Third Degree: A Novel Read online

  Laurel watched her husband from a bottomless well of sadness. The truth might set people free—in theory—but it was difficult to see any upside to sharing her most intimate secrets with Warren. His jealousy had always followed his insecurities. He’d never worried about buff pool boys or bohemian types, however sexy they might be. Warren worried about other doctors, or businessmen who earned more money than he did, anyone who might be ahead of him in the eternal competition that was life. If he were to learn that his whole worldview was wrong, that the greatest threat to his marriage had come from a man who wasn’t competing with him in any way—who in fact cared nothing about competition, but was only and profoundly glad to be alive (and who touched a part of Laurel so deep that her husband had never even glimpsed it)—Warren might not survive that. Watching him now, Laurel suddenly understood the essential nature of what was unfolding before her. Warren was a control freak who sensed control slipping inexorably away. First at work, and now at home. The fear growing inside him probably had no limit.

  “Hey,” Warren said softly. “If I untaped you now, would you go in the bedroom and make love with me?”

  She closed her eyes involuntarily. “If you really want it, I suppose I would. But what we need to do right now is talk. I think someone is trying to hurt you, Warren. Maybe to destroy you.”

  His chin began to quiver like Grant’s when the boy tried not to cry. “Yeah,” Warren said, his voice completely different from the one he’d spoken in a moment ago. “You. I don’t know what I was thinking, asking you for sloppy seconds. I just wish I knew how long I’ve been getting them.”

  The words stung her more deeply than she would have imagined. “Warren, please listen to me—”

  “I’m going to find out,” he vowed, slapping the side of the Sony’s screen. “This porn is just the beginning, I’m sure. I’m going to dig out every last secret in this pile of garbage before I’m through.”

  Laurel felt tears coming again.

  A savage light had entered his eyes. “Maybe we should show some of these pictures to the kids when they get home. Show them what Mom does in her spare time.”

  Her heart seized at the mention of the kids. So Warren was well aware that they would soon be home. But how did he think they would get here, with her trussed up like a turkey? Did he plan to lock her in the trunk of his Volvo and pick them up himself? The idea didn’t seem as impossible as it would have an hour ago.

  “Screw you,” she said. “You want them to stay up and watch you jerk off to soft-core on Cinemax after we’re asleep? Dictating medical charts, my ass.”

  He stared at her with visceral hatred.

  “God, we’re pathetic,” she said, meaning it.

  She had no idea what to do or say next. Warren wasn’t going to listen to anything from her. His obsession with her infidelity had nothing to do with love. It was about possession. Ownership. Someone had appropriated his personal property, and he wanted revenge. She was like all his other possessions, something to be jealously guarded, not because of her intrinsic worth, but because she was his. That concept was laughable now. The issue of ownership had been decided within two weeks after she first kissed Danny McDavitt. No matter whose ring Laurel wore, no matter who mounted her in the dark of the night, Danny owned her, body and soul. That was the reality, and nothing but death could change it.

  CHAPTER

  8

  Kyle Auster sat on the stool in examining room five and silently regarded his nineteenth patient of the day. Arthur M. Johnston. White male, fifty-three years of age, forty pounds overweight, high cholesterol, hypertension, enlarged prostate, erectile dysfunction, history of persistent alcohol abuse, osteoarthritis—the chart went on and on. An intern might look at Johnston’s record and think, This guy is sick, but Auster knew he was looking at a classic malingerer. After working seven years at the now defunct chemical plant, Johnston had somehow talked his way into a full Social Security disability (for back pain, of course). That was a couple of decades back. Now he spent his days cushioned on a carpet of pain medication, watching daytime TV, working in his garden, and taking his grandkids fishing in a boat purchased with government money.

  As he droned on about his need for constant pain relief (which only opiates could provide), Auster wondered how he’d gotten to this little chamber of hell. He’d been a goddamn ace in medical school. The only reason he hadn’t specialized in surgery was that he’d had to get out into the real world and start making money. It wasn’t as if he’d had a choice. He had an expensive lifestyle, even then. People had no idea how much money changed hands in a frat house during football season. You could dig a deep hole without ever rolling out of bed.

  “What do you think, Doc?”

  The patient’s question penetrated Auster’s reverie. “I think you’re doing about as well as you’re going to do, Mr. Johnston. You’re not going to play ball for the Yankees, but you’re not going to drop dead anytime soon either. You’ll probably still be fishing when they bury me.”

  Johnston gave a little laugh. “I hope so, no offense. But I was thinking, Doc, you know. . . . I might need some tests.”

  Auster looked back in puzzlement. Johnston had the tone of a patient who’d read some article on preventive medicine in Reader’s Digest. He probably wanted a goddamn sixty-four-slice CAT scan of his heart. “What kind of tests?”

  Johnston’s face looked blank as a baby’s. “Well, you’re the doctor. I thought maybe you could tell me.”

