Praise for The HR Toolkit
“Dozens of sample memos, policies, training aids, exercises, checklists and more that readers can use immediately for a wide range of HR tasks. Author Denise A. Romano, an HR professional for more than 14 years, does more than offer sample documents and review laws relevant to HR. She urges HR professionals to be “credible activists” who are willing—and well-trained enough—to point out when their companies are violating laws or just handling things improperly through inadvertent errors. She also addresses HR professionals’ worries—including advising them on coping with workplaces that devalue HR. “
The HR Toolkit: An Indispensable Resource for Being A Credible Activist was named an HR “Books in Brief” Best-Seller! Each month HR Magazine reviews HR and management books. Read the reviews for the following books on the SHRMStore site or in your issue of HR Magazine.
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 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 hospital, The 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. “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 matter.” 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 with Columbia University (her former employer), 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 from OSHA. “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 at Columbia University and what I was experiencing as an employee of Columbia University,” she adds.
In 2000, as Romano had been determined to do since being hired by Columbia in 1994, she completed her graduate studies and, since 2002, she has been Director of Human Resources and Organizational Development at a Public Benefit Corporation (a city-state partnership) located in downtown Manhattan. “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 my experiences at Columbia, I’ve learned in an extremely poignant way how crucial 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. She was also a member of the prestgious student group, Veg S.O.U.P. (Student Organized Undergraduate Productions). Her favorite professors were Richard Finkelstein and Celia Easton, in the English Department. She also studied ballet, modern, African and jazz 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.
Romano is trained in Certified Emotional Intelligence and Relationship Coaching;Denise Romano is also a student and practitioner of Non Violent Communication, and is fascinated by the possibilities of combining sound conflict resolution and mediation skills with Emotional Intelligence and Non Violent Communication.
Denise is passionate about people having more nourishing, healthy, and respectful partnerships, friendships, family relationships, and workplace relationships. Denise is also passionate about workplace ethics and empowering employees at all levels to be Credible Activists in their workplaces in favor of ethical choices and decision-making based in integrity.
FOR IMMEDIATE RELEASE
Friday, Dec. 20, 2002
Columbia University Pays More Than $5 Million To U.S.; Whistleblower Case Alleged That Medical School Obstetricians Defrauded Medicaid Over Midwife-Handled Deliveries
NEW YORK CITY – Columbia University obstetricians defrauded Medicaid for more than a decade by falsely taking credit for deliveries routinely handled by certified nurse midwives at The New York and Presbyterian Hospital’s Allen Pavilion, according to court documents unsealed today after the university agreed to pay more than $5 million to the U.S. to settle the allegations.
U.S. District Judge Louis L. Stanton today approved a settlement among =he United States, whistleblower Denise A. Romano, and the university, according to Timothy J. McInnis, a Manhattan attorney specializing in whistleblower suits who represents Romano, a former Columbia University employee who brought the False Claims Act case to the U.S. Department of Justice.
According to a federal civil Complaint unsealed today, OB/GYN physicians at the Allen Pavilion, 220th Street and Broadway, had between September 1990 and January 2001:
· billed for MD-performed obstetric and gynecological services that actually were carried out by certified nurse midwives.
· allowed Columbia University physicians to sign charts for services that were performed not by Medicaid-certified physicians but graduate medical students, i.e. interns, residents, and fellows working towards specialized credentials;
· directed a Medicaid-eligible Columbia University-affiliated physician to bill for abortions that had been performed by a medicaid-ineligible physician; and
· paid $50 per chart for physicians to prepare and sign charts for other physicians not eligible to bill Medicaid, including entering services that the physicians did not carry out.
“The double billing aspect of these schemes is brazen,” McInnis said, in light of the fact that Medicaid, under its ‘Cost Report System’ was already reimbursing NY-Presbyterian for midwifery fees as part of the facility’s overhead.”
