P is for Peril

"I thought he was the administrator."

"His title was Medical Director slash Administrator. I was the Associate Administrator, so I suppose you're correct."

"Can you tell me why you left?"

"Genesis, the management company that oversees the operation of Pacific Meadows, received notification that Medicare was conducting a rigorous audit of our records."

I raised my hand. "What prompted them to do that? Do you have any idea?"

"Probably a complaint."

"From?"

"One of the patients, a guardian, a disgruntled employee. I'm not sure what it was, but they seemed to know what they were doing. Apparently, the clinic was suspected of any number of violations, from overpaying our suppliers to submitting false or inflated claims for services. Dr. Purcell was in a panic and blamed the bookkeeper, Tina Bart, which was absurd and unfair. Ms. Bart was working for Pacific Meadows before I arrived and she was faultless in her performance. I went to bat for her. I wasn't going to let them push it all off on her. She didn't make the decisions. She didn't even pay the bills; Genesis did that. She processed purchase orders and prepared the room-and-board bills for each resident, including central supply, therapy, anything other than medication. This was Medicare, Medicaid, HMOs, private insurance, and private pay. The same information crossed my desk as well. She didn't generate the paperwork. She forwarded what she was given."

"Why isn't Genesis considered responsible for the problem if they pay the bills?"

"We supply them the information. As a rule, they don't stop to verify the data, nor did Ms. Bart."

"But she was fired, anyway."

"Yes, she was, and I turned in my notice the very same day. I was determined to file a complaint with the Labor Relations Board."

"What was their response?"

"I never got that far. I had second thoughts and decided not to go through with it. Tina Bart didn't want to make a fuss. She was as reluctant as I was to call attention to Dr. Purcell's situation."

"His situation?"

"Well, yes. We're all fond of him. He's a darling human being and a wonderful doctor. If he didn't have a head for business, that wasn't an actionable offense as far as we were concerned. I'm being candid in this. He just had no clue when it came to the Medicare rules and regulations-which items were billable and which would automatically be disallowed, co-payments, deductibles, claims for fee-based services. I grant you, it's enormously complicated. Make one mistake- god forbid you put a code in the wrong place or leave even one window blank-and the form comes right back at you, usually without a hint about where you've erred."

"But Dr. Purcell didn't do the billing."

"Of course not, but it was his job to review the TARs-"

"The TARs?"

"The Treatment Authorization Requests. He was also responsible for reviewing CPT codes and approving the cost of any ancillary services or DME's. I have to emphasize, he was always genuinely concerned and very innovative when it came to patient care and well-being-"

"You don't have to work so hard to defend the man," I said. "I'll take your word for it. What I hear you saying is when it came to the day-to-day management, he was incompetent."

"I suppose, though it seems too strong a word."

"Didn't Glazer and Broadus realize what was going on?"

"It wasn't their place. They purchased the property from the previous owner, did extensive improvements, financed and built the annex. The rest was up to Genesis and Dr. Purcell. Please understand, this is just my personal opinion, but I've worked with a number of doctors over the course of my career. It almost seems that the better a man is at the practice of medicine, the worse he is at business. Most of the doctors I know have a hard time admitting this about themselves. They're used to being gods. Their judgment is seldom questioned. They have no awareness of the limits they face, so they're easily duped. They may have medical knowledge, but often not an ounce of common sense when it comes to money management. At any rate, I didn't mean to digress. I'm just trying to explain how Dr. Purcell could have gotten himself into such a mess."

"Didn't you explain it to him?"

"On numerous occasions. He seemed to listen and agree, but the errors continued to accrue."

"But if you suspected he was screwing up, couldn't you have gone to the operating company yourself?"

"Over his head? Not if I wanted to keep my job."