  Auster’s financial antennae went on alert. He glanced at the upper-right corner of Mr. Johnston’s file, searching for a faint check mark in pencil. There was none, as he had suspected. If there had been, it would indicate that Mr. Johnston was a “special” patient, meaning that he’d undergone some tests that might have been unnecessary in a strictly medical sense, but which had proved lucrative for both doctor and patient. But there was no pencil mark. So what the hell was Johnston hinting at?

  “What are your symptoms, Mr. Johnston?”

  A sly grin now, minus three front teeth. “Well, Doc, I thought maybe you could tell me that, too.”

  A few months ago, Auster would have been happy to oblige Mr. Johnston. Thorough lab work was good, sound medicine, and a chest X-ray never hurt anybody. But given the present state of affairs, Mr. Johnston’s not-so-subtle hints were like the blare of a fire alarm. Auster put on his soberest countenance, the face he used when telling people they had a disabling or deadly illness.

  “Mr. Johnston, in the past, I’ve worked with patients to solve their health problems as creatively as I could, given the state of government regulations. But recently the government has taken a dim view of that kind of alternative medicine. It’s become very risky to do anything unconventional these days. Anyone who does could be subject to severe penalties. Abusing the Social Security disability program would be a good example.”

  Mr. Johnston blanched.

  “Am I being clear enough, sir?”

  Johnston was already getting up. “You know, I think I’m doing fine, Doc, except for this back of mine. If you could just renew that prescription, I’ll be on my way.”

  Auster stood and patted him on the shoulder. “Happy to do it.”

  He wrote out another prescription for Vicodin, then, cursing under his breath, marched out of the exam room and down the hall to his private office. Things were spinning out of control. Vida was doing everything she could to erase all trace of questionable activity, but people kept crawling out of the woodwork with their hands out.

  The patients weren’t even the main problem. The real threat was the state’s Medicaid Fraud Unit. Five attorneys, eleven investigators, and four specially trained auditors bird-dogging every medical practice in the state that accepted Medicaid patients. The injustice chapped Auster’s ass no end. Many doctors refused even to treat Medicaid patients, so pathetic was the level of reimbursement. It was the humanitarians who found it in their hearts to treat the poor and indigent who got raped by the go
vernment. It made you want to leave the damn country.

  Auster knew the Fraud Unit was on his tail. Patrick Evans, his doubles partner on the high school tennis team, was an executive assistant to the governor. Pat was wired into every agency in the state, and a week ago he’d quietly informed Auster that Paul Biegler, the pit bull of the Fraud Unit, had begun investigating him, based on a tip called in to the attorney general’s office. The whistle-blower could have been anybody, but it was probably a disgruntled patient, someone who’d made a little extra money off Auster, then wanted more and got angry after being turned down. Or maybe it was a woman. Auster didn’t get many attractive female patients, but when he did, he wasn’t above a little horse-trading. An ER doc had taught him this racket during his residency. Five Mepergan could get you a hell of a blow job from a strung-out woman, and that beat seventy taxable dollars for an office visit any day of the week.

  Medicaid investigations typically lasted months before an indictment, but Auster sensed imminent danger. He felt like a rebel village waiting to be hit by government troops. The blow could fall at any hour of the day or night. The IRS was already auditing the partnership’s Schedule Cs for the past five years, and probably his personal returns, too. God knows what they’d found already. His gambling income was the problem there, although lately all he’d had to report were losses. Auster was a good gambler; he just didn’t always know when to stop. That was why he’d spent a lot of weekends working seventy-two-hour shifts in emergency rooms. Doctors were so reluctant to move to Mississippi that rural hospitals would pay large sums for ER coverage. But Auster was too old to be scrounging extra money that way. His colleagues thought it unseemly, and worse, the work itself was becoming a lot more technical. The standard of ER care was higher. Auster didn’t have time for the continuing-education classes he needed to stay competent in that arena, so that extra income had faded away.

  It was Vida who’d helped him replace it. They’d started small, sliding a little cash off the books, for example. What smart businessman didn’t do that? But they’d quickly moved on from there, and soon Auster had found himself making serious misrepresentations of fact. Up-coding Medicaid claims—charging for a Level 4 exam when you’d only spent five minutes with the patient, that kind of thing. But it was the collusion with patients that had really kicked up the cash flow. Vida got the idea from an Internet story about some Korean doctors in New York City. They’d persuaded members of the Korean immigrant community to pretend to have various ailments, then had done loads of tests and procedures on those patients and paid them a fee for their trouble. Vida figured the poorer African-American patients would jump on a chance like that, if Auster put it to them right. But she’d been wrong. Everybody jumped on it in a big way. Not one patient Auster had ever pitched had turned him down. It was a no-brainer. Everyone felt dehumanized by the healthcare system and thus eminently justified in screwing it back—just as Auster did. When he thought about how many hours he’d spent with indigent patients for no pay, he had no qualms about finding another way to get compensated for his time.

