It was a Friday afternoon and Debbie Dillinger was hoping for a pain-free weekend. Car accidents had left the 47-year-old mother of three with chronic neck pain and headaches, and to deal with it she was visiting Dolson Avenue Medical, a clinic in Middletown, New York.
Around 5 p.m., Dillinger swung through the glass front door of the office. She checked in at a curved reception desk in the clinic’s large, open treatment area, where patients lay on massage tables and exercised on a variety of equipment. Behind the desk, a floor-to-ceiling mural of a waterfall, trees and a soaring eagle set a serene tone.
The clinic was run by two brothers, James “Jay” and Jeffrey “Jeff” Spina. For more than 30 years, they had worked in Middletown as chiropractors — medical providers who treat musculoskeletal disorders, commonly through manipulation of a patient’s spine.
On this day in March 2017, Dillinger’s treatment included something else. She was directed into one of the private rooms, where Charles Bagley, an M.D. and neurologist, would give her a facet injection. A facet joint, one of the locations where adjacent vertebrae meet in the spine, can become inflamed due to trauma like Dillinger’s. Injecting lidocaine into a joint can relieve the pain. But inserting a needle into the spine involves risk, and many experts say the injections should be used only as a last resort — and even then, sparingly, no more than eight times a year.
This was Dillinger’s third facet injection that month.
She climbed onto the examination table, rolled over on her stomach and pressed her face into a doughnut-shaped pillow. Bagley pushed a long needle into a facet joint in her neck and injected the medication. Dillinger’s body went limp. Bagley felt for a pulse. Nothing.
If you went to a chiropractor’s office with a sore neck, the last thing you’d expect is Dillinger’s fate: Taken away in an ambulance, she was dead within a week.
A criminal scheme revealed
Dolson Avenue Medical had a good reputation among its many longtime clients. How could something so egregious happen under the watch of the Spina brothers, whose outside activities hinted that they had their community’s best interests at heart? Jay regularly made presentations to schoolchildren about the importance of avoiding drugs. Jeff distributed food to the homeless, coached youth soccer and basketball, and volunteered with the Salvation Army.
Five months after Dillinger’s death, however, the FBI showed up at Dolson Avenue Medical. Federal agents combed through the clinic’s files, cramming a white van with stacks of cardboard boxes containing confiscated medical records, handwritten notes and other material.
The raid was a shock to longtime patients, including Jacqueline Padilla, a retired New York City police officer who had been getting treatments at Dolson Avenue Medical for more than a decade. The place had a warm, family-like vibe, she told me. She loved that the clinic provided multiple services, including chiropractic and physical therapy. And she never had to wait for an appointment; she could walk in at any time and receive the treatment she was seeking for her back pain. “Nothing seemed out of the norm,” Padilla said.
But things were far from normal at the clinic. A year after the raid, the government announced that Bagley had pleaded guilty to conspiracy to commit health care fraud. With the disgraced doctor as a witness, the government charged Jay and Jeff Spina; their sister Kimberly Spina, who was a practice administrator; and business manager Andrea Grossman with defrauding insurance providers out of $80 million. Facing overwhelming evidence, the three Spinas and Grossman pleaded guilty to criminal charges relating to the scheme in 2019; they later were ordered to pay more than $28 million in total restitution.
The Spinas’ practice appeared to be well run and respectable. But a multiagency investigation conducted by the FBI, the U.S. Department of Health and Human Services (HHS) and the Office of the New York State Comptroller revealed the depths of a massive, seven-year-long financial conspiracy. It was an illicit operation that raked in millions of dollars from Medicare and private insurance companies including Allstate, Nationwide and Travelers. And it was a scheme that put patients’ health at risk. “Some of them became unconscious” while undergoing treatments, said Susan Frisco, an HHS special agent. “One died.”
‘An enormous burden to taxpayers’
The sad truth is that the crimes committed at Dolson Avenue Medical — crimes like double billing, unnecessary treatments and lethal malpractice — are anything but rare in our arcane and exploitable health care system. The Spina case is not an outlier; it is simply one example of an everyday occurrence. Health insurance fraud costs the U.S. economy an estimated $36.3 billion annually, according to the Coalition Against Insurance Fraud, an advocacy group comprising government agencies, insurance organizations, district attorneys, consumers and others.
Some experts suspect the losses could be substantially higher. “It’s a colossal waste of money and an enormous burden to taxpayers,” said Malcolm Sparrow, a Harvard University fraud control scholar and author of the book License to Steal: How Fraud Bleeds America’s Health Care System. “Medicare costs go up, resulting in higher taxes and higher copays. The bleeding goes on, year after year after year.”
When I first came across a press release about the Spinas’ illicit operation and Dillinger’s death, I was astonished. How does something like this happen? How can it go on for years before authorities put a stop to it? To investigate, I combed through thousands of pages of legal documents; attended multiple court hearings; interviewed health, legal and law enforcement experts and witnesses; and corresponded with the imprisoned Jay Spina, whom the government deemed the mastermind of the operation. As a result, I’ve learned not only how easy it is to cheat Medicare and other health insurers but also what some people will do to enrich themselves this way, often putting others at grave risk.
Behind the scam: a chiropractic dynasty
Chiropractic has been a family affair for the Spinas going back more than five decades. Jay and Jeff’s father, James Spina Sr., opened a chiropractic clinic in 1968 in Liberty, New York, a Revolutionary War–era town about 100 miles northwest of Manhattan. James’ four sons — Jay, Mark, Jeff and David — all followed his career path. A local newspaper story once counted eight chiropractors in their extended family, with a total of 225 years of experience. “Spina,” appropriately enough, is Latin for spine.
“My dad practiced the old-fashioned way,” Jay wrote to me in a letter. “People paid what they could afford, or what they felt was right.” He said his father often told him, “Your right hand is your service hand, and your left hand is your money hand. Always make sure you lead with your right. When you lead with your left, you have gone off the rails.”
In 1986, the family expanded the business, opening the office in Middletown, about 65 miles from New York City. Jay ran the business operations. Jeff became Jay’s partner.
Jay had a vision for the business that went well beyond chiropractic. “Patients would return to the office and say, ‘You guys do this so good. … You should do physical therapy and rehabilitation services here,’ ” he told me. But under New York state law, chiropractors are licensed only to treat spinal misalignments; they can’t employ other types of health care providers or benefit financially from referrals.