WASHINGTON - Payback can be a bitter pill for the nation's deadbeat doctors.
The government has seized tax refunds and unemployment checks, claimed judgments against them in federal court, banned them from billing Medicare and Medicaid, even posted their names on a public shaming list.
Yet 930 medical professionals nationwide remain in default, owing the government more than $116 million for loans many stopped repaying more than 18 years ago. Among them:
Detroit dentist Duane Senior, 55, has been on the default list since 1997 and reported owing $651,783 as of Nov. 1. A graduate of Meharry Medical College in Nashville, Tenn., Senior works in a small dental practice.
Dr. Larose McCluskey, 61, of Cheney, Wash., an osteopathic doctor who graduated from the Kansas City University of Medicine and Biosciences in 1987, owes the most of anyone on the list -- $933,675. The initial federal claim against her in 1998 was for $222,055. She practiced family medicine in Washington state for about five years and then stopped to raise her four children and become a medical missionary.
Dr. Thomas McElhinney, 76, an Elkton, Fla., chiropractor who owes more than $572,900 for his training at Life University in Marietta, Ga. He relinquished his license to practice in 2004 and said he was never able to establish his practice. "Being a chiropractor sounded like a good idea at the time, but I couldn't earn a living at it," he said.
The last loans in the program came in 1998. This year, the Health Resources and Services Administration (HRSA) budgeted $2.8 million for the program, with more than a dozen employees tracking the deadbeat docs and monitoring 30,000 other professionals paying back more than $730 million on time.
The Health Education Assistance Loan (HEAL) program was intended to help keep medical training open to middle-class students starting in 1978.
The money was supposed to be a last resort -- private loans from banks, credit unions and other lenders guaranteed by the federal government to help pay for graduate study for doctors, dentists, optometrists, chiropractors and others. Interest started accruing immediately and ran into double digits for many loans.
Over 20 years, the program loaned $4 billion to about 157,000 students, of whom 95 percent have kept up with payments. Lenders for the minority that did not turned to the government when they couldn't collect. Those defaults forced Congress to appropriate more than $300 million to pay off the loans.
"It's not the government's money, it's the taxpayer's money. People in Washington tend to just let it go out the door and not worry as much about whether it ever gets paid back," said Thomas Schatz, president of the Washington, D.C., watchdog group Citizens Against Government Waste.
The HRSA has not offered a loan-guarantee program for medical education since HEAL loans ended.
Medical-school students today graduate with an average debt of more than $162,000, yet government and school officials say their loan-default rates are only about 1 percent. The overall default rate on all higher education loans is estimated at around 13 percent , according to the U.S. Department of Education.
Although the HRSA says "millions of dollars have been received from defaulters as a result of the activities associated with publicizing their names," 30 percent of the individuals on the default list today were on it in 1995.
Asked to comment on the enduring delinquency, HRSA spokesman David Bowman said in a written statement: "HRSA does not know and cannot speculate why one-third of the defaulted doctors continue on the defaulted doctors list." He declined to allow anyone in the agency to be formally interviewed on camera.
Scripps asked HRSA Administrator Mary Wakefield to comment about the effectiveness of her agency in collecting defaulted HEAL loans as she left a conference on rural health Feb. 4.
She declined to answer, but said she would try to find someone to discuss the program. HRSA officials later repeated their refusal to submit to a formal interview.
Some professionals on the deadbeat list say they didn't intend to default, but were overwhelmed by high interest rates, business mistakes and other debts.
Detroit dentist Senior said he had tried to settle his debt, but "I wasn't able to maintain that obligation." He told Scripps that he stopped practicing for a time and has other federal and state tax obligations.
"It's not really my intention to stick it to the taxpayers. I have made every reasonable effort to try and pay things back. I just haven't been as financially successful as I had hoped to have been," Senior said.
McCluskey, whose Oregon medical license expired in 2006, describes herself on her website and blog as a "board-certified, residency-trained family doc" who "sold my practice and moved out in faith" to do free medical clinics and evangelistic outreach overseas. She reports having worked in 20 countries and supports her trips with donations.
Her husband, Ronald, is also an osteopathic physician licensed in Washington state who took part in the HEAL program, but is not on the default list. Dr. Larose McCluskey did not respond to several emailed requests for an interview. A phone listing for the McCluskey family led to a disconnected number.
In Florida, as in several other states, a law allows licensing boards to suspend health professionals who fail to repay guaranteed student loans.
Chiropractor McElhinney, after having a judgment entered against him in federal court in 1996 and being warned that he faced suspension of his license in 2002, did nothing to respond, according to a June 2004 emergency suspension order issued by the Florida Department of Health.
In August 2004, McElhinney signed an agreement with the state's Board of Chiropractic Medicine to voluntarily give up his license. "When I got out of school, I was in my mid-40s and there were seven chiropractors in town. Two years later, there were 18 of us and there just weren't enough patients," he said in a telephone interview.
"I've had heart attacks and I'm trying to get 100 percent disability from the military. My hands are so bad I couldn't practice now, even if I had the opportunity. I have an adjusting table in my house, but I can't even adjust my wife," McElhinney said. He said he wasn't aware his name was still on the default list. "There's no way I could pay that back now." He said he would look into getting his debt discharged because of his disability.
Once placed on the public default list, deadbeat borrowers generally are removed only due to death or permanent disability or by reaching a settlement agreement with the Department of Justice.
The U.S. Attorney for the Northern District of New York made one such settlement last April with a Catskill optometrist, Dr. Christine Scrodanus, who had failed to make any payments on a $61,838 loan toward her medical education at Nova Southeastern University in Fort Lauderdale, Fla.
By 2007, she faced a judgment of $121,646 with fees and interest, but the government was unable to collect. In mid-2011, she was excluded from billing federal health programs. Soon after, she contacted the U.S. Attorney's office and ultimately paid $120,000 to settle the claim.
Scrodanus did not return phone calls requesting comment.
U.S. Attorney Richard Hartunian said the loans "are designed to help people get an education and help provide services to our citizens, and we take that obligation seriously. We've been aggressive in running those cases down." In some instances, his office's Financial Litigation Unit obtains sworn depositions from debtors to determine their assets and business interests.
Not every deadbeat doc is aggressively pursued. Those who have dropped out of professional practice or retired or have no assets are seldom a high priority.
Hartunian said his office was focusing on a dozen upstate New Yorkers who together owe about $1 million and appear to have ongoing professional businesses. "We all have limited resources, so we try to go after the individuals that will give us the greatest opportunity to recover those funds."
A 2010 report from the Department of Health and Human Services' inspector general used a special state database to determine that more than half of nearly 1,100 on the deadbeat-docs list at the time had no apparent income. Of the 486 defaulters who earned any money, 98 made $50,000 or more and owed more than $15 million.
"Congress doesn't provide enough resources to collect all this money," Schatz said. "That's one of the many reasons that these programs tend to drag on for many years. Congress spends more time setting up new programs than they do going after the people that don't pay the money back."