Investigating Doctors WHo Over-prescribe
My grandfather was a doctor, working until he was eighty years old as a family practitioner in the same Detroit hospital for five decades. He died of cancer two years after retirement in a dingy room in the very hospital he’d served in. He’d never gotten rich, and did house calls for free because that’s what a good doctor did. I admired his black leather medical bag, the size of a pumpernickel loaf, packed with the standard knee-knocker, silver stethoscope, blood pressure kit, and small pack of Lucky Strike cigarettes that sustained him and, eventually, quietly tucked him into death.
Today I spent four hours investigating a two-thousand page medical file full of red flags for doctor fraud. The doctor’s patient, a dishwasher, had alleged eighteen body part injuries in a Cumulative Trauma claim resultant from one year of work. What the rest of us call soreness and fatigue, the patient had been calling a disability, but the real culprit became the patient’s doctor, who immediately prescribed five medications (three narcotic pain killers, one muscle relaxer, and one tranquilizer), eventually ordered eleven different MRIs in-house, and scheduled a re-examination every two weeks.
All the patient had to do to continue getting his disability checks was show up for the unnecessary MRIs, comply with physical therapy, and keep taking his pills. If a urinalysis showed no drugs in his system, the insurance adjusters would stop his payments under the assumption that his pain was no longer real.
The patient wanted his disability checks, so he had to take the drugs. And yet, none of the patient’s MRIs had been remarkable beyond their padding of the doctor’s bottom line at five grand a pop.
After a few months, the doctor had groomed a steady income stream: The patient had become an addict from the over-prescribing of narcotics, returning to the doctor for refills and exaggerating his pain to get the higher doses appropriate to his strengthening addiction.
Stronger pills were prescribed, more MRIs ordered, and the patient eventually suffered from real physical ailments that needed treating. The bilateral shoulders, the bilateral knees, the bilateral wrists, and the gastrointestinal problems he’d originally claimed had now become amplified as a consequence of the body breaking down from the narcotics in his system, and from the lifestyle that comes with taking them.
Doctor fraud — milking the insurance companies, for starters — is easier to suspect than to prove. In assisting with a conviction, an investigator must identify “intent.” Did the medical provided mean to order unnecessary MRIs and turn his patients into drug addicts, or was he just bad at his job? Wasn’t the patient exaggerating ailments so he could take a break from work, and the doctor simply rooting for a diagnosis?
Or, was the doctor taking advantage of a classic co-culpability scam, letting the patient lie to him so that the doctor could lie to the insurance company in return? Those second homes, rental investments, and Audi Q8s don’t come cheap, after all.
In contrast to proving doctor fraud, it is often easy for insurance companies to prove that a patient is exaggerating his pain: Under examination, a patient might state that he is too injured to lift a gallon of water, but under surveillance the patient is identified that same afternoon bench pressing like a maniac at his local gym — in investigative terms, we call this discrepancy, “acting outside of his stated limitations.”
Surveillance video becomes evidence that the patient is intending to defraud his medical provider in order to obtain the pharmaceuticals he’d become addicted to. In a best case scenario, the drug addicted patient is simply cut off from his supply, the insurance company refusing payment. In worse cases, the patient is prosecuted for filing a fraudulent medical claim and providing false information during exams.
Occasionally, the patient does time. If receiving probation instead, he is ordered to pay restitution to the big box insurers. The doctor, of course, skates with his medical practice, and bank account, intact.
I loved my grandfather. I loved the way he drove or walked slowly toward places that he cared about: A patient’s home, a restaurant once a week, the small rooms in the hospital he patrolled, and the inevitable small rooms of the soul that each of us moves toward when time beckons.
I loved that he cared about medicine. As such, I grew up caring about it, too, honoring those in the medical profession with a feeling of intimacy I have been hard pressed to explain. Today, though, there’s a doctor who could use a little prison stretch on the books, just a few months to get his head straight. I hope I can help put him there.