  The Medicaid Fraud Unit wouldn’t see it quite the same way, of course. Guys like Paul Biegler were congenitally blind to the color gray. If I hadn’t pushed it so far so fast, Auster thought uselessly. But he knew enough psychiatry to diagnose his own problem: poor impulse control. Nature had combined with nurture to make him the kind of man who, confronted with a hundred grand in blackjack losses, would double down rather than walk away from the table. He had the same habit with women. Two were better than one, and three better still. Ideally, you had several available at various hours of the day, every day of the week, including Sundays. That way, you moved so fast from woman to woman that you never had to focus on the complications with any particular one. Nevertheless, Auster had somehow acquired two wives along the way, probably because he tended to tell people what they wanted to hear, regardless of his true feelings.

  Just now he was managing three women full-time: wife number two, Vida, and a drug rep from Hoche. He had a backup stable of part-timers, but lately he’d been unable to do much there. His problem was Vida. She was the classic double-edged sword: an asset and a liability rolled into one. For an ex-waitress with a year of junior college, she was a whiz at accounting. And she gave great head, no question. But she had some very unrealistic expectations about the future. She’d cling to him like a terrier biting his leg, or in her case, his prick. Vida definitely didn’t fit into any of the scenarios he saw in his future. She probably wouldn’t cause much of a stir in Vegas, but they’d laugh her out of the clubs he liked to frequent in L.A., or even Atlanta.

  Auster was thinking of taking out the bottle of Diaka vodka he kept in his bottom drawer when his phone buzzed. He put his hand on the drawer handle, dreaming of the transparent fluid that dedicated Poles filtered through diamonds before bottling it in crystal. One sip could erase an hour’s worth of stress—

  “I have a phone call for you, Doctor,” Nell said through the phone’s staticky speaker. “An Agent Paul Biegler, from the Medicaid office in Jackson?”

  Auster let his hand fall from the handle. He had the sensation of a sailor who has stared for days over threatening seas finally seeing an enemy periscope rise in front of him. At least it wasn’t a complete surprise. For the hundredth time he congratulated himself on making the right political donations over the years. That was how you stayed wired in this state—in any state, for that matter—and staying wired was how you protected yourself. “Ah, is Vida up there, Nell?”

  “No, sir. I think she went out for a smoke break. You want me to try to find her?”

  He thought about it. The last thing he wanted was Vida standing at his shoulder trying to coach him through a phone call. This couldn’t be too bad. If it were, Biegler would have shown up at the clinic door with a search warrant, not called him on the telephone from Jackson.

  “Did the guy say he was in Jackson, Nell?”

  “No, but the caller ID shows a state-of-Mississippi number.”

  Auster suddenly had visions of a government surveillance van parked outside his office, a convoy of black cars filled with agents ready to tear his office apart. “Could it be a cell phone?”

  “Looks like a landline prefix to me. But I can’t be sure. You want me to take a message?”

  Auster didn’t want Biegler thinking he could be intimidated by a phone call. He’d been expecting a surprise search for the past few days. That was the government’s style. They’d show up with a search warrant, a stack of subpoenas, and a team of agents. They’d confiscate your files, your computers, every damn thing you needed to run your practice. They’d act friendly and have “informal” chats with you and your staff, every word of which would be recorded and used against you later. Then they’d stop all Medicaid payments to your business, before you’d had a chance to say one word in your defense. In short, they would ruin you, months before you ever saw a courtroom. Sometimes they even denied you a jury trial. Auster’s lawyer had given him careful instructions on how to respond in the event of a surprise search, but no advice on how to deal with an informal phone call. He would just have to wing it.

  “That’s all right, Nell,” he said expansively. “I’ll take the call.” He pressed the button that transferred the caller. “This is Dr. Auster. What can I do for you, Agent Biegler?”

  “Hello, Doctor. Nothing today, actually. This is an informal call, for your benefit more than mine.”

  Right . . .

  “I’m calling as a courtesy, to let you know that you’ve been the subject of a Medicaid fraud investigation for some weeks now. Were you aware of that?”

  “How could I be aware of that?”

  A pregnant silence. “Are you one of those people who answers every question with a question, Doctor?”

  This might actually be fun, Auster thought. “That depends on the question.”

  “Well, up to this point, we’ve mostly been conducting interviews. I wanted to let you know t
hat we’re about to move to the more proactive phase of the investigation, and that’s likely to disrupt your normal business affairs for a short time.”

  Jesus Christ. How would an innocent person react? “I’m not sure I understand. Who have you been interviewing? And why?”

  “Patients of yours, sir.”

  Sir always sounded bad in the mouth of a cop. “Patients? Why have you been talking to my patients?”

  The answering silence felt smug somehow. “Do I really need to explain that to you, Doctor?”

  Fear and anger rippled through Auster’s gut. “I’m afraid you do.”

  He heard paper shuffling. Notebook pages? “Do the names Esther Whitlow, George Green, Rafael Gutierrez, Quinesha Washington, or Sanford Williams mean anything to you?”

  Auster swallowed hard against a geyser of gastric acid rushing up his esophagus. Pulling open his top drawer, he took out a half-empty bottle of Maalox and chugged it. “They’re all patients of mine,” he coughed.