Columbia University did not admit wrongdoing. It also agreed, in addition to the $5.1 million payment, to submit to monitoring by the =.S. Department of Health and Human Services Office of Inspector General pursuant to an Institutional Compliance Agreement, according to the settlement agreement.
Columbia University initially used the name of the first doctor on the attending on-call schedule to bill Medicaid for all services performed by staff midwives on that shift. On one occasion the university billed for an attending doctor who reported for work hours after the delivery occurred, the Complaint states.
In order to bill Medicaid, Columbia University ordered attending physicians to write a note on “all deliveries. Regardless who performs the deliveries,” according to the Complaint. As a result, some attending doctors’ notes were written in patients’ charts, “weeks, months and up to a year after the deliveries had been performed by the other providers,” the Complaint states.
The $50 payments were part of an “incentive program, whereby it would pay doctors fifty dollars to write a note in a patient’s chart for, among other services, deliveries performed by staff midwives and other non-Medicaid eligible providers,” the Complaint states.
In January 2000 the University’s OB/GYN Department Chairman, Rogerio Lobo, M.D., issued a memo to Allen Pavilion doctors to participate in every delivery and “complete a note in the chart for quality of care and billing purposes,” the Complaint states. The university, “only required this for billing purposes” according to the Complaint.
Two months later, Dr. Lobo and Dr. Juanita Jenyons, the pavilion’s Director of OB/GYN, issued a memo to attending doctors advising them that they must state they were present at the delivery in order to bill for service. But some of the attending doctors wrote “present” in their delivery notes even though the doctors were not actually present in the room when the staff midwife delivered the baby, and when the attending doctor may have been performing a cesarean section or was elsewhere in =he hospital,” according to the Complaint.
The case began more than two years ago when Romano, who had worked at The Allen Pavilion for more than two years, “became very concerned when she realized that Columbia University OB/GYN physicians had been billing the federal Government for services they never provided,” McInnis said.
And she raised those concerns to the university and to the Department of Justice,” McInnis added. Romano no longer works for Columbia University and is employed in the Organizational Development field, which focuses on Human Resources, Organizational Psychology, and ethical standards and practices.
McInnis is a former Assistant U.S. Attorney for the District of New Jersey. In addition to representing individuals across the U.S., his =irm also serves attorneys as co-counsel for private “whistleblower” lawsuits brought under the Civil War-era False Claims Act (“the Act”). So-called “qui tam” actions, a term derived from English Common Law meaning “who sues on behalf of the king as well as himself,” allow private citizens with knowledge of fraud to help the Government recover ill-gotten gains and additional civil penalties.
Under the Act, the government can collect up to three times the amount it was defrauded, in addition to maximum civil penalties of $5,500 to $11,000 per false claim. In Fiscal Year 2002, the federal Government recovered more than $1.2 million under the Civil False Claims Act. Since 1986 nearly $6 billion has been recovered when the Government intervened in qui tam suits, according to U.S. Department of Justice Statistics. Whistleblowers usually have received rewards representing 15 to 25 percent of qui tam recoveries, McInnis said.
According to a separately filed agreement between Romano and the United States, the former compliance administrator at Columbia University, who also holds two graduate degrees in psychology from the University, will receive approximately 22 percent of the proceeds in this case, McInnis noted. McInnis initiated the case on behalf of Romano by filing the matter under seal and then providing it to the U.S. Department of Justice for investigation and possible joining. (Out of 2,467 qui tam cases offered to the Government in Fiscal Year 2001, federal authorities agreed to join 550 cases and declined 1,917 others.
More than 50 percent of these False Claims Act actions were health care related, according to U.S. Department of Justice statistics.) After evaluating the allegations provided by McInnis under seal, the Federal Government filed a notice of intention to join the case and the latter moved forward, according to documents unsealed today. Qui tam suits have become increasingly more common since the Act was reformed in 1986, “giving whistleblowers more incentives to come forward with the facts and providing them with more protection for doing so,” McInnis said.