Right now, in the profession that sees me with my own black bag packed tightly with tools (the slim computer, pocket-sized DVR and tripod, rubber-banded batteries and digital voice recorder chronicling this doctor’s statement), I have a rare chance to make a difference.
Often enough, my investigations involve finding someone. Today, I am lucky to know right where he is.
When Your Surveillance Subject Turns Up Deceased
The week before Christmas, I was hired to find a guy who’d absconded from a drug-addled history with the state of Idaho. Database searches had been leading nowhere for my client, so I was called to surveil the man’s last known address, corroborate his absenteeism, and canvas the neighborhood for leads. This type of case, “finding somebody,” is frequent — and always interesting to me, since the premise of the casework is both literal and existential: Where does a man go, after deciding to leave?
In 1990s’ movies and novels that affected my aesthetic, men and women flee an existence in search of either peace or adventure, escaping either violence or its cinematic opposite, boredom. The road between here and salvation is usually a lonely desert full of creeps and sex addicts, with the promise of an ocean on the other side. In my experience as a private investigator, the storyline for fugitives from place or lifestyle hasn’t much changed.
It was thirty-two degrees an hour before sunrise when I parked my vehicle in an upscale neighborhood of townhomes, cut the engine and set my surveillance camera on a monopod gripped to the dashboard. For three hours, I stared at a two-inch monitor and watched the stars fade away, the sky turn dirty blue, the frost on rooftops sparkle like methamphetamine across the coffee tables of my subject’s last thirty years.
Field work tells you what it wants you to do. The client has a hunch, but strategies can change quickly when boots hit the ground. The neighborhood seemed magazine quality, too polished for my subject to be living in, too ornamental for his particular brand of darkness to be comforted by. I knew this because I was similar inside.
Intuition is a valuable investment property; the earlier you buy into it, the richer you get. My ghost brain was telling me that my subject had never hung his clothes in the home I’d been surveilling, only used it as a mailing address, numbers to put on a Cash for Car Title application, a black hole for creditor demands. Of the hundreds of people I’ve investigated, nearly half had a mailbox to Nowhere.
I briefly and unfruitfully canvassed the neighborhood, then returned to my base and immediately ran a death records search.
What I discovered was that the subject, a white male in his sixties, had recently perished in a small motel room in coastal California, having crossed the desert and found his ocean, alas—and yet alone. The cause of death was suicide by gunshot wound to the head.
The death certificate even had the room number of the motel, which I Google-Imaged: Outside, a rectangular swimming pool sparkled with the same pastel undertones of green and blue that have accompanied all swimming pools, forever. Palm trees stood guard, the pool in the shape of a grave for the lost, who leave us.
I have always wanted to run to the ocean. There’s a landlocked inversion in my head sometimes, not mental illness but like woodsmoke or smog that settles into the eyes a few times each winter. The story goes that seaside there is balance, the burn drifting away, the smell of saltwater as thick as cotton candy in the air. Everything, even loneliness, just melts on your tongue. And yet always the question is both literal and existential: Where does a man go, after deciding to leave?
When diving, how deep is the pool?
Using fingerprint technology to track the victim instead of the perp
I recently published a book, The Kill Jar, about the Oakland County Child Killings, which occurred over a 13-month period from 1976 to 1977 in the Detroit area. I spent approximately 10 years researching the story, which ended up being as much about my own history with violence as it was about the case, allegedly cold for nearly 50 years now. The murders of the four children related to the case remain officially unsolved. The book, however, details the many reasons that sensible people should believe this case was—contrary to the official narrative—at least partly solved during the early investigative stages, the results quashed.
Central to my argument was a cataloging of evidence found on the bodies, which contradicts the ongoing investigative narrative that there was no physical evidence on the children, ages 10 through 12, each of whom was abducted, held in captivity for extended periods, and eventually asphyxiated. Medical examination and autopsy narratives obtained through the Freedom of Information Act reveal that evidence cataloged as early as 1976 and 1977 was substantive enough to solve most major crimes of this type under today’s prosecutorial standards. Blood, semen, saliva, fingerprints, and human hair fragments were retained but quashed.
