Did the laboratory at Abington Memorial Hospital in Pennsylvania commit Medicare and Medicaid fraud? That may eventually become a question for a jury to decide, as a former longtime employee has filed a suit against Abington, claiming its lab had been bilking the government by changing the way tests were being conducted and fired her when she complained. The suit is not a qui tam, or whistleblower suit, which are filed under seal and usually are not made public unless the U.S. or state governments join such litigation. Instead, it accuses Abington of retaliating against an employee who tried to seek redress when she claimed other employees had been engaging in violating the federal False Claims Act. Joanne Cleighton, Abington’s patient access manager, had been with the hospital for more than 26 years when she was fired last March. Her most recent job performance evaluation was above the 90 percentile, according to the suit. Where the two sides have butted heads are over Cleighton and Abington’s management of outpatient blood tests and their reimbursement. Cleighton managed the staff who inputted blood test laboratory data. Tests for Keystone Blue Cross’s Medicare Advantage and Medicaid managed care programs were outsourced to another […]
Did the laboratory at Abington Memorial Hospital in Pennsylvania commit Medicare and Medicaid fraud?
That may eventually become a question for a jury to decide, as a former longtime employee has filed a suit against Abington, claiming its lab had been bilking the government by changing the way tests were being conducted and fired her when she complained.
The suit is not a qui tam, or whistleblower suit, which are filed under seal and usually are not made public unless the U.S. or state governments join such litigation. Instead, it accuses Abington of retaliating against an employee who tried to seek redress when she claimed other employees had been engaging in violating the federal False Claims Act.
Joanne Cleighton, Abington’s patient access manager, had been with the hospital for more than 26 years when she was fired last March. Her most recent job performance evaluation was above the 90 percentile, according to the suit.
Where the two sides have butted heads are over Cleighton and Abington’s management of outpatient blood tests and their reimbursement. Cleighton managed the staff who inputted blood test laboratory data. Tests for Keystone Blue Cross’s Medicare Advantage and Medicaid managed care programs were outsourced to another lab, which apparently was part of their provider network.
According to the lawsuit, Cleighton had discovered last year that lab employees began systematically labeling routine Medicare and Medicaid blood work in a way that they received emergency or “stat” turnaround at Abington, which would receive the payments under those circumstances. Stat orders required a written order from a physician in order to be approved, and the suit alleges that lab staff were revising orders to suggest that the physicians had signed off on them.
Cleighton attended several meetings with lab staff where it had been acknowledged that such mislabeling was going on, but it apparently was not stopped, according to the suit. When Cleighton tried to meet with Abington’s compliance officer, she claimed the lab staff began acting in a hostile manner toward her and that she was retaliated against, eventually being accused of violating patient privacy laws and using a racial slur in front of an employee. An internal human resources investigation later determined neither had occurred.
Cleighton was asked to resign not long after, her employer citing what was considered an inappropriate e-mail that had apparently been sent months earlier. She refused to and was fired instead on the same day she had been scheduled to meet with the hospital’s compliance officer.
In a statement, Abington said it has not committed any wrongdoing and that it would vigorously defend against the allegations in court.
Takeaway: Can an unsealed wrongful termination suit play the same role as the traditional whistleblower litigation?
