Thursday, September 20, 2012
Transparency
I asked Beatrice to reflect on the Whistleblower and the Healthcare Corporation readers’ responses to this series. This essay originally was written prior to posting Chapter 4. It appears here to provide new readers with an overview of the issues raised by the first 3 chapters of this report and the debate it engendered. (For a firsthand look at reader reaction, browse through the comments that follow Bea’s essay and each chapter posted on the Adventist Today blog. A link to those posts is supplied.) Chapter 5 is new. Patricia will update the current situation in the upcoming Chapter 6, so stay tuned.
Andy
Information Technology Employee vs. Adventist Health System, Orlando, Florida
by Beatrice Neff
I applaud Andrew Hanson and Adventist Today for taking on the controversial story of Patricia Moleski, the whistleblower who is going up against Adventist Health Systems (AHS). My comment from the beginning was, you will get plenty of cautionary advice from well-meaning people around you warning you that your personal/professional reputation may take a broadside hit due to politics within the Adventist hierarchy. My hat goes off to you for your courage, tenacity, and fearless mindset as you go forward. The conversation has been lively (review the comments from Part 1,2,3 to receive the full impact from all angles). To quote Jack Hoehn on another blog: “We are explaining our thoughts, bringing up possible stumbling blocks or deal breakers. We nibble around the edges of ideas, we stick a toe in water. We pull back in fear or step out to see where the current of thought might take us.” No one involved in the conversation has been timid: rather, bold, edgy, condescending, prompt rebuttals, idealistic. This is an important story to see through to its end – this dialog can move forward in a productive way as we methodically peel the onion. It is through this type of open conversation that we can understand one another better and learn from our differences.
This is a modern day David and Goliath scenario. AHS (defendant), a 32 billion dollar corporation with 50,000 employees, 41 medical institutions throughout several states. Patricia Moleski (plaintiff), her house was allegedly invaded, car set on fire, computer tapped, fired from her job for being a whistleblower and now living in poverty. Her YouTube interview came across as compelling – she is you and me. When you realize the minimal staff position she had, the overwhelming story, the high position the medical organization has in the community, the judges that might have a conflict of interest, it would be so easy to let it disappear without any one person standing up for what is right – and see this through to the finish line. What I mean by right is that everyone, no matter how small, deserves to have due process in the judicial system. II Timothy 1:7 “For God has not given us the spirit of fear; but of power, and of love, and of a sound mind (self discipline). This is what is called for.
Attorney comments on the blog predicted attorneys should be racing to offer assistance on a contingency basis if there was any credibility to her claims. The fact that Patricia is currently acting as her own attorney caused further skepticism. One person sent this information to Spectrum’s blog to encourage more dialog, publicity, and action. It was considered to be “Old News – if it had been worth investigating, it would have been done years ago”. The lawsuit was filed in 2010. Several people on the blog asked, “Did AT just find out about this? Why was it not reported two years ago?”
However, we all remember Erin Brockovich, an unemployed single mother who became a legal assistant and almost single-handedly brought down a California power plant, accused of polluting water supply and causing cancer and death to many. Erin became a strong, tough, spirited environmental activist who took a stand to do what was right. She had a terrible time retaining an attorney and badgered the one she finally retained. 1996 – the largest direct action lawsuit of its kind - $333 million dollars with 600 people who had been tragically affected by death of family.
Another case comes to my mind. Several families in Woburn, MA (suburb of Boston) made a formal complaint of toxic water pollution (1984 Book and Movie – A Civil Action). It took years to retain a law firm. Partners of the prosecutor discouraged him from taking the case, saying that it was hopeless and they would be financially and emotionally bankrupt – but for moral and ethical principles they took the case. Opposing high-power defense attorneys hired by corporate giants resulted in a battle to the finish. Victims’ families were awarded monetarily and the corporation was forced to clean up – the nation’s most expensive clean-up in US history. One of the victims of this tragedy was a friend of mine.
It is at the core of our SDA culture to be protective of our own and especially when there are questions regarding our church leaders and the medical right arm of the church. We immediately deny, without interest in getting further information for enlightenment. We think it is so outrageous, it must not be true. But we are all human; no organization should be above scrutiny, questioning or reproach. As one person commented, “Having been around for a while, I have seen enough to learn that the Adventist System can do weird things and mistreat people. I sure can’t say either way about this case, but I would never take the denomination’s side just because I am also an Adventist.”
In 2004 an SDA pastor (salary $22,000/year) brought his 5-year-old son, who was dying of a brain tumor, to Florida Hospital emergency department. They were refused care because they didn’t have insurance. After a class action lawsuit was filed and after his father sat before Congress, the hospital became interested, offering free care and an ocean cruise. A belated apology was issued to the family at the GC.
We are aware of prior GC president Robert Folkenburg engaging three exclusive law firms, spending over $6 million dollars of tithe monies over a seven-year period, to keep evidence from going to trial. This litigation is not dragging up old business. It is essential to evaluate historical incidents to prevent making the same mistakes. The definition of insanity is to “repeat the same thing over and over and expect a different outcome.” As Maya Angelo has said “When we know better, we do better.”
We can no longer be quick to say, “because it is a religious organization and the right arm of the SDA World Church, it must be right.” Let this be a teachable moment and may we have the courage to stray from the status quo. If there is a flaw, there is “more shame in hiding the truth than in admitting the mistake.” My hope is that we can strive together toward greater honesty, integrity, and clarity.
http://www.atoday.org/article/1304/blogs/hanson-andy/transparency-integrity-honesty-whistleblower-patricia-moleski-information-technology-department-vs-adventist-health-system-orlando-florida
Chapter 1
Reported by Andrew Hanson
Originally posted as a news story in the online June edition of Adventist Today.
It is the carefully stated policy of healthcare institutions that every employee must document and report glitches in any system, care practice, or device that might adversely effect patient treatment.
Only when such an employee report is not welcomed and/or investigated by authorized authorities within the organization; only when such a report is suppressed at the highest administrative levels of the organization; only when the employee is threatened and/or fired in an attempt to keep that report from being made public, does that reporter become a potential whistleblower.
Whistleblowers, by definition, are branded as the enemies by the institutions they worked for. Institutions often use the threat of litigation and character assassination to silence whistleblowers. Their reasons for doing this involve money; reputation, personal or corporate; and/or unlawful behavior.
This is a story about a specific healthcare system and a specific whistleblower. The healthcare system she worked for was in a hurry to make the change from a an old inefficient record keeping system to a unified suite of digital solutions proven to streamline administration, reduce costs and enhance patient safety” in which “an online “digital chart” displays up-to-date patient information in real time, complete with decision-support tools for physicians and nurses. Simple prompts allow swift and accurate ordering, documentation, and billing.
Of course, this recordkeeping change required an initial investment of millions of dollars in hardware, integrated software programs, and technical assistance directed by a company that specialized in hospital recordkeeping. Employee training programs were also required for a healthcare system that administered 41 medical facilities and employed more than 50,000 workers.
When this change was made, problems were inevitably encountered in its implementation, and care was required to prevent the loss or confusion of medical records and employee contracts. Consequently, it became the job of specially trained information technologists to monitor this process and prevent information loss.
The whistleblower in this case is Patricia Moleski, one of those informational technologists. The name of the medical institution is Adventist Health.