It would be unfair to claim that 1970s investigative bodies—which obviously lacked our currently technology—could have used much of this evidence to great end. Investigators did not quash evidence because of an inherent understanding of its future value. Lies were told—and leads were buried—because of an interrelated narrative detailed in the book; a story you’ve no doubt heard before, about the corrupting power of moneyed classes, prosecutors covering their rear ends, and cops caught in the middle.
During and after my writing of The Kill Jar, some of this uncovered evidence was DNA tested. A hair fragment found in the vehicle of a known pedophile, currently serving a life sentence for other crimes, was a DNA match to evidence obtained from two of the bodies. Another individual doing time today—a man who was a teenager and molestation victim in the 1970s—was a DNA match to evidence found on a third body. Without confusing the issue, suffice it to say that the evidence now being tested is linking the crimes to multiple perpetrators, and within these links is the story.
For many years, I spent a lot of time thinking about the evidence left behind on the victims: blood on the shirt and torn underpants, saliva inside the jeans, fingerprints and human hairs on the exterior of a winter coat, and the semen—which nobody really wants to think about. What else did the killer, or killers, leave behind? Which living suspects could be fingerprinted today for comparison to yesterday’s crimes? Whose incarcerated inner cheek could be scraped with a cotton swab for DNA extraction? During the decade of my investigation and writing of The Kill Jar, my focus was often narrow, homing in on those bits and pieces the perpetrator(s) left behind.
Recent technology has evolved to the point that a bullet casing scrubbed with soap and water, leaving no residual fingerprint capable of being isolated by traditional dusting, can still reveal a shooter’s identity in some cases. The shooter’s fingertip moisture can act as a corrosive to the metal casing, so with certain metals and conditions, the individual essentially acid-brands each fingerprint while loading the bullets. These prints, previously written off as nonexistent in the case of a wiped-down surface, remain ripe for extraction. The cold case implications are momentous, as old evidence bags full of metal handguns, clips, and casings get a second look.
There are several new advances in fingerprint technology worth noting in greater detail, but VMD technology (short for Vacuum Metal Deposition)is especially interesting in that it essentially pulls prints from metals via a process of heating other, newly introduced metal fragments to a vapor and allowing them to adhere to the print as a means of highlighting it.
This may be minor for the Oakland County Child Killer hunt. After all, these four kids were murdered by asphyxiation. What I’ve been hunting, however, is the perpetrator’s trace evidence left on the victim—that fingerprint. What if, though, I consider the opposite: What about the evidence the victims left behind? The fingerprints these children imposed upon the metal surfaces during their captivity, the handles or runners of the vehicles used to abduct them, or the bric-a-brac of a suspect’s residence? If prints on a bullet casing can remain for decades, then prints on the remaining personal objects of a victim can be lifted and compared to the personal objects confiscated from a suspect.
We are all made of moisture and skin cells and blood, of tissue and ligaments and cartilage and bone, and of other organic matter that one does not have to be a scientist to understand. If you touch a thing, that thing has been imprinted with a memory of the moment. As the fortune cookie says, “A part of us remains wherever we have been.”
I have been searching through those parts that a perpetrator left behind, each victim of the Oakland County Child Killings a vessel for the memory of those moments besmudged by violence of a cellular level. Today, I wonder, within those visitations, what did the victims leave behind on their perp?
The Tricky Business of Promoting True Crime
I didn’t read a true-crime book until after I’d written my own. This would explain why my true-crime work, The Kill Jar, doesn’t play by the rules. I simply didn’t know there were any rules until after I wrote it. The Kill Jar is as much a memoir as a dissection of the Oakland County Child Killings circa 1976 to 1977 in Detroit, and thereby falls outside the norm.