“Denise Romano’s action has allowed the Government to retrieve millions of dollars of which all taxpayers were defrauded,” McInnis said The United States is represented in this matter by U.S. Attorney’s office for the Southern District of New York, James B. Comey, United States Attorney and Assistant U.S. Attorney Sheila Gowan of the office’s Civil Division. Special Agents of the FBI’s New York City Field Office, under the direction of Special Agent in Charge Joseph Billy Jr., primarily handled the Government’s investigation of this matter.
Columbia University is represented in the settlement by David Spears, Esq., of Richards Spears Kibbe & Orbe, New York City.
For Romano Timothy J. McInnis, Esq. Law Office of Timothy J. McInnis 512 Fifth Avenue, Suite 1700 New York, New York, 10175-0038. (212) 292-4573. Fax (212) 292-4574 McInnisEsq@aol.com http://www.whistleblowerlegal.com
For the United States AUSA Sheila Gowan U.S. Attorney’s Office for the Southern District of New York (718) 422-5615.
For Columbia University David Spears, Esq. Richards Spears Kibbe & Orbe One Chase Manhattan Plaza New York , New York 10005 212-530-1800
Timothy J. McInnis whistleblowerlegal.com Law Office of Timothy J. McInnis 521 Fifth Ave, Suite 1700 New York, NY 10175-0038 Tel: (212) 292-4573 Fax: (212) 292-4574 Cell: (917) 903-9424
Denise A Romano reported to Terence Davidson for several years and Columbia University ignored her complaints about him:
HOSPITAL EXECUTIVE ARRESTED Feds say Columbia official stole 435G
By GREG B. SMITH DAILY NEWS STAFF WRITER
Tuesday, September 19th 2000, 2:14AM
The top administrator of Columbia Presbyterian Medical Center’s obstetrics-gynecology unit embezzled $435,000 from the hospital’s fund-raising coffers – and spent the cash on a European vacation and other luxuries, prosecutors charged yesterday.
Terence Davidson, 48, was arrested at dawn yesterday at his home a few blocks from the Washington Heights hospital as part of an ongoing probe of alleged financial improprieties in the ob-gyn department.
Davidson was charged with one count of wire fraud yesterday as his attorney, Daniel Conti, insisted all of his client’s actions were approved by Dr. Roger Lobo, the chairman of the ob-gyn department.
“He denies any criminal wrongdoing,” Conti said outside court. “He intends to fight this in court.”
Officials from Columbia University, which runs the hospital, declined to comment except to note “the university continues to cooperate with federal authorities,” said Carolyn Conway, a spokeswoman for Columbia’s medical school.
Lobo, a renowned gynecologist who has appeared on “Good Morning America” as a medical expert, could not be reached for comment.
Davidson was hired as department administrator for the hospital’s obstetrics and gynecology department in October 1995, according to a complaint filed by Assistant U.S. Attorney Jonathan Kolodner.
With approval from Lobo, he opened a money market account at Chase Manhattan Bank under the name Sloane Activities in July 1999, according to Conti and another source familiar with the investigation.
Davidson was listed as “one of two signatories” on the money market account, the complaint states.
In September 1999, Davidson opened a Sloane checking account, for which he was the sole signatory, prosecutors said. By last December, he had created a firm operated out of his home called Davidson Management Consultants, according to the complaint.
In the next month, he allegedly transferred $435,000 from both Sloane money market and checking accounts into the Davidson Management account. Columbia officials told the FBI that Davidson was not authorized to make those transfers to Davidson Management.
Using funds from the Davidson Management account, Davidson allegedly bought a Jaguar and spent liberally during a European vacation, according to sources familiar with the investigation.
Between Feb. 26 and March 12, for instance, he dropped $33,665 from the Davidson Management account on hotels, meals and airfare in England, France and Italy, the complaint alleges.
Davidson, who faces up to five years behind bars if convicted, was released yesterday on $100,000 bond by Manhattan Federal Magistrate Michael Dolinger.