Here is her story.
http://www.youtube.com/watch?v=F91hN9nR1KA
Originally posted as a news story in the online June edition of Adventist Today.
It is the carefully stated policy of healthcare institutions that every employee must document and report glitches in any system, care practice, or device that might adversely effect patient treatment.
Only when such an employee report is not welcomed and/or investigated by authorized authorities within the organization; only when such a report is suppressed at the highest administrative levels of the organization; only when the employee is threatened and/or fired in an attempt to keep that report from being made public, does that reporter become a potential whistleblower.
Whistleblowers, by definition, are branded as the enemies by the institutions they worked for. Institutions often use the threat of litigation and character assassination to silence whistleblowers. Their reasons for doing this involve money; reputation, personal or corporate; and/or unlawful behavior.
This is a story about a specific healthcare system and a specific whistleblower. The healthcare system she worked for was in a hurry to make the change from a an old inefficient record keeping system to a unified suite of digital solutions proven to streamline administration, reduce costs and enhance patient safety” in which “an online “digital chart” displays up-to-date patient information in real time, complete with decision-support tools for physicians and nurses. Simple prompts allow swift and accurate ordering, documentation, and billing.
Of course, this recordkeeping change required an initial investment of millions of dollars in hardware, integrated software programs, and technical assistance directed by a company that specialized in hospital recordkeeping. Employee training programs were also required for a healthcare system that administered 41 medical facilities and employed more than 50,000 workers.
When this change was made, problems were inevitably encountered in its implementation, and care was required to prevent the loss or confusion of medical records and employee contracts. Consequently, it became the job of specially trained information technologists to monitor this process and prevent information loss.
The whistleblower in this case is Patricia Moleski, one of those informational technologists. The name of the medical institution is Adventist Health.
Here is her story.
http://www.youtube.com/watch?v=F91hN9nR1KA
Chapter 2
Originally posted as a news story in the online June edition of Adventist Today.
I came across Patricia’s YouTube video about six weeks ago as I was researching another story. The events recounted by Ms. Moleski were so horrific and bazaar that I was immediately skeptical, but I have spent the intervening time investigating her story, and I am convinced it is completely truthful.
I’ve been asked a number of times why I as a life-long Adventist would choose to report on a story that sullies the name “Adventist” and calls into question the “good name” of Adventist Health Systems whose mission statement is Extending the healing ministry of Christ. To put it bluntly, what motivated me to write this series of potentially damaging reports?
Because the Adventist Church has no shortage of crtitics—insightful to lunatic—I thought you ought to know something about be and my motivation before continuing this series. So here’s my answer.
I have been aware of the corporate abuse of power within the Adventist Church since I was nine or ten when an administrator attempted to fire my father so one of his relatives could have the job. In the intervening 60 years, as a college student, a teacher in junior academy, as an elder, a school board member and acting principal, and church member, I’ve observed a kind of institutional pecking order in which certain denominationally employed Adventists got richer in terms of power, money and perks, and others got poorer, not just monetarily, but in influence and social standing.
When I protested that this institutional pecking order was wrong, my wife invariably said, “So what are you going to do about it?” And to my shame, I did very little besides bending the ear of a fellow teacher or sympathetic pastor. I attempted to quiet my conscience by telling myself: “I don’t have time to get involved.” “If those people don’t like the way they’re treated, they can get other jobs.” Sometimes I reasoned, “Money and recognition must not be important to those folks.” And when I was particularly frustrated by the unfairness of the system, I excused myself from speaking out publically by blaming the victims: “If those people are willing to put up with that treatment, they deserve it!
When a person gets to be 70, a review of life lived can’t be avoided, and I decided to meet my wife’s challenge and get publically and professionally involved. I fancied myself qualified to be a theological activist, an editorial critic, and a satirist. It never occurred to me that my public commitment would require me to face the realization that a huge, politically and financially powerful organization, flying the flag, “Adventist”, whose mission statement is Extending the Healing Ministry of Christ, was harming others, as a conscious, premeditated practice. Report that! When the realization hit, I was scared, and I tried out my previous excuses for not getting involved…without success.
And there is a personal reason to involve myself in this fight, something about standing for the right though the heavens fall, and the want of the world is the want of men [and women] who are as true to duty as the needle to the pole. Those are Adventist quotations that have been written on my heart and mind by my Adventist education and my spiritual mentors.
Patricia Moleski is living proof that these are not just words on an Adventist page.
Chapter 3
Originally posted on my blog on August 9 at Adventist
Today
Adventist Health Systems made a big mistake when they hired Patricia Moleski. They should have hired someone less intelligent, less dedicated, less scrupulous, less Christian.
When I was finally able to contact Ms. Moleski, she said she had been so badly treated by AHS and their attorneys that she said she would be delighted to take a lie detector test in defense of everything she alleges in the video, and answer any additional questions put to her regarding her experiences at AHS during that test.
http://www.youtube.com/watch?v=F91hN9nR1KA
Steve Zeltzer, President of California Workmen’s Comp Coalition, has confirmed that Patricia's story highlights the problems virtually all healthcare institutions run into when they adopt new computer-based information systems. In her case, Ms Moleski ran afoul of a corrupt hospital administration and CERNER, the international supplier of hospital information systems. Bugs in CERNER software, reported by Patricia, lead to patient endangerment and, in the two cases she reports, patient death.
Presently, Patricia, acting as her own attorney, has offered extensive evidence that the County Courts and acting AHS counsel are trying to make her liable for criminal prosecution by false accusations and discrediting her whistleblower status, thereby violating her rights to Fifth Amendment protection.
In response, to the Court’s OMNIBUS ORDER ON ALL PENDING MOTIONS,* Ms. Moleski has filed a Motion for Civil Contempt against Adventist Health System** in which she alleges:
Ms. Moleski argues that:
The courts allowed a continuance of this litigation despite her status as a Federal/State Witness and Whistleblower, and after her eight document submissions to this court’s docket from AHCA, OSHA, the EEOC, Governor Crist’s OIG, Assistant U.S. Attorney Sandra Diesler, U.S. Attorney General’s office, Medical Fraud Unit – Orlando Office and the U.S. Office of Civil Rights.
In addition, she has:
--Submitted exhibits to show that she has participated in investigations within her Counterclaim and additional exhibits showing her relationship with law enforcement [FBI] four months prior to Adventist filing this lawsuit against her.
--Informed the court that she cannot reveal the details of the Maitland , Florida, FBI investigation against AHS executives and will continue to invoke her Fifth Amendment Rights. The Orange County Courts continue to coerce Ms. Moleski and tell her that she cannot invoke her Fifth Amendment Rights and that she will have to set up a hearing to get permission to do so.
AHS alleges that Patricia has in her possession confidential information taken from them illegally. They want back, and are involved in legal proceedings to get it. (No evidence has been produced that establishes this fact, and it’s something that Patricia denies.) However, she refuses to reveal or discuss any information regarding her ten-month participation in the FBI investigation. The agents she worked with informed her that their investigation would be compromised if she divulged that information. (On several occasions she “wore a wire” to work.)
