we can be indicted for ordering “unnecessary tests?” They also misunderstand what specialists and generalists caring for complicated patients do.
When it comes to complicated illnesses with a long history of treatment and medical care. We spend most of our time studying the patient’s chart, looking for anything that might have been missed or could be elucidated further, deciding on a probable course of action, and creating a provisional plan before we even see the patient. This is all done before we see or sometimes even schedule a patient. I personally would not accept patients on controlled medication for care unless they had seen a specialist or had cancer.
That’s not because I don’t think patients sometimes need them. I do. It’s because I had decided, around 2018 or so, to let specialists start controlled medication care. I would consider continuing it if I felt the chart and my evaluation justified it, with the benefits outweighing the risks. I would also depend on my learned colleagues to share their expertise and insights, helping me care for my patients. I would have loved to have someone with Dr. Rifai’s qualifications in my area.
None of this mattered to the DEA when they came for me, and it didn’t stop them from coming after Dr. Rifai. Another note. Dr. Rifai is a psychiatrist, and it is not unusual for psychiatrists to go off the physical exam from the referring GP and not bother with one themselves. A specialist’s time is in high demand, with patients sometimes waiting many months to be seen. The patient is not well served by us performing a medical student comprehensive exam when these are also well documented in the chart.
In this case, the government derided a brief psychiatric intervention as a “15-minute med check,” a term eliminated from CPT terminology back in 2013.” Where did the government go for ammunition against the doctor? To disgruntled employees, of course. If you’ve read my article on the three mortal dangers to your practice, you’ll recognize this tactic. One of the government’s relied upon coding “experts” had no training beyond high school and, on the stand, retracted his prior sworn statements, admitting to flawed analytics.
A registered nurse testifying for the prosecution admitted tearfully that her conscience did not allow her to support the government’s claims. Don’t you think the government knew this before putting these people on the stand? A DEA-sponsored undercover police officer had failed to detect any diversion but insisted that the forms she had filled out years before were forgeries. These records would have existed in the charts prior to the indictment, so Dr. Rifai was supposedly psychic enough to predict a witness years before trial.
Perhaps he was tapping into the collective unconscious Jung was always going on about. But psychic or not the good doctor was no fool when it came to legal preparation. Unlike yours truly, he knew to hire healthcare specialist attorneys and experts to defend him. One of these was the renowned law professor Paul Hetznecker. Professor Hetznecker is not just an attorney; he is a civil rights attorney and member of the Defender Association of Philadelphia.
He also teaches courses at Arcadia University on civil rights, surveillance, and the criminal injustice system. I may have edited that last part a bit. I’m a bitter soul these days. He has a long history of fighting for the freedom of others, which you can read about here. Suffice it to say that he does not assume the government is correct about anything, much less everything, as so many criminal defense attorneys do when representing physicians in federal court.
He also had an expert coder who simplified the billing process for the jury and exposed the government’s flawed analytics. This is essential. I had a toxicologist take $20 thousand and not even show up for me, but that’s a different story for another day. Complicated subjects of science and medicine require experts who can boil everything down to the essentials. It usually also requires charts and graphs. Without visuals, your jury is usually at a loss, and they’ll be prone to accepting the government’s arguments.
Anyone without extensive medical training will have trouble understanding the subtle difference between a discrepancy of opinion between the charged doctor and the government’s experts and a criminal act. Finally, he had an expert psychiatrist explain that most of what a psychiatrist does is talk to a patient, forming the bond of trust necessary to start the healing process.
The jury acquitted Dr. Rifai, but he’s not out of the woods yet. The government never admits a mistake. They will hound his state medical board to sanction him, and they’ll use their administrative powers to punish him further for the crime of being innocent.