Mostly, the book gets a lot of four- and five-star reviews from readers who appreciate that I wove my personal narrative with the narrative of the crimes. There are also readers who say things like, “Who cares about Appelman’s shady, drug-addicted girlfriend! I want to know about the murders!” And I’ve been accused of being a narcissist for speaking about myself in the same sentence as the dead, even though a major goal of the book is to connect the living with those who we’ve lost. Insinuations that I’m self-serving are always hurtful but those few disgruntled readers approach The Kill Jar through a strict true-crime genre lens, so they’re understandably disappointed. They don’t get what they expect and they give the book meager stars to reflect that. I’ve mostly stopped reading reviews, but on occasion, I will glance at my Amazon rating, and I’ll feel either joy or anguish—predicated not by the reviews themselves but by the degree of shame I feel at having looked at the reviews in the first place.
I like to think that public reception doesn’t matter, that we write the book we were meant to write. In fact, I didn’t even set out to write about a true crime event. But perhaps I should have known I would end up in this genre: As a child, somebody had tried to abduct me during a period when the city of Detroit was on alert for a serial killer of children. It’s natural that my own abduction story, as uneventful as it was, would make me obsessed with unsolved child killings, which would turn into a major focus of my work.
I need to confess, though: I’ve always been an obsessive. Once, a woman from my graduate school disappeared for two days. She was rumored to be suicidal and I spent approximately 24 hours out of 48 driving in a one-hour radius around her home, intensely searching for her. She turned up in a motel room 10 minutes beyond that radius, alive but having overdosed. Later, when she got out of the psychiatric ward, we took a walk and held hands. But here’s the twist: I barely knew her. Rather, I had obsessed about her possible demise and, in doing so, had briefly fallen in love—not with the woman but with her potential absence.
There was also a brief period in my life when I would park my car outside a certain mobile home community where 12 out of 30 residents were registered sex offenders. I took my lunch breaks sitting behind tinted windows and watching the community entrance. I like to think I was standing guard, trying to protect future victims, but like most obsessives, I was also standing guard over something from my past. In this instance, I think I felt compelled toward duty and service. I was somewhat darkly honoring the lives of those I hadn’t the power to affect when it might have mattered most.
In writing The Kill Jar, I also set out to tell a story that deals with my obsessions. One of the unforeseen consequences of exploring the Oakland County Child Killings (OCCK), as with any true crime exploration, is that the victims’ remaining loved ones were affected by my obsession. In my book, my intention was to treat the dead and living alike with great respect. Upon reflection, I can see moments when I inadvertently overstepped. I give myself 4.5 out of 5 stars for consciously caring about everyone my research and writing touched. I was pretty good, but I wasn’t perfect. I remember reading from The Kill Jar to a public audience, with 150 people present. One of them was a family member of an OCCK victim. I spent a lot of time schmoozing the crowd, exciting them with tales of how my book found its way to a publisher. But later, the shame I felt for doing this was overwhelming. My obsession had shifted from selling the case to selling the book.
Last week, a TV show, which my book was the springboard for, debuted on the Investigation Discovery Network. Titled Children of the Snow, the four-hour docuseries chronicles, among many other things related to the OCCK investigation, my personal hunt for the truth behind these killings. I was an on-camera investigator and one of the executive producers, so of course I wanted people to watch the show. I sent out messages about the project via Twitter, Instagram, Facebook, and LinkedIn. I updated my website and sent emails. I texted friends and used my family members to help spread the word through their own social platforms.
But at some point, a few days after the airing of Children of the Snow was met with accolades, I watched a cold rain fall outside my living room window and felt that familiar shame again. I spend a lot of time alone, writing in rooms that nobody visits, speaking to walls that don’t speak back, so it’s natural to want company, to want an audience, to nearly beg for a conversation about what I’ve been up to. I’m alone with my process and I’ve now dedicated 14 years of my life to thinking about four children I never knew. That’s important, right? That’s what I tell myself, anyway, when the machine (the publishing industry) requires that I promote the material at my own time and expense. In fact, if I don’t promote The Kill Jar, the machine might just turn itself off to me.