Ms. Moleski has informed the court that she is currently unable to be physically present at court because she lacks funds to travel to Florida and has caregiver responsibilities. She has documented these facts by unemployment compensation stubs and an official document allowing the court to access her 2009-2011 IRS tax returns. In spite of this evidence, the courts will not implement whistleblower laws and AHS attorneys are attempting to use her failure to appear in court to destroy her whistleblower protections. (AHS attorneys have made no effort to obtain a deposition.)
Patricia now lives in Ohio and is desperate to find a job. She is living in poverty and believes she has been blacklisted. She has also informed the judge that she is fearful of what might happen to her should she return to Florida. When her whistleblower status was discovered, a bullet was fired into her residence, her car was firebombed, and repeated attempts were made to break into her home. (Her home alarm system was triggered twice.)
It is instructive to realize that whistleblowers, although protected by a variety of laws, can be victimized over an extended period of time by other laws and court proceedings. In Patricia’s case, her life has been made miserable for the past five years by Adventist Health Systems because she in good faith alerted AHS of bugs in the CERNER electronic record system that, unless corrected, could place Adventist Health Systems in serious trouble with HIPAA.*** Because Ms. Moleski refused, under duress, to commit these illegal and irresponsible actions, and subsequently reported these illegal violations to appropriate state and federal agencies, the AHS filed an injunction against her in an attempt to avoid the revocation of the institution’s nonprofit status and civil and criminal prosecution. In the mean time, Patricia was placed on administrative leave and then fired.
As far as can be determined, the investigation of AHS is ongoing. (Two months ago, when Ms. Moleski discussed the FBI investigation with the Maitland Office, she was told to “hang in there,” you have given us a very difficult case.”)
This is the third in a series of six Whistleblower and the Healthcare Corporation reports.
NOTE: Since Adventist Today publicized Ms. Moleski’s YouTube video, it has been seen by over 3000 new viewers.
_____________________________________________________________
*
IN THE CIRCUIT COURT OF THE NINTH JUDICIAL CIRCUIT IN AND FOR ORANGE COUNTY, FLORIDA, CASE NO.: 2009-CA-019445-O
ADVENTIST HEALTH SYSTEM, SUNBELT HEALTHCARE CORPORATION, Plaintiff,
v.
PATRICIA L. MOLESKI, Defendant.
**
IN THE CIRCUIT COURT OF THE NINTH JUDICIAL CIRCUIT IN AND FOR ORANGE COUNTY, FLORIDA, CASE NO.: 2009-CA-019445-O
JUDGE PATRICIA DOHERTY
Patricia Moleski, Counter Plaintiff, Defendant
V.
Adventist Health System, Counter Defendant, Plaintiff
****
The Health Insurance Portability and Accountability Act “enacted August 21, 1996) and signed by President Bill Clinton. Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs. Title II of HIPAA, known as the Administrative Simplification (AS) provisions, requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers.” http://en.wikipedia.org/wiki/Health_Insurance_Portability_and_Accountability_Act
Adventist Health Systems made a big mistake when they hired Patricia Moleski. They should have hired someone less intelligent, less dedicated, less scrupulous, less Christian.
When I was finally able to contact Ms. Moleski, she said she had been so badly treated by AHS and their attorneys that she said she would be delighted to take a lie detector test in defense of everything she alleges in the video, and answer any additional questions put to her regarding her experiences at AHS during that test.
http://www.youtube.com/watch?v=F91hN9nR1KA
Steve Zeltzer, President of California Workmen’s Comp Coalition, has confirmed that Patricia's story highlights the problems virtually all healthcare institutions run into when they adopt new computer-based information systems. In her case, Ms Moleski ran afoul of a corrupt hospital administration and CERNER, the international supplier of hospital information systems. Bugs in CERNER software, reported by Patricia, lead to patient endangerment and, in the two cases she reports, patient death.
Presently, Patricia, acting as her own attorney, has offered extensive evidence that the County Courts and acting AHS counsel are trying to make her liable for criminal prosecution by false accusations and discrediting her whistleblower status, thereby violating her rights to Fifth Amendment protection.
In response, to the Court’s OMNIBUS ORDER ON ALL PENDING MOTIONS,* Ms. Moleski has filed a Motion for Civil Contempt against Adventist Health System** in which she alleges:
- Violations of State and Federal Whistleblower laws
- Harassment of a Federal & State Witness
- Violations of the US Constitution – 5th Amendment
- Corruption
- Fraudulent & Vexatious Litigation against a State/Federal Witness
- Coercion/extortion
- False Claims Act Violations
- Workers compensation violations
- Sexual harassment
- Concealing/contaminating evidence
- Attorney/client privilege violations
Ms. Moleski argues that:
The courts allowed a continuance of this litigation despite her status as a Federal/State Witness and Whistleblower, and after her eight document submissions to this court’s docket from AHCA, OSHA, the EEOC, Governor Crist’s OIG, Assistant U.S. Attorney Sandra Diesler, U.S. Attorney General’s office, Medical Fraud Unit – Orlando Office and the U.S. Office of Civil Rights.
In addition, she has:
--Submitted exhibits to show that she has participated in investigations within her Counterclaim and additional exhibits showing her relationship with law enforcement [FBI] four months prior to Adventist filing this lawsuit against her.
--Informed the court that she cannot reveal the details of the Maitland , Florida, FBI investigation against AHS executives and will continue to invoke her Fifth Amendment Rights. The Orange County Courts continue to coerce Ms. Moleski and tell her that she cannot invoke her Fifth Amendment Rights and that she will have to set up a hearing to get permission to do so.
AHS alleges that Patricia has in her possession confidential information taken from them illegally. They want back, and are involved in legal proceedings to get it. (No evidence has been produced that establishes this fact, and it’s something that Patricia denies.) However, she refuses to reveal or discuss any information regarding her ten-month participation in the FBI investigation. The agents she worked with informed her that their investigation would be compromised if she divulged that information. (On several occasions she “wore a wire” to work.)
Ms. Moleski has informed the court that she is currently unable to be physically present at court because she lacks funds to travel to Florida and has caregiver responsibilities. She has documented these facts by unemployment compensation stubs and an official document allowing the court to access her 2009-2011 IRS tax returns. In spite of this evidence, the courts will not implement whistleblower laws and AHS attorneys are attempting to use her failure to appear in court to destroy her whistleblower protections. (AHS attorneys have made no effort to obtain a deposition.)
Patricia now lives in Ohio and is desperate to find a job. She is living in poverty and believes she has been blacklisted. She has also informed the judge that she is fearful of what might happen to her should she return to Florida. When her whistleblower status was discovered, a bullet was fired into her residence, her car was firebombed, and repeated attempts were made to break into her home. (Her home alarm system was triggered twice.)
It is instructive to realize that whistleblowers, although protected by a variety of laws, can be victimized over an extended period of time by other laws and court proceedings. In Patricia’s case, her life has been made miserable for the past five years by Adventist Health Systems because she in good faith alerted AHS of bugs in the CERNER electronic record system that, unless corrected, could place Adventist Health Systems in serious trouble with HIPAA.*** Because Ms. Moleski refused, under duress, to commit these illegal and irresponsible actions, and subsequently reported these illegal violations to appropriate state and federal agencies, the AHS filed an injunction against her in an attempt to avoid the revocation of the institution’s nonprofit status and civil and criminal prosecution. In the mean time, Patricia was placed on administrative leave and then fired.
