Investigators Contend Use of ‘Drivers’ to Solicit Patients Was Key to Scheme

In the smaller provincial villages of Vietnam, where automobiles are scarce, some doctors pay pedicab drivers, or “bicycle boys,” to solicit patients and drive them to their clinics.

“It was illegal . . . (and) it was considered very, very unethical,” said Dr. Tran Minh Tung, former minister of health for the Republic of Vietnam. “But there are black sheep in any country.”

Investigators with the state attorney general’s Bureau of Medi-Cal Fraud believe the idea of using “drivers” to solicit patients may have been brought to the United States by a few of the Southeast Asian doctors who resettled here after the fall of Saigon.

‘Gas’ Money Paid for Driving Patients

Investigators now contend that such drivers were the backbone for the method of Medi-Cal fraud uncovered in February, 1984, by Southeast Asian Project investigators.

Because many Vietnamese immigrants have neither the language skills nor the money to use public transportation, some Vietnamese physicians began paying “gas” money to refugees who had cars to drive patients to their offices.

But instead of providing transportation for ailing refugees, some doctors and drivers discovered it was easier and more profitable to simply collect Medi-Cal cards and bill the government for non-existent office visits.

Prescriptions written on the Medi-Cal cards were then taken to pharmacies owned by Vietnamese and sold or exchanged for items such as fabric and cigarettes. In some cases, those things were mailed to Vietnam and sold on the black market. The pharmacist, meanwhile, would bill Medi-Cal for the drugs on the prescription.

“The initial legitimate use of drivers some years ago was a good idea,” said Dan Beall, senior special investigator for the Bureau of Medi-Cal Fraud. “It became corrupt when they decided to eliminate the middle man, meaning the patient.”

Used Them in Vietnam

Dr. Vu Dinh-Minh, a pulmonary specialist who practices in Santa Ana, said “a few” of those arrested in the Southeast Asian Project case are known to have used drivers in Vietnam, although he would not mention them by name.

But Beall and some Vietnamese physicians who requested anonymity said Dr. Quynh Gia Nguyen, a general practitioner and acupuncturist who settled in Westminster in 1975, used pedicab drivers to solicit patients for his clinic in the provincial city of Nha Trang, about 160 miles northwest of Ho Chi Minh City.

Nguyen, 61, has been described as the personal physician to former South Vietnamese Premier Nguyen Cao Ky, who now owns a Westminster liquor store. He and his wife, Lan Phoung Nguyen, a cosmetologist who shares office space with her husband on Bolsa Avenue, were arrested in the Southeast Asian Project investigation and remain free pending their trials. Attorneys for the couple would not allow them to be interviewed.

“Drivers books” seized by investigators detail a similar pattern. Simply stated, drivers would be paid from $4 to $7 for each Medi-Cal card brought to the doctor’s office. The driver would be given from $5 to $7 for new patient cards and $4 for old cards.

The driver would bring any number of cards to the physician, who would peel off stickers on the card, attach it to a patient treatment form and bill Medi-Cal from $12 to $56, depending on the type of “examination” the doctor claimed to have provided. Additional amounts would be billed for blood, urine or other tests.

Handling of Prescriptions

The doctor would then write prescriptions on each of the stickers, most often for drugs such as Ampicillin or Tylenol, valuable commodities on the Vietnamese black market. The driver would then take the prescriptions to a pharmacy, where he would be paid $1.50 for each one. The pharmacist would then either sell the prescriptions for an amount less than the drugs were worth or trade them for other items.

Dung Vu, a driver for Dr. Van Thi Nguyen, a Westminster physician convicted in the Southeast Asian Project investigation, said in court documents that he made $700 to $800 a month delivering patients and patient cards to Van Thi Nguyen and to other Orange County doctors. Dung said Van Thi Nguyen initially refused to accept only the cards when Dung began working for him in late 1982. Van Thi Nguyen later relented, Dung said, and at the time of his arrests, about half Dung’s trips to the office involved delivering only Medi-Cal cards.

Sentence Completed

Van Thi Nguyen, 61, who grew up in Hanoi, was educated in Saigon and later worked as a company physician for U.S. corporations in South Vietnam, completed a one-year jail sentence for Medi-Cal fraud last month. Van Thi Nguyen, who worked in a clinic managed by defendant Loan Bich Truong for a guaranteed salary of $4,000 a month, told Orange County Deputy Probation Officer Mark Takayama that he feared that if he did not participate in the fraud, “he would lose patients and (Truong) would replace him with another doctor who would agree to this practice.”

Drivers books taken from Van Thi Nguyen’s office show that from July, 1983, to February, 1984, he paid $17,969 to 72 drivers, according to court records. In 1983, he received $159,741 from Medi-Cal.

Truong, 30, who pleaded guilty to Medi-Cal fraud and was sentenced to 16 months in prison, told the same probation officer her actions were “dumb and stupid.” Her husband, pharmacist Bach Xuan Nguyen, 36, who was given a three-year prison sentence for Medi-Cal fraud, said in a report by county Deputy Probation Officer Katherine Sano: “There was a lot of competition (among Vietnamese physicians), and billing for non-service became a common practice.”

Struggle to Build Practice

Dr. Tran Nam Vuu, 46, another physician convicted in the Southeast Asian Project investigation, also said it was the struggle to build up a practice that led him to defraud Medi-Cal. Vuu, who after the fall of Saigon spent a year in a Vietnamese “re-education” camp before fleeing the country with his family in 1978, also said in his probation report that he wrote prescriptions without examinations because he feared patients would go to another doctor.

“In other words,” Vuu said, “the motivation for my improper and illegal act are the weakness of the heart and the failure of the nerve.”

There are other explanations given for the actions of those physicians and pharmacists involved in Medi-Cal fraud. Some believe a sudden increase in Vietnamese physicians in late 1981 and 1982 led to a vicious competition for patients. Still others believe that the physicians were eager to earn the money and regain the social status they held in Vietnam. Some say the doctors were manipulated by their wives, who in many cases managed their husbands’ offices. Vietnam is to some degree a matriarchal society, and women handle money matters.

Detective’s Theory

Police Detective Doug Zwemke, who directed the Southeast Asian Project investigation in San Jose, advances the theory that many of the physicians involved in fraud here were probably among those who worked in the provincial towns in Vietnam and made a habit of paying kickbacks to the “bicycle boys.”

“They had the idea there,” he said, “and they simply carried it over here.”

Prosecutor Ron Prager believes there is no mystery about the motive.

“Greed,” he said.