I have other obsessions besides the dead. One day, I hope to write about life. Sometimes I think about Mark Stebbins, Jill Robinson, Kristine Mihelich, and Timothy King—each a victim to the OCCK—and I imagine them playing in the grass somewhere, or I imagine the chlorinated smell of their hair after a swim, the hot sunlight across their cheeks. I like to think that those perfect moments, for all of us, can outlast the darkness.
But I think part of the shame I feel comes from my accidental objectification of the dead. I know, deeply, there are many reasons to have written about the OCCK case, not the least of which was to provide exposure in an effort to solve these crimes. Still, I think my fluctuating sense of shame is important to maintain because writing about murder is really something. The dead bang their fists on our doors, telling us they’ve paid enough. They don’t want a ticket to whatever show we think we’ve done them justice by. When I’m writing, the threat of the dead approaching my threshold keeps me honest. If they never show up again, I hope this means I’ve done my job or, at least, whatever job I could do with my limited skill set. True crime is, after all, a story of the once-living, those as close to our hearts as our own loved ones and neighbors. As an honest person, I might sell you a copy of my book but I wouldn’t sell you out. Why should I be any less careful about my relationships with the dead?
When the subject of A Surveillance Op Turns up Deceased
The week before Christmas, I was hired to find a guy who’d absconded from a drug-addled history with the state of Idaho. Database searches had been leading nowhere for my client, so I was called to surveil the man’s last known address, corroborate his absenteeism, and canvas the neighborhood for leads. This type of case, “finding somebody,” is frequent — and always interesting to me, since the premise of the casework is both literal and existential: Where does a man go, after deciding to leave?
In 1990s’ movies and novels that affected my aesthetic, men and women flee an existence in search of either peace or adventure, escaping either violence or its cinematic opposite, boredom. The road between here and salvation is usually a lonely desert full of creeps and sex addicts, with the promise of an ocean on the other side. In my experience as a private investigator, the storyline for fugitives from place or lifestyle hasn’t much changed.
It was thirty-two degrees an hour before sunrise when I parked my vehicle in an upscale neighborhood of townhomes, cut the engine and set my surveillance camera on a monopod gripped to the dashboard. For three hours, I stared at a two-inch monitor and watched the stars fade away, the sky turn dirty blue, the frost on rooftops sparkle like methamphetamine across the coffee tables of my subject’s last thirty years.
Field work tells you what it wants you to do. The client has a hunch, but strategies can change quickly when boots hit the ground. The neighborhood seemed magazine quality, too polished for my subject to be living in, too ornamental for his particular brand of darkness to be comforted by. I knew this because I was similar inside.
Intuition is a valuable investment property; the earlier you buy into it, the richer you get. My ghost brain was telling me that my subject had never hung his clothes in the home I’d been surveilling, only used it as a mailing address, numbers to put on a Cash for Car Title application, a black hole for creditor demands. Of the hundreds of people I’ve investigated, nearly half had a mailbox to Nowhere.
I briefly and unfruitfully canvassed the neighborhood, then returned to my base and immediately ran a death records search.
What I discovered was that the subject, a white male in his sixties, had recently perished in a small motel room in coastal California, having crossed the desert and found his ocean, alas—and yet alone. The cause of death was suicide by gunshot wound to the head.
The death certificate even had the room number of the motel, which I Google-Imaged: Outside, a rectangular swimming pool sparkled with the same pastel undertones of green and blue that have accompanied all swimming pools, forever. Palm trees stood guard, the pool in the shape of a grave for the lost, who leave us.
I have always wanted to run to the ocean. There’s a landlocked inversion in my head sometimes, not mental illness but like woodsmoke or smog that settles into the eyes a few times each winter. The story goes that seaside there is balance, the burn drifting away, the smell of saltwater as thick as cotton candy in the air. Everything, even loneliness, just melts on your tongue. And yet always the question is both literal and existential: Where does a man go, after deciding to leave?
When diving, how deep is the pool?
