Medicare fraud investigator files lawsuit against Naples hospital group for wrongful termination

A retired FBI investigator who worked for Naples-based Health Management Associates has filed a lawsuit against the hospital chain saying he was wrongly fired after he uncovered fraudulent Medicare billing, according to the lawsuit.

Officials at the for-profit hospital chain say they fired Paul Meyer on Sept. 6 for insubordination when he refused to cooperate with an internal investigation and for disclosing confidential internal information, according to a counterclaim HMA filed

HMA had been served with federal subpoenas and Meyer had documents that belong to the company which he refused to return, said Susan Toepfer, HMA’s defense attorney.

“That was the sole reason for his termination,” she said. “He refused to cooperate with HMA’s legal obligations, to respond to those government subpoenas.”

Meyer’s attorney, Eric Isicoff, could not be reached for comment.

Meyer filed his lawsuit Oct. 19 in Broward County, where he lives. HMA had the case transferred to federal court in Fort Lauderdale. Meyer has since asked for the case to be remanded back to the Broward court system.

Meyer said Physicians Regional Healthcare System in Collier County was one of the hospitals where he found fraudulent billing. The federal insurer was billed for higher reimbursement for inpatient care for patients who had been treated in a less-costly outpatient basis, according to his complaint.

The accusation of fraud is the second one to be filed in a two-year span by an HMA insider.

The former chief executive officer of Physicians Regional-Collier Boulevard, Michal Mastej, filed a whistleblower claim in January 2010, that said HMA illegally induced physicians with money and favors in exchange for patient referrals.

The federal government declined to join in Mastej’s original complaint and the case was closed. Mastej filed an amended complaint in August 2010 and that case remains active, according to court filings.

Last August, HMA disclosed that it had received federal subpoenas involving possible Medicare billing improprieties and physician referrals. The disclosure was made in quarterly reports with the Securities and Exchange Commission that could affect its 59 hospitals in 15 states.

Meyer was hired by HMA in March 2006, a few weeks after retiring from a 30-year career at the FBI, where his last position had been as supervisor of the health-care fraud unit in Miami.

He was hired by HMA to serve in its corporate compliance department. He became director of the department in January 2010.

At that time, he started monitoring activity at four HMA hospital systems — Physicians Regional at Pine Ridge and Collier Boulevard; the Medical Center of Southeastern Oklahoma in Durant, Okla.; and Dallas Regional Medical Center in Mesquite, Texas.

He reported his findings to corporate officials but found that “no meaningful action had been taken to rectify the fraudulent billing practices ongoing within these facilities.”

The lawsuit does not contain a time span for when Meyer believes fraudulent billing occurred but does refer to an email that a physician reviewer wrote.

“The more charts I review, the more I understand that the problem is not just a process problem,” the email said. “It is a metastatic malignancy that has encroach(ed) upon their entire system.”

Toepfer declined to comment about a time frame or how many months of records Meyer may have reviewed.

“That is a subject that will be part of the case,” she said.

In response to his written report about the Medicare fraud billing, Meyer said HMA changed his job duties in January 2011 to limit his contact with the hospitals in question and to eliminate his compliance function, his lawsuit said.

He was assigned to compliance training and potential hospital acquisition and was “purposely shielded from any information regarding an investigation and follow up, if any, with respect to the serious fraudulent activity he had uncovered and reported,” his lawsuit said.

He kept inquiring how HMA was going to remedy the problems and said if the company did not report the violations, he intended to do so.

“It is my intent that the right thing is done in this investigation,” he wrote in a Sept. 6 2011 email. He was fired that afternoon, according to his complaint.

In HMA’s counterclaim, the company denied that Meyer’s job was changed to remove him from contact with the hospitals that he said committed fraudulent billing. Instead, his job responsibilities had changed to be responsible for compliance training.

HMA said Meyer was fired for insubordination after he refused to cooperate with an internal investigation and refused to return documents he had at home that were needed to respond to subpoenas from the U.S. Department of Health and Human Services (HHS).

“HMA received from HHS a copy of the confidential and privileged information that was given to HHS from Meyer,” according to HMA’s counterclaim.

In addition, Meyer had taken proprietary company information and converted that HMA property for his own benefit, which also violated of his non-compete and non-disclosure agreement, the counterclaim said.

© 2012 marconews.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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