BY MIKE GALLAGHER
The Cincinnati Enquirer
A registered nurse has filed a federal whistleblower suit claiming Deaconess Hospital, its subsidiaries and two of its doctors falsified federal Medicare and Medicaid claims by billing for a day's treatments that would have taken more hours than there are in a day.
Mary B. Martin of Cincinnati, a nurse specializing in geriatric care, also claimed Deaconess and the doctors provided inadequate or improper care for many elderly nursing home patients.
Ms. Martin was administrative manager of Sycamore Professional Association Inc., an affiliate of Deaconess that provides services to several Tristate nursing homes.
According to the suit unsealed Thursday by Judge S. Arthur Spiegel in U.S. District Court in Cincinnati, the problems Ms. Martin alleges occurred from at least 1995, when a Deaconess subsidiary acquired Sycamore. Ms. Martin said in the suit that she was fired on Nov. 8, 1996, a little more than a month after she called the U.S. Department of Health and Human Services to report what she considered to be improper practices.
The suit said Deaconess doctors routinely engaged in "gang visits," where they would perform quick and inadequate medical checks on large numbers of elderly patients at the nursing homes in a single day.
According to the suit, one such visit occurred on Oct. 24, 1995, when Dr. Philip M. Goldman visited 47 patients at one nursing home. "The total time typically required at the patient's bedside for these 47 claims billed on Oct. 24, 1995, would be 28.67 hours," the suit said.
In another case cited in the suit, Dr. Claude John Mason, through Deaconess affiliates, submitted claims for treating 70 patients at three different nursing homes in Indiana and Ohio on Dec. 20, 1995. "The total time typically required for these claims would be 32.85 hours of services," not counting driving time between the three facilities, according to the suit.
Drs. Goldman and Mason are defendants in the suit.
Additionally, the suit claims that the health of many elderly nursing home patients was jeopardized because Deaconess nurses are permitted to "adjust medication dosages, including controlled substances, and to direct treatment, without prior physician input."
Also, nurses working in the nursing homes under the auspices of the defendants are authorizing and ordering prescriptions for medications, including narcotics, for elderly patients, without a doctor's knowledge or approval, the lawsuit said.
Bills for those unauthorized and medically dangerous drugs are then sent to Medicare and Medicaid for reimbursement. Often, a doctor's signature is forged on authorization forms by the nurses, according to the suit.
Barbara Lohr, Deaconess' director of corporate marketing and communications, said Friday she could not comment on the lawsuit because she had not received a copy of it. Deaconess' corporate counsel, Andrew Botschner, also named as a defendant in the suit, was on vacation and could not comment, she said.
Dr. Goldman did not return calls seeking comment. Dr. Mason, who is believed to reside now in Missouri, according to the suit, could not be reached.
The suit also names as defendants: Deaconess Associations Inc., a not-for-profit corporation that serves as a holding company; Deaconess Hospital of Cincinnati, a subsidiary of Deaconess Associations; Deaconess Health Care Services Co., a subsidiary of Deaconess Associations that provides physician office services; Tristate Health Systems Inc., a professional association controlled by Deaconess that provides services to Deaconess subsidiaries and affiliates doing business as Extend Care Physician Services Inc., or as Sycamore Professional Associates; and Extend Care Physician Services Inc., an Ohio corporation controlled by Deaconess that provides medical director services to long-term care facilities in Greater Cincinnati, and physician services to patients in these facilities.
The suit was filed under seal two months ago. The federal False Claims Act allows the government to investigate the claims during that period and determine if it wants to intervene in the case. When the government declined to intervene, the case was unsealed and Ms. Martin, through her attorney Phyllis Brown of Cincinnati, is permitted to pursue the claims.
The act provides that any person who knowingly submits a false or fraudulent claim to the federal government for payment or approval is liable for a civil penalty of not less than $5,000 and not more than $10,000 for each claim, plus triple those amounts for each proven claim. Ms. Martin, as the person bringing the suit, is entitled to a share of any recovery made. She also is seeking reinstatement to her job, lost earnings and legal fees.