As far as can be determined, the investigation of AHS is ongoing. (Two months ago, when Ms. Moleski discussed the FBI investigation with the Maitland Office, she was told to “hang in there,” you have given us a very difficult case.”)
This is the third in a series of six Whistleblower and the Healthcare Corporation reports.
NOTE: Since Adventist Today publicized Ms. Moleski’s YouTube video, it has been seen by over 3000 new viewers.
_____________________________________________________________
*
IN THE CIRCUIT COURT OF THE NINTH JUDICIAL CIRCUIT IN AND FOR ORANGE COUNTY, FLORIDA, CASE NO.: 2009-CA-019445-O
ADVENTIST HEALTH SYSTEM, SUNBELT HEALTHCARE CORPORATION, Plaintiff,
v.
PATRICIA L. MOLESKI, Defendant.
**
IN THE CIRCUIT COURT OF THE NINTH JUDICIAL CIRCUIT IN AND FOR ORANGE COUNTY, FLORIDA, CASE NO.: 2009-CA-019445-O
JUDGE PATRICIA DOHERTY
Patricia Moleski, Counter Plaintiff, Defendant
V.
Adventist Health System, Counter Defendant, Plaintiff
****
The Health Insurance Portability and Accountability Act “enacted August 21, 1996) and signed by President Bill Clinton. Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs. Title II of HIPAA, known as the Administrative Simplification (AS) provisions, requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers.” http://en.wikipedia.org/wiki/Health_Insurance_Portability_and_Accountability_Act
Chapter 4: The AHS Response
I made it clear to Kevin Edgerton that in Chapter 4 of this series, I would post only material provided by the corporation without comment. After my News Editor received his letter, along with a pdf file containing AHS’s omnibus litigation, I again contacted Mr. Edgerton’s office by phone. I was told he was not available. I then left a message that I would like him to contact me regarding some of the questions his letter generated. He never returned my call.
To: www.atoday.org
Re: Andrew Hanson’s multi-part review of YouTube video
We would like to clarify information that has recently appeared in Adventist Today regarding a
former AHS employee and self-described whistleblower.
The former employee accessed, downloaded and removed without authorization confidential
patient records and confidential litigation documents from the work files of other AHS
employees. After unsuccessful attempts to retrieve the confidential documents directly from the
former employee, AHS filed suit in June 2009 in order to fulfill its HIPAA obligations and
maintain the confidentiality of the removed patient records and litigation documents.
In response to AHS’ action, the former employee began describing herself as a whistleblower and
filed various patient, whistleblower and retaliation claims with federal and state investigative
agencies and the court. Regardless of how the former employee describes herself or her motives,
the facts are that she removed confidential AHS documents, that AHS had a legal obligation to
recover those confidential documents, and that AHS was forced to file suit after the former
employee refused to return them.
To date, none of the investigative agencies–federal or state–has found merit in any of the former
employee’s claims against AHS. In the pending lawsuit, the court inspected certain removed
documents and ordered approximately 1,000 pages of confidential documents be returned to
AHS. More recently, after conducting a hearing, the court dismissed all of the former
employee’s self-described whistleblower, retaliation and other claims against AHS. Based on the
former employee’s delay and obstruction of the court process, the judge also held her in contempt
of the court. AHS expects the court to issue final rulings in the lawsuit before year end.
Adventist Today did not speak with anyone at Adventist Health System before publishing
the one-sided description of the events. Although it is Adventist Health System’s practice
not to discuss pending litigation in the press, this statement has been submitted to provide
more complete and accurate information on this matter.
Sincerely,
[signature]
Kevin Edgerton
Executive Director
Marketing & Communications
------------------------------------------------------------------------------------
Below are scans of the Omnibus Litigation. You can view them individually by clicking the images or download the entire document in PDF form here.
http://www.atoday.org/article/1338/blogs/hanson-andy/part-4-the-whistleblower-and-the-healthcare-corporation
To: www.atoday.org
Re: Andrew Hanson’s multi-part review of YouTube video
We would like to clarify information that has recently appeared in Adventist Today regarding a
former AHS employee and self-described whistleblower.
The former employee accessed, downloaded and removed without authorization confidential
patient records and confidential litigation documents from the work files of other AHS
employees. After unsuccessful attempts to retrieve the confidential documents directly from the
former employee, AHS filed suit in June 2009 in order to fulfill its HIPAA obligations and
maintain the confidentiality of the removed patient records and litigation documents.
In response to AHS’ action, the former employee began describing herself as a whistleblower and
filed various patient, whistleblower and retaliation claims with federal and state investigative
agencies and the court. Regardless of how the former employee describes herself or her motives,
the facts are that she removed confidential AHS documents, that AHS had a legal obligation to
recover those confidential documents, and that AHS was forced to file suit after the former
employee refused to return them.
To date, none of the investigative agencies–federal or state–has found merit in any of the former
employee’s claims against AHS. In the pending lawsuit, the court inspected certain removed
documents and ordered approximately 1,000 pages of confidential documents be returned to
AHS. More recently, after conducting a hearing, the court dismissed all of the former
employee’s self-described whistleblower, retaliation and other claims against AHS. Based on the
former employee’s delay and obstruction of the court process, the judge also held her in contempt
of the court. AHS expects the court to issue final rulings in the lawsuit before year end.
Adventist Today did not speak with anyone at Adventist Health System before publishing
the one-sided description of the events. Although it is Adventist Health System’s practice
not to discuss pending litigation in the press, this statement has been submitted to provide
more complete and accurate information on this matter.
Sincerely,
[signature]
Kevin Edgerton
Executive Director
Marketing & Communications
------------------------------------------------------------------------------------
Below are scans of the Omnibus Litigation. You can view them individually by clicking the images or download the entire document in PDF form here.
Wednesday, September 19, 2012
Chapter 5
There is nothing like the frustration of a reporter that has a compelling story to tell but discovers that that story cannot be told. As a consequence, Chapter 5 contains the material I planned to include in an Epilogue. Patricia will now have the last word in Chapter 6.
Patricia Moleski is telling the truth. I am convinced of that fact for the following reasons:
She is a credible witness. As a retired schoolteacher and university professor, I’ve been told a lot of stories that were lies or half-truths. I knew immediately that Patricia wasn’t lying or even shading the truth. He body language said so; her willingness to take a lie detector test, the fact that she named names and confronted her accusers in court; the consistency of her story as recounted in legal documents and during my interrogation of her; and her amazing ability to support her story with accurately recalled dates, names, situations, and places.
The question then became, is she a former employee out to revenge herself on the employer that fired her; a nut case; a “gold digger”. I could find no evidence that she was any of these things. In fact, the harder I looked, the more evidence I discovered that she acted to insure the safety and legal rights of AHS patients and employees and to protect the corporation she loved. I could find no evidence that she was a nut case based on her exemplary performance on the job previous to her refusal to make “deletions” that she considered to be unethical and illegal, her emails to her superiors, court documents, letters to professional agencies, or in her conversations with me. In fact, her story was so credible that the FBI used her as an informant for ten months. And I could uncover no evidence of a “for-profit” motive.
