By Kristen Hinman Spring 2004 Part 2 (Go to: Part 1)

How are all of these charges interrelated?

According to the indictment, Help the Needy established U.S. bank accounts beginning in 1995 with false social security numbers and an inaccurate birth date for the signatories.

It proceeded to launder money from its institutional accounts to a personal one, the indictment says, and funneled at least $4 million to an account held by Maher Zagha in Jordan.

From time to time, Dhafir ordered Zagha to transfer money “from the relief” to individuals in Iraq, the charges state. At least $165,000 appears to have been sent there. At the same time, Help the Needy represented itself on public documents as an organization that helped needy Americans, according to the indictment. Dhafir’s accountant has already pled guilty to filing false documents to this effect with the IRS, and prosecutors may use him as a witness in the case against the doctor.

Prosecutors also claim that Help the Needy gave donors receipts falsely stating that their donations were tax deductible. Yet the IRS had never granted it tax-exempt status. In addition, Dhafir is accused of deducting his own donations to the group; he evaded $398, 410 in personal income taxes from 1996 to 2001, according to the indictment.

Prosecutors also charged Dhafir with health care fraud and lying to Medicare investigators. For one, he allowed an unlicensed laboratory technician to regularly administer injections and, on occasion, chemotherapy, when he was not at the practice. The technician signed Dhafir’s name as if he had given the care, according to the charges. There are also issues with Dhafir’s billing. A physician can charge a higher rate for services provided when he (or a back-up physician) is in the office, whereas a nurse may bill at only 85 percent of that rate when the doctor is out. The government maintains that Dhafir’s office billed Medicare at the physician’s rate on numerous occasions when Dhafir was traveling. And, they say, he lied to Medicare authorities in a September 2002 audit; Dhafir told them he hadn’t needed to hire a back-up physician, though the government found he’d traveled overseas three times prior to the review.

I re-read these charges on the train one day, traveling to my parents’. I also read reports that Dhafir’s associates – Ayman Jarwan, Help the Needy’s executive director, Osameh Al Wahaidy, and Ahmed Yusef Ali – pleaded guilty to conspiracy, sanctions violations and falsifying documents, respectively, and that Dhafir’s wife pleaded guilty to lying to Medicare officials about the doctor’s whereabouts.

I got off the train feeling troubled an hour later and met my mother at the car. They seem to have so much against him, I said, climbing in. Someone who seemed to only help people, my mother protested. How could they?

I would learn that weekend, and later, that few in Dhafir’s world outside the mosque knew of Help the Needy’s work. My mother and others had heard casually from the doctor’s employees that he provided medical care in Iraq, but no one I spoke to had asked him about it, and he hadn’t solicited patients for donations. Patients were aware of the doctor’s absences, though: he’s celebrating Ramadan, attending a conference, doing mission work, the staff told them.

Employees, for their part, knew the organization existed but were fuzzy on its details. Some remembered Dhafir’s generosity – how he solicited and boxed up medical supplies, clothing and toys to send to a city or country in distress. (Worshippers at the mosque recalled him doing this, too.)

Islamic Society worshippers, on the other hand, knew a bit more. They saw Dhafir less frequently on the weekends these last few years because he spent considerable time traveling for Help the Needy. Some had attended slide show presentations at which Dhafir explained the devastating effects of the sanctions on Iraq’s food supply, hospitals, schools and children. I went to the Internet and found a recording of a Help the Needy presentation that Dhafir had given on a trip through Australia in early 2001. Iraq was obliterated during the 1991 Gulf War, even its garbage trucks, he said. Ever since, the country’s children had been suffering.

Remains of depleted uranium, which had been used to destroy Iraqi tanks, had draped the ground like dust, causing birth defects and cancer, Dhafir said. Medical schools used textbooks printed in 1991, anesthesia didn’t exist, and schools hadn’t desks or pencils. He showed photographs: deformed, malnourished, burned and vomiting children. Destruction, destruction, destruction, he repeated. Hopelessness. Hatred. Resentment. These children could be mine or yours, he said. And, at the end: Our project provided meat for 900,000 people last year. We won’t rest until the world lifts the sanctions.

“Eyes dampened with tears, many emptied their wallets, while the sisters rid themselves of their jewelry to donate to this honorable cause,” recounted a summary of that trip in the newsletter “The Call of Islam.” “Others donated mobile phones and watches which were auctioned to the audience. In an unforgettable moment in Sydney, one brother donated $10,000 [USD $7,600] without any hesitation when the audience was prompted.”

