Backbreaker

During that first year in the field, Goroway and a partner opened a clinic in Hollywood, at NW 72nd Avenue and Taft. For his down payment on the building, Goroway got $25,000 from his mother. They called it Flamingo Chiropractic.

Six months after this venture, Goroway swooped back to gobble up the Pompano Beach clinic. In 1992, his first year as a practicing chiropractor, he already had two offices, where, according to his own estimates, he treated more than 350 patients per week. Goroway estimated he made $200,000 that year.

In his deposition, Goroway credited his rapid expansion to his work ethic and clinical skill. But his talents as a salesman no doubt helped too. According to critics of chiropractic, most minor back pain resolves itself within a few weeks even if untreated. The key for a chiropractor is to not only convince the patient that he owes his progress to chiropractic adjustments but that he will need to make regular visits to keep the condition from returning. Goroway must have been adept at this part of the job.

Despite his booming practice, Goroway grew frustrated with his patients. In his deposition, he estimated that 30 percent of his clientele had insurance "and the rest was — excuse the expression — crap. We didn't make money on them, you know? They were Medicare, and Medicare doesn't pay garbage."

His initial solution was to open more offices. In 1994, Goroway partnered with another chiropractor in an office in Coral Gables. The following year, he opened another office, this one in Deerfield Beach. And in 1996, he opened yet another in that city. All this came in addition to another job he'd assumed, as medical director for a Fort Lauderdale spa. Goroway screened patients and referred them to the spa's staff of chiropractors, massage therapists, and physicians.

By that year, he estimated his annual income to be around $400,000. Goroway had married a former model named Patricia, with whom he'd had two children. They lived in a 10,000-square-foot mansion in Southwest Ranches. Goroway drove a burgundy 1993 Corvette. At 30, the American dream had arrived early.

But somehow, it didn't feel like success to Goroway. His daily regimen — up at 5 a.m., in the gym by 6, at work by 8, and home at 8 p.m. — left little time to bask in the good life. Even when Goroway found time to take vacations, he had trouble forgetting about work. Once, while on a Cancun golf course with his brother, Goroway admitted that the pressure of maintaining the clinics had pushed him to the brink of a nervous breakdown. His brother suggested he walk away from his work entirely.

Instead, Goroway redirected his ambitions. "I was bored in clinic," he would say later. "Clinic was not mentally stimulating to me. I wanted to play bigger games in business, do bigger things."

Specifically, he began shifting his focus from acquiring more patients to earning more money per patient. This plan assumed a more concrete shape during a 1998 reunion with Markell Boulis and another college chum, Brad Goldstein. Goldstein had used his degree to launch a firm for performing electrodiagnostic tests, which purport to help chiropractors identify their patients' conditions. The tests had fancy names — "nerve conduction velocity tests," "dermatomal evoked potential tests," and "somatosensory evoked potentials." Although some medical experts question the diagnostic worth of such tests, they offered one obvious incentive to chiropractors: They could be billed under major medical and automobile insurance providers. The tests also required trained specialists, which is why many are performed by "mobile" diagnostic teams like the ones Goldstein employed in his Boca Raton firm, Premier Medical Group.

Goroway had used these four tests with his own patients. For each one tested, the chiropractor could bill the health-care provider about $1,000. At the same time, the mobile electrodiagnostic unit could bill the provider for the cost of performing the tests and interpreting the results at a rate of $1,100 to $3,700 per order, according to Goldstein. The more patients tested, the more money for everyone.

In his deposition, Goroway recalled a fateful dinner with Goldstein and Boulis that took place at Hobo's Fish House in Coral Springs. Goldstein boasted that his company performed 200 tests a month. Goroway told him he'd "smoke that." Goldstein invited him on board, and Goroway promised that within three months, Goldstein's team would be running 300 tests a month. In exchange, Goroway wanted a percentage of the profits Goldstein collected from patients Goroway recruited. Goldstein offered 50. Goroway wanted 60. Drunk from three bottles of wine, Goroway and Goldstein arm-wrestled for the extra 10 percent. Goroway won. (Goldstein remembers the dinner but not the arm-wrestling.)

Goroway had other big ideas. For one, he suspected his fellow chiropractors were not coding their treatments in a way that made it possible to fully bill insurance carriers. Having studied the billing codes carefully during his own clinical work, Goroway felt qualified to audit other chiropractors' books. Like a collections agency, he'd get paid by helping his clients get paid.

By that time, he had already invited Boulis into a venture he called Practice Mechanix.

Goroway's old roommate had fallen on hard times and had few other options. In 1991 — the same year that Goroway followed the sunshine to Florida — Boulis was busted for orchestrating the sale of cocaine to a stripper who happened to be an undercover cop. A search of Boulis' apartment turned up 12 grams of coke. The conviction would eventually cost Boulis his license to practice chiropractic in Pennsylvania, where he'd returned since graduating.