Finely, she is a practicing Christian who was thrilled to be hired by a Christian organization. She took AHS training to become a Spiritual Ambassador, and was an active member of a prayer group. She had begun attending the local Adventist Church and sent emails to AHS pastors to assist them in implementing prayer teams at all 41 health facilities for patients and employees. Then her world fell apart. She has never once used the word “revenge” in our conversations. She uses the words “vindication” and “vindicated” often but “justice” only rarely. She has already forgiven her tormentors and prays that they will “just tell the truth”. And that would be the end of it as far as she is concerned.
http://www.youtube.com/watch?v=F91hN9nR1KA
CERNER’s computer based hospital recordkeeping program was inadequate and “buggy” as a recordkeeping system during the time Patricia was an IT employee. Failures such as the ones specifically cited by Patricia have been documented in other CERNER hospitals and in many, if not all, computer based systems worldwide.
Adventist Hospital Systems has done everything possible to deny Patricia whistleblowing status. Rather than providing evidence to counteract Patricia’s claims of malfeasance, they have attempted to destroy her reputation and her protection as a whistleblower. Their latest attempt to silence her legally rests on the claim that she removed from AHS headquarters “approximately 1000 pages of [unidentified] confidential documents” without authorization. Something she denies.
Patricia states that thousands of AHS facility employees had access to laptops that were taken home daily and none of these employees are questioned about their actions when they dialed in from home. She was only interrogated and harassed after she reported the unethical deletions to the Global Compliance Hotline.
Electronic hospital patient and employee records can be permanently changed after initial input. HIPPA only “advises” that responsible persons should be tasked for this assignment. Patricia raised the issue to AHS executives. She reported that the Assistant Risk Director had access to medical records. This was the officer who worked closely with the Claims and Risk Management attorneys when patient lawsuits were brought against AHS facilities. Patricia states that she worked closely with the FBI and documented the HIPPA violations that Risk Management’s access to medical records made possible.
AHS has produced no evidence that the governing agencies to which Patricia reported have denied the validity of her claims. AHS only claims that these agencies have dismissed her allegations because as of yet none of these agencies has instituted a public fact-finding investigation. As readers of this blog have pointed out, investigations of corporations of this size and political influence may take years. In fact, Patricia was told by the FBI that it was a tough case and to “hang in there kiddo” and that “you did a good thing.”
There is evidence that AHS officials are engaged in fraudulent practices and might go to great lengths to avoid potential lawsuits.
Adventist Health System and affiliated hospitals paid $8.9 million to settle allegations that they overbilled Medicare from 1992 to 1999.
In February, 2012, Adventist Health Service was fined $3.9 million to resolve false claims allegations related to Kyphoplasty.
Currently, “a whistle-blower lawsuit based on insider information from a former Florida HospitalOrlando billing employee and a staff physician alleges that seven Adventist Health hospitals in Central Florida have overbilled the federal government for tens of millions of dollars in false or padded medical claims.
“If found guilty, the health system would not only be responsible for repaying the excess money received, but also for paying civil penalties of $5,500 to $11,000 per false claim, and damages, he said.
"’When you're looking at something that happened thousands of times, and that carries substantial civil monetary penalties for each claim and treble damages, the total exposure could exceed $100 million,’ Wilbanks said.” A trial is set for December, 2013.
In addition, AHS executives face losing millions in salaries and criminal penalties if Patricia’s testimony is proven to be factual. She has recently filed an appeal in The Florida Supreme Court, and may attempt to have her appeal heard by a Federal judge. Patricia holds to the fact that AHS and the Orange County Courts have violated The Florida State Whistleblower Law, and she will continue to litigate until this law is implemented on her behalf.
Costly litigation hurts hospital bond ratings and sales. Money made through bond sales enables AHS to expand its operations and increase the number of patients it can “serve” and profit from. Currently, no AHS bonds are being traded. It is assumed that this is the result of the recent federal lawsuit. The financial consequences to AHS have yet to be determined.
There are the salaries and bonuses of the 21 Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees to be protected. The reported 2010 annual income of these people ranged from $2,925,356 to $317,331 with a median salary of $423,065. Four individuals made well over $1,000,000. Financial records are not yet available for 2011.
There is evidence that these salaries do not reflect past compensation highs. On December 31, 2009, Scott Maxwell of the Orlando Sentinel reported the following under the title of “The Good, The Bad and The Idiotic of 2009”:
“Biggest ‘nonprofit’ salary disclosed: Adventist Health CEO Don Jernigan's $3.5 million. Yes, Florida Hospital's parent company may be a ‘faith-based nonprofit,’ but that doesn't mean it's not profitable to work there. Tax records for this tax-exempt group showed that at least seven Adventist execs had annual packages worth more than $1 million. And Jernigan's $3.5 million was more than the top administrators of the famed Mayo Clinic and Johns Hopkins Health System made … combined.”
Finally, there are the cautionary words of Mick Conners: CPA, Senior Vice President of Finance and Chief Financial Officer, Cape Cod Healthcare
“In spite of the real needs for [data] access, there will be a strong temptation to use this privilege for other purposes. Who are those with a stake in this process? There are a number of parties: health care providers, insurance companies, medical researchers, including medical schools, and, of course, patients. From the perspective of health care providers as internal stakeholders, the medical research community is a joint stakeholder. Insurers may require similar information, but they have interests beyond those of diagnosis and treatment. In many ways, the insurers and patients hold the position of customers, which is that of an external stakeholder. Patients are external stakeholders because they receive the treatment and the information is about them. Insurers stand in the place of the patient with respect to their incurring the brunt of financial liability. Although both are external stakeholders, they are not the same.
“For the internal stakeholders, there are corporate stakes. Corporations, even hospitals, medical consortiums, and research and teaching institutions must at least break even, if not make a profit, to maintain their very existence. To survive, quality of care must improve continuously while reducing costs (Marsh, 1996). Establishing that access to electronic medical records via the Web contributes to either or both of these goals, will make it a matter of self-preservation to acquire that capability. Thus having such a capability moves from being a utilitarian issue of being able to provide better service, to one of ethical egoism in the most basic sense -- not simply self-interest but continued existence. With respect to the misuse of data, there would be obvious financial repercussions if such an occurrence were to be exposed, so the corporate players would certainly be operating in their own interests to try to avert any incident. This is true as well for the external stakeholders, at least for the insurers. By the same principle of ethical egoism, they would try to avoid misuse of data.
“However, here is where the definition of misuse comes into play. For what may constitute misuse in the view of the other external stakeholder mentioned (the patient), may constitute an act of self-preservation in the view of the insurer (or even possibly the research or teaching institution). For the patient, there may be issues of ethical egoism (not wanting certain information to be known because there could be negative repercussions), but also an ethical formalism could hold: that it is simply "not right" to disseminate a patient's medical record without express permission, regardless of the possibility for the "greater good".
“Because of the great financial pressures that could come to bear on these corporate stakeholders, internal and external, competing ethical principles could come into play. While they may initially have a well-founded reluctance to misuse data, simply because it is "not right", the desire for self-preservation could dominate. The individual patient may have the least leverage, from an economic sense, and may well not even be aware of any abuses unless there is a direct negative effect. Even in such a case, the cost of litigation, both financial and emotional, can dissuade the individual from seeking recourse.