Investigating Doctors who Overprescribe
My grandfather was a doctor, working until he was eighty years old as a family practitioner in the same Detroit hospital for five decades. He died of cancer two years after retirement in a dingy room in the very hospital he’d served in. He’d never gotten rich, and did house calls for free because that’s what a good doctor did. I admired his black leather medical bag, the size of a pumpernickel loaf, packed with the standard knee-knocker, silver stethoscope, blood pressure kit, and small pack of Lucky Strike cigarettes that sustained him and, eventually, quietly tucked him into death.
Today I spent four hours investigating a two-thousand page medical file full of red flags for doctor fraud. The doctor’s patient, a dishwasher, had alleged eighteen body part injuries in a Cumulative Trauma claim resultant from one year of work. What the rest of us call soreness and fatigue, the patient had been calling a disability, but the real culprit became the patient’s doctor, who immediately prescribed five medications (three narcotic pain killers, one muscle relaxer, and one tranquilizer), eventually ordered eleven different MRIs in-house, and scheduled a re-examination every two weeks.
All the patient had to do to continue getting his disability checks was show up for the unnecessary MRIs, comply with physical therapy, and keep taking his pills. If a urinalysis showed no drugs in his system, the insurance adjusters would stop his payments under the assumption that his pain was no longer real.
The patient wanted his disability checks, so he had to take the drugs. And yet, none of the patient’s MRIs had been remarkable beyond their padding of the doctor’s bottom line at five grand a pop.
After a few months, the doctor had groomed a steady income stream: The patient had become an addict from the over-prescribing of narcotics, returning to the doctor for refills and exaggerating his pain to get the higher doses appropriate to his strengthening addiction.
Stronger pills were prescribed, more MRIs ordered, and the patient eventually suffered from real physical ailments that needed treating. The bilateral shoulders, the bilateral knees, the bilateral wrists, and the gastrointestinal problems he’d originally claimed had now become amplified as a consequence of the body breaking down from the narcotics in his system, and from the lifestyle that comes with taking them.
Doctor fraud — milking the insurance companies, for starters — is easier to suspect than to prove. In assisting with a conviction, an investigator must identify “intent.” Did the medical provided mean to order unnecessary MRIs and turn his patients into drug addicts, or was he just bad at his job? Wasn’t the patient exaggerating ailments so he could take a break from work, and the doctor simply rooting for a diagnosis?
Or, was the doctor taking advantage of a classic co-culpability scam, letting the patient lie to him so that the doctor could lie to the insurance company in return? Those second homes, rental investments, and Audi Q8s don’t come cheap, after all.
In contrast to proving doctor fraud, it is often easy for insurance companies to prove that a patient is exaggerating his pain: Under examination, a patient might state that he is too injured to lift a gallon of water, but under surveillance the patient is identified that same afternoon bench pressing like a maniac at his local gym — in investigative terms, we call this discrepancy, “acting outside of his stated limitations.”
Surveillance video becomes evidence that the patient is intending to defraud his medical provider in order to obtain the pharmaceuticals he’d become addicted to. In a best case scenario, the drug addicted patient is simply cut off from his supply, the insurance company refusing payment. In worse cases, the patient is prosecuted for filing a fraudulent medical claim and providing false information during exams.
Occasionally, the patient does time. If receiving probation instead, he is ordered to pay restitution to the big box insurers. The doctor, of course, skates with his medical practice, and bank account, intact.
I loved my grandfather. I loved the way he drove or walked slowly toward places that he cared about: A patient’s home, a restaurant once a week, the small rooms in the hospital he patrolled, and the inevitable small rooms of the soul that each of us moves toward when time beckons.
I loved that he cared about medicine. As such, I grew up caring about it, too, honoring those in the medical profession with a feeling of intimacy I have been hard pressed to explain. Today, though, there’s a doctor who could use a little prison stretch on the books, just a few months to get his head straight. I hope I can help put him there.
Right now, in the profession that sees me with my own black bag packed tightly with tools (the slim computer, pocket-sized DVR and tripod, rubber-banded batteries and digital voice recorder chronicling this doctor’s statement), I have a rare chance to make a difference.
Often enough, my investigations involve finding someone. Today, I am lucky to know right where he is.