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Auditor says Eskenazi fired her for identifying improper billing

November 10, 2016

A compliance auditor at Eskenazi Health claims she was fired after alerting her supervisor that the hospital was improperly billing the federal government and Indiana for potentially hundreds of patients whose bills were already being paid by research grants.

Colette D. Jackson filed a complaint Thursday in U.S. District Court in Indianapolis against Eskenazi and its parent, Health and Hospital Corporation of Marion County, saying they retaliated against her after she tried to get them to stop submitting the false claims.

Jackson said she discovered the problems in June, when one of her research billing specialists brought the matter to her attention. The complaint did not specify which grants, studies or types of treatments were involved, nor the amount of money at stake. The problem involved “potentially hundreds” of Medicare or Medicaid patients over at least two years, the suit said.

An Eskenazi spokesman said it would be inappropriate to comment on a pending lawsuit.

According to the suit, Medicare and Medicaid regulations require that when a medical provider gives treatment to a patient who is also part of a study that receives grant funding, the provider must include a specific code in its billing to Medicare or Medicaid, so the agencies can determine whether the treatment that is being billed for was already paid by the grant.

After receiving the information from her billing specialist that many patients were being treated through grants, Jackson in July forwarded the information to her supervisor, Gina Thompson, Eskenazi’s chief compliance officer. Jackson recommended that the research billing “be temporarily suspended pending further review.”

Instead, Thompson told Jackson to drop the investigation, the complaint said. On Sept. 15, Thompson terminated Jackson.

The reason given for the termination, according to the complaint, was that Thompson had recently found inconsistencies in two separate versions of the resume in her personnel folder. According to the complaint, however, the inconsistencies consisted of one unspecified typo, which was later corrected in the updated resume, and “actually true statements which had been misunderstood by Thompson.”

“No reasonable employer would have terminated Jackson under these circumstances and without giving her an opportunity to address Thompson’s concerns,” the complaint said. “Thompson’s only purpose in reviewing and conducting background research into Jackson’s application materials was to find pretext for terminating her employment.”

It continued: “The real reason for the termination of Jackson’s employment was to retaliate against Jackson for trying to stop Defendant from submitting false claims to the federal government and the state of Indiana.”

Jackson is asking to be reinstated, with back pay, damages and attorney fees.

 

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