Press
Columbia Settles Suit on Billing Practices
By ROBERT F. WORTH
Published: December 21, 2002
The New York Times
Columbia University agreed yesterday to pay $5.1 million to settle a civil complaint that it billed the state Medicaid program for obstetrical services that Columbia doctors did not provide.
The settlement resolves a lawsuit brought by federal prosecutors accusing the university of billing the government for birthing services that were actually performed by midwives, residents and other doctors who were not eligible for Medicaid reimbursement.
The false billing took place over the last decade at the Allen Pavilion, a community hospital in Upper Manhattan that is operated by New York Presbyterian Hospital.
The university, whose medical employees work at New York Presbyterian, admitted no wrongdoing in the agreement. But the university submitted to a five-year training program and reviews of its billing and other practices by the federal Department of Health and Human Services.
"The issues raised by the government in this case relate primarily to proper billing documentation," the university said in a statement released yesterday. "The quality and availability of care were never at issue."
The university's statement also said, "New billing procedures and new management and administrative teams are in place to guarantee that Columbia is in full compliance with Medicaid requirements and unequivocally meets the government's standards."
According to the government's complaint, doctors at the Allen Pavilion wrote delivery notes in the charts of babies they had not helped to deliver so that the hospital could bill Medicaid. In some cases doctors were paid $50 to write the notes, prosecutors said, and at times they wrote "present" on the charts of births in which they had had no role. Some of the notes were written months after the birth.
Twenty staff midwives are responsible for most of the baby-delivery services at the Allen Pavilion, which serves Inwood, a neighborhood where much of the medical care is paid for through the Medicaid program. Midwives may receive Medicaid reimbursement for their services under federal and state law, and some of the midwives at the Allen Pavilion were in fact eligible to receive it.
But the university presented bills suggesting that doctors had been responsible for supervising births where they were not, prosecutors said. In many cases, the university also double-billed the government for the services of the midwives and other staff members, submitting payment requests both for salaries and for separate service fees, prosecutors said.
Columbia became aware of a double-billing problem in May 2000, and returned $135,000 to Medicaid, according to government documents.
The government's lawsuit stemmed from an inquiry that began after Denise Romano, a former Columbia billing employee, alerted the government to the problem.
The federal government pays for half the obstetrical services provided to Medicaid beneficiaries in New York State, with the state picking up the rest. A portion of the funds from the settlement will be turned over to the state, prosecutors said.
"No provider -- big or small -- is exempt from following the rules," said James B. Comey, the U.S. Attorney for the Southern District of New York in Manhattan, in a statement.
The settlement agreement was approved yesterday by Judge Louis L. Stanton of Federal District Court in Manhattan.
Over the last several years, federal prosecutors have brought a number of cases against large teaching hospitals for false billing.
Multi-Million-Dollar Medicaid Fraud Busted: Geneseo Alumna Blows the Whistle on Her Ivy League Grad School
By JO KIRK
Published: Winter 2005
Geneseo Scene
The case: The United States of America ex rel Romano vs. Columbia University.
The relator: “whistleblower” Denise Romano, represented by attorney Timothy J. McInnis, filing the case on behalf of the U.S. Government, represented by U.S. Attorney’s Office legal staff and Federal Bureau of Investigation special agents.
The defendant: Columbia University, Romano’s former employer (and graduate alma mater), represented by attorney David Spears.
The law: the False Claims Act, also known as “Lincoln’s Law,” which allows private citizens with knowledge of fraud to help the U.S. Government recover ill-gotten gains and additional civil penalties by joining in legal actions commonly dubbed “whistleblower lawsuits.”
The claim: fraudulent Medicaid billing practices by Columbia physicians and administrative officials at the New York and Presbyterian Hospital’s Allen Pavilion.
The settlement: agreement by Columbia to pay $5.1 million to the U.S. and Romano, and to submit to U.S. Government monitoring.
The story:
When Denise Romano ’89 blew the whistle on her employer, lodging the complaint that would earn her more than a million dollars (before taxes and attorneys’ fees), she was already known to the Federal Bureau of Investigation (FBI). In fact, the agency had approached her as a potential recruit in the mid-nineties, after she assisted with an investigation into a cult group in which a friend of hers had become involved. Health problems – Romano has a chronic cough – and doubts about carrying a gun caused her to withdraw from the application process, but she was strongly attracted to the idea of a career fighting crime, she says.
So, several years later, when her employer, Columbia University, moved her to a small community, Allen Pavilion, and “it became clear to me something fishy was going on,” she leapt at the chance to report what she saw. “This was my chance to expose wrongdoing, to protect myself, and to assist the FBI in some capacity - without having to carry a gun.”
In the obstetrics/gynecology department where Romano worked as a claims administrator, she observed that 90 percent of the deliveries were attended by midwives, but that in most cases a doctor signed the note required for billing. Romano had no work experience in medical billing but was forced to transfer to the medical billing position against her will, despite complaints to the department Chair and HR that she believed this transfer was in retaliation for legitimate complaints Romano had previously made at CU.