Any listener of that speech could sense Dhafir’s dismay over the effects of the U.S.’s post-Gulf War Iraq policy. But Dhafir didn’t engage the audience in America-bashing, and he made clear that he didn’t want to comment on the Iraqi regime, thereby distancing himself from making political statements against both his native and adopted lands. Muslims from the Islamic Society confirmed to me that Dhafir shied away from politics. When asked for his opinion of Saddam Hussein at a June 2002 Help the Needy presentation, Dhafir responded, I don’t want to get involved, according to Mohammed Khater, a fellow worshipper.

Yet, Dhafir had previously told Khater, privately, that he hated and feared Hussein. Khater advocated political activism, suggesting they and other Muslims speak up. But Dhafir refused. (He also declined to participate when a local group, led in part by Khater, approached him for help in forming an organization to propel Muslim voter registration.) To establish credibility for Help the Needy, Dhafir felt he needed to separate himself from any political initiative, Khater explained. But Dhafir had an even more pressing reason to distance himself, according to Khater: Hussein’s wrath. The doctor feared what Hussein might do to Dhafir’s family members still in Iraq as well as the people working on the ground there on Help the Needy’s behalf, upon learning of the doctor’s work, Khater said.

Was keeping a diminished visibility one reason not to apply for the license? A source close to Dhafir suggested that the doctor had indeed applied but hadn’t heard anything. His lawyer refused to answer the question.

Dhafir kept a profile so low that his name is not listed in any Help the Needy documents or bank files, according to court papers. Danya Wellmon, Dhafir’s medical technician, who pledges total allegiance to the doctor – yet may be a witness for the prosecution at his trial – said she was publicly recorded as the organization’s president. She’d never met the other board members or attended any meetings, however.

Did you feel used by Rafil Dhafir? the grand jury asked her. No, I felt moved to help, Wellmon said. She didn’t see anything improper. If she’s called on at the September trial, she’ll tell the truth as she knows it, she said, because lying is a serious sin for Muslims. I have to answer to God, she said. Khater remarked similarly when justifying Dhafir’s doings: He wasn’t dealing with anybody but God, Khater said. It sounded like what two other people, a friend and an employee, said they learned from Dhafir: that religion is a way of life, not just something practiced on Sundays.

AT Faxton Hospital Regional Cancer Center’s satellite office in Rome, my mother said she felt like a number. The employees never recognized her name or face. White cinder-block walls in the basement waiting room gave her goose bumps. And it was tiresome getting Grandma’s blood tested at the hospital several days before an appointment, a task that had taken only a minute at Dhafir’s. By May, Grandma was exhausted, adjusting poorly to the changes. She came to the house for a Mother’s Day picnic and barely pecked at the food. She’s anemic, that’s all it is, my mother heard the new doctor say at the next appointment.

But by June, Grandma seemed worse. She went to the surgeon, who scanned her yellow complexion, ordered blood drawn, a liver panel and a liver scan. “Ouchouchouchouchouch,”

Grandma moaned as the technician ran the instrument over her. She started a new round of chemotherapy that day.

About two weeks later, Grandma seemed more spirited. She told the doctor she was feeling OK. But unlike Dhafir, always optimistic, the new doctor broadcast his pessimism and issued a death sentence. You don’t look good, he said. Your mother is not going to be here for Christmas, so let’s be realistic, he continued, addressing my mother and uncle in my grandmother’s presence.

They were stunned. Mom felt better, and she’d recovered her glow, they argued. The doctor finally agreed to continue the chemotherapy.

Next appointment, July 3. That day, however, he changed his mind and rang a hospice organization. A week later, Grandma slumbered into heaven, serene and submissive.

My mother struggled to find solace. Dhafir’s way was not everyone’s, she had learned, and she wondered if that had made a difference.

The new oncologist’s office had only weighed Grandma once and tested her blood only monthly, my mother noted. And the doctor didn’t order a liver panel in the blood work until the surgeon discovered the cancer’s return, my mother said.

At Dhafir’s practice, Grandma’s weight, blood and liver were monitored meticulously, every visit, so that she would be given appropriate doses of chemo. Gauging the right dose was essential, because it prevented her from getting sick and kept her treatments on schedule, Dhafir’s former nurse practitioner explained to me. Sickness and skipping treatments – which Grandma had experienced at the new doctor’s office – was exactly what Dhafir’s office always tried to avoid. True, Grandma was going on 80, and she wouldn’t have lived forever had Dr. Dhafir not been arrested. But my mother believed she would have lived longer with him around.

