After the operation Coburn admonished both the woman and her mother not to discuss it. "She asked me, since she was under 21, how did I tie her tubes -- since I told her I wouldn't and Title 19 wouldn't pay for it," Coburn said in the deposition. "I said I did it anyway and that she shouldn't talk about it because ... I did a procedure that was not recognized under Title 19 reimbursement." Thus Coburn admitted he had tried to silence his patient because he knew he was billing Medicaid illegally.

D. McCarty Thornton, former chief counsel to the inspector general at the Department of Health and Human Services and a specialist in healthcare fraud, said that anyone claiming Medicaid funding has certain disclosure duties. He told Salon that in claiming funding, "the fundamental legal duty is that [you] must be honest and completely open about the claim and about the circumstances that led to the claim. That being the fundamental starting point, you can break that legal duty down into some pieces ... There is a duty not to file a claim where you know that the services you provided are not reimbursable under the rules of the federal program ... You have a duty to disclose all the facts that you know to be material to the government. You have a duty to accurately compile the underlying documentation, such as the surgical records. If you knowingly fail any of these duties, then that is healthcare fraud."

Salon could not reach Coburn for comment. His campaign manager, Michael Schwartz, said that he was not familiar with the case and that it was "way off the radar screen" because the case happened 12 years ago.

At least, it is Coburn's hope that the scandal passes below the radar in his contest with Carson, who is in almost every respect Coburn's opposite. Unlike Coburn, Carson has fought hard to win federal funding for his district -- for transportation, rural healthcare, education and environmental cleanup. For his efforts, he was reelected by 74 percent in 2002.

Carson is a sixth-generation Oklahoman whose mother's family came to the state on the Cherokee Nation's Trail of Tears. His father worked for the Indian Bureau. Carson attended Baylor University, a conservative Baptist university in Texas, becoming its first graduate to win a Rhodes scholarship in 75 years. After finishing at the top of his class at the University of Oklahoma law school, he joined a major law firm, where he devoted one-third of his time to pro bono work. In 1997, he was a White House Fellow serving as a special assistant to the secretary of defense. A member of the Cherokee Nation, Carson helped establish a Native American Museum in Oklahoma City.

"This is a guy who knows how to wear cowboy boots with his Brooks Brothers suit, and he sounds like he's from here," says Keith Gaddie, a political science professor at the University of Oklahoma. "He's trying to thread the needle that all Democrats have to thread, and that is simultaneously satisfy this very extreme religious and social conservatism of Oklahomans but also make an appeal to the strong populism of the state."

Although the candidates are from the same district in eastern Oklahoma, Coburn may have the advantage in building a statewide majority. "Tom Coburn delivered 4,000 babies over his career in the Second District," one Democrat familiar with state politics said. "It may sound very naive for me to say this, but I really think it's going to help him [there] a bunch."

It remains a persistent problem for the Carson campaign that Coburn's views don't seem too far out of the mainstream to many Oklahomans. "A lot of positions that they're going to try to make out as extremist are kind of semi-mainstream in Oklahoma," says V. Burns Hargis, chairman of the Oklahoma City Chamber of Commerce and a political commentator on television. "It's just a hard sell to try to run to the left of the guy in Oklahoma."

"It's a great challenge," Carson said in an interview with Salon. "We rarely point out the things that are truly wacky ... We point out that [Coburn] treats politics like a game, as if it weren't important, that you can go up to Washington and try to howl into the void and make points that make you feel a little better but never do anything for the people back home who are desperate for your help."

According to Hicks, Carson is running a two-level campaign. "He's on the air right now, and he's trying to prove that he's got Oklahoma values and is a conservative," Hicks said. "Below the radar they're doing a lot of GOTV [get out the vote], and they're spending a lot of time talking about Coburn's radical libertarianism on fiscal issues and his conservatism on social issues. They're trying to say to individual voters, 'This guy is really not in line with Oklahoma values. You may be a conservative, but he's a radical.'"

Coburn, meanwhile, continues to spout off. Last week, he declared Oklahoma lagging in economic development because "you have a bunch of crapheads in Oklahoma City that have killed the vision of anybody wanting to invest in Oklahoma." His spokesperson could not explain who or what Coburn was talking about. What's more, Coburn proclaimed the Senate race a "battle of good vs. evil."

"He's on his own private mission with his own small band of followers," Carson told the Washington Post. "With everything that's going on in the world, using good and evil to describe a Senate race turns off voters."

Whether the voters of Oklahoma regard Coburn as an exemplar of moral purity after learning about his false Medicaid filing may well determine not only the outcome of the contest there but the fate of the Senate.

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