To help ensure respect for the rights of the individual patient, while providing for a reasonably "level playing field" for all corporate concerns, another external stakeholder could and will come into play. The government has long been in the business of regulating health care standards, and there is no indication that this arena would be any different. The U.S. Senate bill, S.1360, the Medical Records Confidentiality Act of 1995 (Bennett, 1995), and its corresponding House bill, HR 435 (Thomas), show that the government will weigh in on this issue.
http://webpages.cs.luc.edu/~laufer/ethics97/papers/MickConners.html
REFERENCES
CERNER
1. Cerner Hosting Outage Raises Doctor, Hospital Concerns
Cerner's national network went down for a day, forcing physicians to resort to handwritten orders.
By Ken Terry
InformationWeek
July 26, 2012
http://www.informationweek.com/healthcare/electronic-medical-records/cerner-hosting-outage-raises-doctor-hosp/240004446
2. Patient Data Outage Exposes Risks Of Electronic Medical Records
'Human error' is blamed for a five-hour computer outage last week. It highlights the risks of a nationwide switch to electronic medical records.
August 03, 2012|By Chad Terhune, Los Angeles Times
http://articles.latimes.com/2012/aug/03/business/la-fi-hospital-data-outage-20120803
3. Contra Costa's $45 million computer health care system endangering lives, nurses say
By Matthias Gafni
Contra Costa Times
Posted: 08/14/2012 05:30:07 PM PDT
Updated: 08/14/2012 08:55:52 PM PDT
MARTINEZ -- A new medical computer system used at Contra Costa correctional facilities recommended what could have been a fatal dose of a West County Jail inmate's heart medication last week, an incident that a detention nurse characterized Tuesday as one of many recent close calls with the month-old program. However, the inmate's nurse was familiar with his medical history, recognized the discrepancy and administered the correct amount of Digoxin…
It's just one of a number of computer errors that medical staffers say have been endangering inmates, medical staff and sheriff's deputies at the county's five jail facilities since Contra Costa switched on July 1 to EPIC, a computer system that links the correctional facilities to the Contra Costa Regional Medical Center and other county health care operations…
"It's dangerous. It's very dangerous," said an emotional Lee Ann Fagan in a phone interview. The registered nurse works at West County Detention Facility in Richmond. "It's hard to work in an environment that's so frustrating. "What nurses want is for the EPIC program to go away until it's fixed," she said…
Staff superusers have warned management of EPIC issues, and two training sessions in May and June were inadequate, Fagan said. "They were next to useless because the program wasn't in place well enough to practice," she said. "Everyone in the classes could see the gross loopholes in information."
MANIPULATION OF RECORDS
1. Manipulation of 12,000 Medical Records Made Easy by HER
http://www.hcrenewal.blogspot.com/2012/07/manipulation-of-12000-medical-records.html
FRAUDULENT PRACTICES
1. Adventist Health System & Affiliated Hospitals Pay Nearly $9 Million For Overbilling Medicare
http://www.justice.gov/opa/pr/2000/December/686civ.htm
2. Fraudulent Claims Cost Adventist Health System, Florida, $3.9 Million
Four hospitals affiliated with Adventist Health System/Sunbelt Inc. in Florida will pay a total of $3.9 million to Resolve False Claims Act Allegations Related to Kyphoplasty
http://www.justice.gov/opa/pr/2012/February/12-civ-173.html
3. Whistleblower lawsuit alleges Florida Hospital filed millions in false claims
By Marni Jameson, Orlando Sentinel
August 8, 2012
http://articles.orlandosentinel.com/2012-08-08/health/os-whistleblower-lawsuit-florida-hospital-20120808_1_adventist-health-suit-claims-celebration-health
BOND RATINGS AND SALES
1. AHS bond trading ended on August 7, 2012
http://florida.municipalbonds.com/bonds/issue/684503V85
SALARIES
http://www.guidestar.org/
(click to enlarge)
AHS Update
UPDATE
Chapter 6, Patricia's final post, will follow shortly.
Florida Hospital whistle blower case widens to emergency departments
by Marni Jameson, Orlando Sentinel
Wed Oct 17 2012 6:30 PM
A whistleblower case alleging that Florida Hospital and six affiliates knowingly overbilled Medicare "tens of millions of dollars" in radiology services has widened to include the hospitals' emergency departments, according to an amended complaint filed this month.
The new complaint against Adventist Health System, which owns the hospitals, alleges that routine billing fraud occurred in the emergency departments from 2001 to 2008 and possibly longer, said Marlan Wilbanks, attorney for the whistle-blowers.
One of them, Amanda Dittman, worked in Florida Hospital's billing department during that time and claims in the suit that the hospitals routinely submitted false, duplicate or padded medical claims for emergency services, too.
The new allegation "fits like a glove with the original complaint," Wilbanks said. "It demonstrates the same lack of overall institution supervision."
The original complaint, filed in July 2010, claimed Florida Hospital used improper coding from 1995 to 2009 to overbill Medicare, Medicaid and Tricare, all federal government payers, for radiology services. The suit also alleges that the hospital routinely overbilled for a drug — octreotide — used to enhance MRI scans by billing for larger doses than were actually administered. It also alleges that bills were issued for computer-aided-detection analyses that were never performed.
For instance, in 2006 the CAD system, which helps doctors interpret mammography scans, wasn't working, yet the hospital billed for the CAD scans anyway, the suit alleges. The hospital never refunded the money, according to the suit.
When asked for comment, Florida Hospital spokeswoman Samantha O'Lenick issued this statement: "Florida Hospital takes seriously our obligations under the law. If we discover mistakes, we take appropriate action to correct them. "However, we believe the recent allegations relating to emergency room billings are asserted to achieve settlement pressure in the context of ongoing litigation. We believe the allegations are without merit, and we note that the relators had no involvement in emergency room billing. We will continue to defend the claims in court," the statement said.
Saw a pattern
The second whistle-blower in the case is Dr. Charlotte Elenberger, a radiologist affiliated with Florida Radiology Associates since 1995. Dittman, a bill-coding and reimbursement-compliance officer, worked for Florida Radiology Associates from 1996 to 2001 before going to work for Florida Hospital. Shortly after she began working at the hospital, she began to see a pattern, Dittman said. "I saw the upcoding happening daily in heavy volumes across seven hospitals in the Orlando area," she told the Sentinel. Dittman had computer access to systemwide billing records, she said. "I could see all the accounts, the charges, dates of service, the payers, what was paid and when," she said. She brought the errors to the attention of her superiors, she said. "Soon I knew that they knew what was going on, and that they knew what they were doing was wrong, and they didn't want to correct it," Dittman said. "They were more interested in the bottom line than in doing the right thing."
In response to her concerns, the hospital system's financial-services directors conducted an internal investigation that confirmed double- and overbilling were occurring, the suit alleges, but did not correct the problem or refund the money. "If there was a mistake, their culture was that they would not refund the money unless the payer specifically asked," Dittman said. "And then they would only refund the money on that one account, even though they knew how often it occurred." Each hospital followed the same fraudulent guidelines, she said, adding that those who input the codes weren't aware they were upcoding.
At one point, Dittman said, she was told she was "being an obstacle." She has since relocated and now works for a hospital in California. Motion to dismiss Wednesday morning, the hospital system filed its second motion to dismiss the claim. Its first motion to dismiss was denied by U.S. District Judge John Antoon, who called the evidence "extensive and sufficient."