Just days before Grandma died, a judge denied the doctor bail for the third time. In February this year, he was again refused bail, deemed a flight risk. Dhafir’s brother, a dermatologist in Orchard Park, N.Y., and more than 30 friends, meanwhile, had demonstrated their faith in Dhafir by offering more than $1 million to guarantee his appearance at trial. As for Dhafir’s patients, many await his release and return to his office in Rome. Some won’t see another doctor until then.

Dhafir and I never met while my grandmother was alive. We began corresponding this January. I wanted to visit, learn more about him, I wrote. His reply: Yes, come.

Suddenly, on the eve of our late-February visit, Dhafir’s lawyer contacted me. You can’t go without us; we’ll have to reschedule, his secretary said.

I went anyway. Three times, in fact, before finally showing up when Dhafir still had spare visits. (He gets five weekly but no more than two per day.) The doctor entered the cubby in toothpaste-green jail garb and a gray thermal shirt. He clutched a book and a cobalt-blue athletic jacket. He didn’t set them down on the desk. Instead, he cocked his head, eyeing me, for a minute.

I was keenly aware of the fact that my visit might rob the doctor of one from his wife. (It didn’t.) I knew he might also be chagrined to see me without his lawyer. Is he annoyed? I wondered, watching him stare at me immobile and speechless. I touched the glass and mouthed, it’s Kristen Hinman. We gestured for a minute, picked up the telephones, and the doctor sat down. I had to know if you still wanted to talk to me, I explained. Dhafir reassured me. There was no problem, I could return for hours and hours, as many as I wanted. Just call the lawyer, he’ll reschedule. (It’s now April, and he hasn’t.) You’ll get your story; you’ll be the first, he said. I exhaled. This was progress.

Even if he still seemed mysterious. The visit lasted no more than five minutes.

When I turned to go, he tapped the glass. Say hello to your mother.

* Rafil Dhafir is an honorary member of the BRussells Tribunal.

KATHERINE: I have a couple of comments to make on this article for clarification.

1. The Social Security number that the government said was false was a number issued to Maher Zagha when he was a student at Onondaga Community College (located in Syracuse). He used this number without any problems, including getting a driver’s license.

2. The technician that Kristen Hinman mentions was highly qualified and highly respected in her field (I believe she taught other technicians), she had also received years of training from Dr. Dhafir. When Kristen Hinman said she was “unlicensed” I believe she simply meant that the technician did not have a Medicare number that would allow her to bill by herself.

3. The whole Medicare case (25 counts) revolved around the “Incident to” rule (incident to the Dr.’s treatment). During the trial the defense proved that Dr. Dhafir’s reading of how to submit billing under this rule was correct. The technician did not have a Medicare number of her own which meant she could not submit her own bills. The procedure was that she should write the Dr’s name on the bill and it would be submitted like this (the paperwork was not physically submitted, submissions were done electronically, the paper work was for the office records only). During the trial the prosecution spent days on end getting the two nurses and the technician to verify their signature on the forms (proving nothing, except that they had indeed signed the forms). The defense called one witness for 15 minutes, this was the top Medicare authority person, and he confirmed Dr. Dhafir’s reading of how bills should be submitted. Also, Dr. Dhafir was put on a “pre-payment flag” in 1992 after he wrote a forceful letter to Medicare, therefore his bills were not paid by Medicare before they had been examined. For people interested in more information here are some links:

Medicare Letter:

Last day of the proceedings with “top” Medicare guy:

Dr. Dhafir’s trial concluded today, Wednesday, January 26, 2005

4. From my witness of the proceedings I believed that much of the money that the government was accusing Dr. Dhafir of stealing actually went on treatment. When Mrs. Dhafir was sentenced she was ordered to pay back $62,000 to Medicare. On the day of the sentencing I asked the head prosecutor, Michael Olmstead how much of that money actually went on medicine and he said he did not know. I then went to the prison to ask Dr. Dhafir (this was the only time I visited him and was for about 5 minutes). Dr. Dhafir told me that 90% of the money that Mrs. Dhafir was to pay back to Medicare actually went on chemotherapy medicine (this leaves 10% of the payment for Dr.’s time, nurses time, technician time and blood work tests). He also told me that in 2002 his office spent more on medicine alone than they were reimbursed from Medicare. Access to the records could verify this, but Dr. Dhafir has been denied access to all of his records.

Also, a person knowlegeable in the medical field told me that Medicare fraud usually involves fictitious patients and made-up diseases, Dr. Dhafir’s case had none of this. As I understood it from the proceedings the government were saying he billed wrongly and therefore Medicare should have reimbursed him nothing, as a consequence he was to pay it all back to Medicare. I was present through all the Medicare part of the proceedings.

Go to: Part 1