The situation worsened when Romano was instructed by her supervisor to make sure these notes were written, she says. “When a particular doctor quit before signing for procedures she had just performed, I had to nag another doctor to write not only those notes, but more than 50 others for earlier procedures by the same doctor (who had quit). I also had to nag Medicaid-eligible physicians to write notes in charts for doctors and medical residents and fellows who had performed medical procedures on their own but who were not yet eligible to bill for Medicaid-funded services.”
There was even a system of kickbacks, Romano says. “I had to report to my supervisor how many charts each doctor was signing, and the department would pay him/her $50 for each one.” A NYPH hospital employee in the Ob/Gyn dept. kept a database of these kickback payments based on Romano’s reporting.
Eventually, she took to a lawyer-friend some of the documents that were coming to her, including a memo from the Dept. Chair instructing physicians to sign patients’ charts and write delivery notes for births whether or not they were involved in the birth.
She had been talking to this lawyer for over a year about issues of harassment and discrimination she both experienced and observed which shocked and dismayed her.
“It was one of many smoking guns,” she says, and the kind of evidence her lawyer said could open the way to a Lincoln’s Law suit – which, if successful, would recoup money for the government and a relator’s share for Romano, as the private citizen filing on the government’s behalf. How much that share might be would depend upon FBI guidelines, under which the amount varies according to how helpful a whistleblower has been, and on the risks he/she has taken.
“I began to assist my attorney and the U.S. Government in what was suddenly an official, federal investigation,” says Romano. As a courtesy to the FBI and U.S. Attorney’s Office, she prefers not to detail investigation procedures or the meetings she had with their agents and legal staff.
She did not become nervous until her attorney arranged for her to present a memo expressing her concern about fraud directly to her employers, she says. “That meeting was awful,” Romano said, “because even my attorney perceived that they were clearly going to try to blame all of this on me, personally, when it was actually coming from the top.” Romano adds, “This is why I was so nervous; all of my experiences in making legitimate complaints at CU and going through appropriate reporting and complaint channels, always resulted in retaliatory actions against me, and others experienced this also. It is not what you expect at an Ivy League University – or anywhere, for that matterf.”
This was followed by the arrival of some of the FBI agents at her workplace, armed with subpoenas for witnesses and documents. They acted as if they were meeting Romano for the first time, “but, even so, people started asking me questions,” she says. “I would change the subject – I wasn’t supposed to lie – but I could feel their eyes looking at the back of my head as I walked down the halls.”
At the end of 2002, more than two years after lodging her complaint and more than a year after leaving Columbia, the long proceedings finally came to an end. The Ivy League university admitted no guilt, but agreed to pay out more than $5 million. Romano netted 22 percent of these proceeds, slightly more than the 16-20 percent average earned by private citizens under whistleblower law. She made it clear that she would not sign a gag agreement, because “I wanted to be free to tell the whole story,” she says.
“The whole story” began long before she was moved to the hospital where she was involved in Medicaid billing, she says, and in retrospect it seems surprising that she was transferred there at all. On more than one previous occasion she had reported to her supervisors what she alleges were gross infringements of workplace safety laws and other employee rights. On receiving no response, she referred at least one complaint on to an appropriate external agency, bringing down a $10,000 fine on her employer.
“So I was already labeled a troublemaker at Columbia,” says Romano, who claims her re-assignment to Allen Pavilion Hospital was done in retaliation for her legitimate complaints. “But they still put me in a position where I would see illegal activity going on.”
“The whole process was simultaneously harrowing and fascinating” because throughout it Romano was studying at the university which employed her. She began with a master’s degree in counseling psychology, and – motivated by what was happening to her at work – added another master’s, in organizational psychology. “I was, and remain, struck by the cavernous gap between what I was learning about the workplace in my classes and what I was experiencing as an employee,” she adds.
In 2000, as Romano had been determined to do since being hired by Columbia in 1994, she completed her graduate studies and, for close to three years now, she has been in her “dream job,” as Director of Human Resources and Organizational Development at a Public Benefit Corporation located in downtown Manhattan, which is a city-state partnership.
“I chose this career based on some bad experiences, and now I use it to positively influence the culture and community of the place I work,” she says. “From what happened to me at Columbia, I’ve learned in a way that I can never forget - how important it is to treat those who work for and alongside us with respect, honesty, integrity and fairness.”
There are other things Romano has gained from her “bad experiences,” she says, including “sweet vindication” against her former employer and “the very nice financial reward, which was never a given – but one of the biggest things that came out of all this was learning that I’m much stronger than I ever could have imagined.”
At Geneseo, where Romano earned a double major in English and Theatre, she worked in the theatre department as box office manager and was president of Cothurnus, the student theatre club. Her favorite professors were Richard Finkelstein and Celia Easton, in the English Department. She also studied dance and has continued to dance.
Romano continued literary studies at Naropa University in Boulder, CO, where she earned a Master of Fine Arts degree in writing and studied with Allen Ginsberg, her “poetry hero.” In 1994, she published a book of poems, titled “Paper over Flames,” and for a while was active in performance arts combining poetry, percussion and movement.
Outside her full-time job with a public benefit corporation located in downtown Manhattan, Romano is a Certified Emotional Intelligence and Relationship Coach and can be reached at Denise@LoveAndWorkCoach.com