The seven Adventist hospitals listed in the complaint are Florida Hospital Orlando, Florida Hospital Altamonte, Florida Hospital Apopka, Florida Hospital East Orlando, Florida Hospital Celebration Health, Florida Hospital Kissimmee and Winter Park Memorial Hospital. "We allege they knew exactly what was going on and they didn't change their practice," Wilbanks said. "Basic errors were being made over and over in a very reckless fashion. It's not in doubt that these errors were being made. The question is how many times, and how much [money] did they keep that they shouldn't have kept?" he said.
Though the discovery process hasn't started, he said, the problem is systemic. "Based on the paper trail we've seen, we have a basis for believing that this was a problem for a number of years," Wilbanks said. If found guilty, Adventist would not only be responsible for repaying the excess money received, but also for paying damages and civil penalties of $5,500 to $11,000 per false claim, he said. The damages alone could easily be in the tens of millions of dollars, he added. A trial is set for December 2013. mjameson@tribune.com or 407-420-5158 Click here to view this article <http://mobile.orlandosentinel.com/k/4awyz>
A whistleblower case alleging that Florida Hospital and six affiliates knowingly overbilled Medicare "tens of millions of dollars" in radiology services has widened to include the hospitals' emergency departments, according to an amended complaint filed this month. The new complaint against Adventist Health System, which owns the hospitals, alleges that routine billing fraud occurred in the emergency departments from 2001 to 2008 and possibly longer, said Marlan Wilbanks, attorney for the whistle-blowers. One of them, Amanda Dittman, worked in Florida Hospital's billing department during that time and claims in the suit that the hospitals routinely submitted false, duplicate or padded medical claims for emergency services, too.
The new allegation "fits like a glove with the original complaint," Wilbanks said. "It demonstrates the same lack of overall institution supervision." The original complaint, filed in July 2010, claimed Florida Hospital used improper coding from 1995 to 2009 to overbill Medicare, Medicaid and Tricare, all federal government payers, for radiology services. The suit also alleges that the hospital routinely overbilled for a drug — octreotide — used to enhance MRI scans by billing for larger doses than were actually administered. It also alleges that bills were issued for computer-aided-detection analyses that were never performed. For instance, in 2006 the CAD system, which helps doctors interpret mammography scans, wasn't working, yet the hospital billed for the CAD scans anyway, the suit alleges. The hospital never refunded the money, according to the suit.
When asked for comment, Florida Hospital spokeswoman Samantha O'Lenick issued this statement: "Florida Hospital takes seriously our obligations under the law. If we discover mistakes, we take appropriate action to correct them. "However, we believe the recent allegations relating to emergency room billings are asserted to achieve settlement pressure in the context of ongoing litigation. We believe the allegations are without merit, and we note that the relators had no involvement in emergency room billing. We will continue to defend the claims in court," the statement said.
Saw a pattern
The second whistle-blower in the case is Dr. Charlotte Elenberger, a radiologist affiliated with Florida Radiology Associates since 1995. Dittman, a bill-coding and reimbursement-compliance officer, worked for Florida Radiology Associates from 1996 to 2001 before going to work for Florida Hospital. Shortly after she began working at the hospital, she began to see a pattern, Dittman said. "I saw the upcoding happening daily in heavy volumes across seven hospitals in the Orlando area," she told the Sentinel. Dittman had computer access to systemwide billing records, she said. "I could see all the accounts, the charges, dates of service, the payers, what was paid and when," she said.
She brought the errors to the attention of her superiors, she said. "Soon I knew that they knew what was going on, and that they knew what they were doing was wrong, and they didn't want to correct it," Dittman said. "They were more interested in the bottom line than in doing the right thing." In response to her concerns, the hospital system's financial-services directors conducted an internal investigation that confirmed double- and overbilling were occurring, the suit alleges, but did not correct the problem or refund the money. "If there was a mistake, their culture was that they would not refund the money unless the payer specifically asked," Dittman said. "And then they would only refund the money on that one account, even though they knew how often it occurred." Each hospital followed the same fraudulent guidelines, she said, adding that those who input the codes weren't aware they were upcoding.
At one point, Dittman said, she was told she was "being an obstacle." She has since relocated and now works for a hospital in California. Motion to dismiss Wednesday morning, the hospital system filed its second motion to dismiss the claim. Its first motion to dismiss was denied by U.S. District Judge John Antoon, who called the evidence "extensive and sufficient."
The seven Adventist hospitals listed in the complaint are Florida Hospital Orlando, Florida Hospital Altamonte, Florida Hospital Apopka, Florida Hospital East Orlando, Florida Hospital Celebration Health, Florida Hospital Kissimmee and Winter Park Memorial Hospital. "We allege they knew exactly what was going on and they didn't change their practice," Wilbanks said. "Basic errors were being made over and over in a very reckless fashion. It's not in doubt that these errors were being made. The question is how many times, and how much [money] did they keep that they shouldn't have kept?" he said.
Though the discovery process hasn't started, he said, the problem is systemic. "Based on the paper trail we've seen, we have a basis for believing that this was a problem for a number of years," Wilbanks said. If found guilty, Adventist would not only be responsible for repaying the excess money received, but also for paying damages and civil penalties of $5,500 to $11,000 per false claim, he said. The damages alone could easily be in the tens of millions of dollars, he added. A trial is set for December 2013. mjameson@tribune.com or 407-420-5158 View this article at <http://mobile.orlandosentinel.com/k/4awyz>
Chapter 6, Patricia's final post, will follow shortly.
Florida Hospital whistle blower case widens to emergency departments
by Marni Jameson, Orlando Sentinel
Wed Oct 17 2012 6:30 PM
A whistleblower case alleging that Florida Hospital and six affiliates knowingly overbilled Medicare "tens of millions of dollars" in radiology services has widened to include the hospitals' emergency departments, according to an amended complaint filed this month.
The new complaint against Adventist Health System, which owns the hospitals, alleges that routine billing fraud occurred in the emergency departments from 2001 to 2008 and possibly longer, said Marlan Wilbanks, attorney for the whistle-blowers.
One of them, Amanda Dittman, worked in Florida Hospital's billing department during that time and claims in the suit that the hospitals routinely submitted false, duplicate or padded medical claims for emergency services, too.
The new allegation "fits like a glove with the original complaint," Wilbanks said. "It demonstrates the same lack of overall institution supervision."
The original complaint, filed in July 2010, claimed Florida Hospital used improper coding from 1995 to 2009 to overbill Medicare, Medicaid and Tricare, all federal government payers, for radiology services. The suit also alleges that the hospital routinely overbilled for a drug — octreotide — used to enhance MRI scans by billing for larger doses than were actually administered. It also alleges that bills were issued for computer-aided-detection analyses that were never performed.
For instance, in 2006 the CAD system, which helps doctors interpret mammography scans, wasn't working, yet the hospital billed for the CAD scans anyway, the suit alleges. The hospital never refunded the money, according to the suit.
