Healthcare Compliance Perspective – Wrongful Discharge:
The “Ethics” of a Compliance and Ethics Program is dependent upon a cultu
re that encourages, if not rewards, timely and accurate disclosures. Such a culture only exists with openness and a willingness to honestly investigate, as opposed to retaliate and intimidate.
A former employee recently filed suit against a Missouri medical center where she had worked as a medical coder for about 40 years. Her suit claims that she was a victim of wrongful discharge and experienced retaliation for her efforts to avoid the medical center’s violation of the False Claims Act (FCA). She also alleges that the discharge involved age discrimination.
The woman seeks “compensatory damages in excess of $75,000” in accordance with FCA rules that authorize the recovery of “lost wages and benefits, attorneys’ fees and reinstatement.”
Last April, the woman alleges that she was instructed to submit reimbursement claims without proper supporting documentation and for charges not eligible for reimbursement. The actual complaint alleges that she was terminated for “reporting, raising concern about, and disclosing, unlawful, unethical, and fraudulent billing practices” along with “age discrimination and retaliation in violation of the Missouri Human Rights Act.”
The woman reportedly advised her supervisor about the claims that were not “technically eligible for Medicare reimbursement,” and expressed her concern that the company might be audited which could result in large fines. After that, she submitted the claims but included notification that she had been authorized by her superiors against her belief that the charges were fraudulent.
She was transferred to a coding job in another area of the company and replaced by a person 15-years younger. The company also disciplined her with a write-up and a 3-day suspension and imposed an “Individual Development Plan.” She notified the center’s Human Resources Department that she felt she was being disciplined because of her age and the actions she took to oppose the center’s fraudulent billing.
There was a meeting held between the woman, the coding manager and HR after which the woman was “accused of violating the Health Insurance Portability and Accountability Act (HIPAA) of 1996.” After again complaining to HR, she was soon fired.
Responding to the HIPAA accusation, the complaint stated, “Merely because plaintiff could see patient information while performing duties in the coding program (that she needed to access to perform her job), she was subject to discipline and suspension.”