When asked for comment, Florida Hospital spokeswoman Samantha O'Lenick issued this statement: "Florida Hospital takes seriously our obligations under the law. If we discover mistakes, we take appropriate action to correct them. "However, we believe the recent allegations relating to emergency room billings are asserted to achieve settlement pressure in the context of ongoing litigation. We believe the allegations are without merit, and we note that the relators had no involvement in emergency room billing. We will continue to defend the claims in court," the statement said.
Saw a pattern
The second whistle-blower in the case is Dr. Charlotte Elenberger, a radiologist affiliated with Florida Radiology Associates since 1995. Dittman, a bill-coding and reimbursement-compliance officer, worked for Florida Radiology Associates from 1996 to 2001 before going to work for Florida Hospital. Shortly after she began working at the hospital, she began to see a pattern, Dittman said. "I saw the upcoding happening daily in heavy volumes across seven hospitals in the Orlando area," she told the Sentinel. Dittman had computer access to systemwide billing records, she said. "I could see all the accounts, the charges, dates of service, the payers, what was paid and when," she said. She brought the errors to the attention of her superiors, she said. "Soon I knew that they knew what was going on, and that they knew what they were doing was wrong, and they didn't want to correct it," Dittman said. "They were more interested in the bottom line than in doing the right thing."
In response to her concerns, the hospital system's financial-services directors conducted an internal investigation that confirmed double- and overbilling were occurring, the suit alleges, but did not correct the problem or refund the money. "If there was a mistake, their culture was that they would not refund the money unless the payer specifically asked," Dittman said. "And then they would only refund the money on that one account, even though they knew how often it occurred." Each hospital followed the same fraudulent guidelines, she said, adding that those who input the codes weren't aware they were upcoding.
At one point, Dittman said, she was told she was "being an obstacle." She has since relocated and now works for a hospital in California. Motion to dismiss Wednesday morning, the hospital system filed its second motion to dismiss the claim. Its first motion to dismiss was denied by U.S. District Judge John Antoon, who called the evidence "extensive and sufficient."
The seven Adventist hospitals listed in the complaint are Florida Hospital Orlando, Florida Hospital Altamonte, Florida Hospital Apopka, Florida Hospital East Orlando, Florida Hospital Celebration Health, Florida Hospital Kissimmee and Winter Park Memorial Hospital. "We allege they knew exactly what was going on and they didn't change their practice," Wilbanks said. "Basic errors were being made over and over in a very reckless fashion. It's not in doubt that these errors were being made. The question is how many times, and how much [money] did they keep that they shouldn't have kept?" he said.
Though the discovery process hasn't started, he said, the problem is systemic. "Based on the paper trail we've seen, we have a basis for believing that this was a problem for a number of years," Wilbanks said. If found guilty, Adventist would not only be responsible for repaying the excess money received, but also for paying damages and civil penalties of $5,500 to $11,000 per false claim, he said. The damages alone could easily be in the tens of millions of dollars, he added. A trial is set for December 2013. mjameson@tribune.com or 407-420-5158 Click here to view this article <http://mobile.orlandosentinel.com/k/4awyz>
A whistleblower case alleging that Florida Hospital and six affiliates knowingly overbilled Medicare "tens of millions of dollars" in radiology services has widened to include the hospitals' emergency departments, according to an amended complaint filed this month. The new complaint against Adventist Health System, which owns the hospitals, alleges that routine billing fraud occurred in the emergency departments from 2001 to 2008 and possibly longer, said Marlan Wilbanks, attorney for the whistle-blowers. One of them, Amanda Dittman, worked in Florida Hospital's billing department during that time and claims in the suit that the hospitals routinely submitted false, duplicate or padded medical claims for emergency services, too.
The new allegation "fits like a glove with the original complaint," Wilbanks said. "It demonstrates the same lack of overall institution supervision." The original complaint, filed in July 2010, claimed Florida Hospital used improper coding from 1995 to 2009 to overbill Medicare, Medicaid and Tricare, all federal government payers, for radiology services. The suit also alleges that the hospital routinely overbilled for a drug — octreotide — used to enhance MRI scans by billing for larger doses than were actually administered. It also alleges that bills were issued for computer-aided-detection analyses that were never performed. For instance, in 2006 the CAD system, which helps doctors interpret mammography scans, wasn't working, yet the hospital billed for the CAD scans anyway, the suit alleges. The hospital never refunded the money, according to the suit.
When asked for comment, Florida Hospital spokeswoman Samantha O'Lenick issued this statement: "Florida Hospital takes seriously our obligations under the law. If we discover mistakes, we take appropriate action to correct them. "However, we believe the recent allegations relating to emergency room billings are asserted to achieve settlement pressure in the context of ongoing litigation. We believe the allegations are without merit, and we note that the relators had no involvement in emergency room billing. We will continue to defend the claims in court," the statement said.
Saw a pattern
The second whistle-blower in the case is Dr. Charlotte Elenberger, a radiologist affiliated with Florida Radiology Associates since 1995. Dittman, a bill-coding and reimbursement-compliance officer, worked for Florida Radiology Associates from 1996 to 2001 before going to work for Florida Hospital. Shortly after she began working at the hospital, she began to see a pattern, Dittman said. "I saw the upcoding happening daily in heavy volumes across seven hospitals in the Orlando area," she told the Sentinel. Dittman had computer access to systemwide billing records, she said. "I could see all the accounts, the charges, dates of service, the payers, what was paid and when," she said.
She brought the errors to the attention of her superiors, she said. "Soon I knew that they knew what was going on, and that they knew what they were doing was wrong, and they didn't want to correct it," Dittman said. "They were more interested in the bottom line than in doing the right thing." In response to her concerns, the hospital system's financial-services directors conducted an internal investigation that confirmed double- and overbilling were occurring, the suit alleges, but did not correct the problem or refund the money. "If there was a mistake, their culture was that they would not refund the money unless the payer specifically asked," Dittman said. "And then they would only refund the money on that one account, even though they knew how often it occurred." Each hospital followed the same fraudulent guidelines, she said, adding that those who input the codes weren't aware they were upcoding.
At one point, Dittman said, she was told she was "being an obstacle." She has since relocated and now works for a hospital in California. Motion to dismiss Wednesday morning, the hospital system filed its second motion to dismiss the claim. Its first motion to dismiss was denied by U.S. District Judge John Antoon, who called the evidence "extensive and sufficient."
The seven Adventist hospitals listed in the complaint are Florida Hospital Orlando, Florida Hospital Altamonte, Florida Hospital Apopka, Florida Hospital East Orlando, Florida Hospital Celebration Health, Florida Hospital Kissimmee and Winter Park Memorial Hospital. "We allege they knew exactly what was going on and they didn't change their practice," Wilbanks said. "Basic errors were being made over and over in a very reckless fashion. It's not in doubt that these errors were being made. The question is how many times, and how much [money] did they keep that they shouldn't have kept?" he said.
Though the discovery process hasn't started, he said, the problem is systemic. "Based on the paper trail we've seen, we have a basis for believing that this was a problem for a number of years," Wilbanks said. If found guilty, Adventist would not only be responsible for repaying the excess money received, but also for paying damages and civil penalties of $5,500 to $11,000 per false claim, he said. The damages alone could easily be in the tens of millions of dollars, he added. A trial is set for December 2013. mjameson@tribune.com or 407-420-5158 View this article at <http://mobile.orlandosentinel.com/k/4awyz>
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