Former Bingham Memorial employees allege fraudulent activity
Updated On: Jun 07 2012 03:20:21 PM CDT
As Blackfoot Police continue their criminal investigation into Bingham Memorial Hospital, a pair of former employees are making allegations of possible fraudulent activity at the hospital.
Our station has been looking into allegations by past and present employees for nearly a month.
"This is crazy," said Nichole Rammell, of what went through her mind when she said managers at Bingham Memorial gave her a new task in October 2011.
"They wanted a report on how I was going to have my department increase length of stay," said Rammell, who served as director of social services and utilization review at the hospital from September 2010 to November 2011.
Length of stay is defined as how long patients are in the hospital. Critical Access Hospitals, like Bingham Memorial, can't have an average stay greater than four days or 96 hours.
In a statement to our station on Tuesday, Bingham Memorial Chief of Staff, Dr. Clark Allen was quoted, stating: "The decision of how long a patient stays in the hospital is the sole responsibility of the attending physician. Such decisions are based on the overall health, condition and best interest of the patient. I have not seen anything from our staff that indicates otherwise."
But Rammell said the request to increase patient stays came via an email from administrative assistant Justin Dalling.
It read: "Nichole, we need to have the average daily census up to 4.0, excluding nursery, by next month. Your report is due by November 20."
Rammell said daily census is how many patients are in the hospital during the day. To clarify the assignment, she said she responded, asking if that meant the average length of stay per month.
According to email documents, Chief Nursing Officer Cindy Christensen wrote back: "Yes. He means the average length of stay."
Rammell said a supervisor told her in a separate conversation that the directive didn't apply to those with private or no insurance.
"They only wanted it to be with Medicare and Medicaid patients," said Rammell.
As a critical access facility, Bingham Memorial gets cost plus one percent in reimbursement from Medicare. Rammell said she was told the increase in length of stay was to help increase revenue.
"One point where they said if we increase length of stay by one ... one day it would increase it by 1 million dollars a year," she said.
Former Health Information Manager Tina Cobia remembered the topic being brought up at monthly utilization review meetings.
"They just said we need to increase length of stay by a day," said Cobia.
"There has to be medical necessity and the doctors should have to make an order that the patient needs to stay longer," said attorney Ron Swafford, who's been practicing law in Idaho Falls for more than 30 years.
Swafford said purposely increasing length of stay, if it's unnecessary, could fall into the fraudulent category.
"That would appear to be a different breed of, a different animal entirely, from an accident or negligence involving record keeping," said Swafford. "That would fall more in line with intentional actions to increase the cost to the government and to taxpayers, actually."
Rammell said she was concerned and told her department to keep doing things by the book.
"We're going to keep doing things ethically and we're not going to jeopardize our licenses and anything that's going to be fraud," said Rammell.
Angie McLean said she faced a similar conflict as a Certified Nursing Assistant, or CNA, in charge of emergency room clerks, who admit patients to the ER.
"One of the Emergency Room physicians came to me and said that they had come to realize that we weren't filling out these Medicare forms for Medicare patients," she said. "Any patient who had Medicare that was coming into the emergency room and we needed to go back two years and fill out these Medicare forms."
McLean said the order was given ahead of a Medicare audit. She said the forms ask a variety of questions from when a patient was signed up for Medicare, to whether another insurance agency could be billed.
McLean said they weren't filled out for a number of years because, she said, when she took on the additional role of ER clerk, she only got a few hours of training.
"We just never were shown that we needed to do those," said McLean.
The BMH employee of 15 years said pressure was mounting.
"I didn't feel like it was right but I had managers coming to me every day, like, all the way to the top," said McLean.
McLean said finally, she filled out the two years' worth of forms. She said every yes or no question was answered whether the information was in the ER charts or not.
"Some of the information we could get, but some of it, I would say, yes, was probably made up," said McLean.
Watching McLean's last statement, Swafford said "That's quite serious."
"That goes over the line a long ways in terms of intentional fraud, which could actually subject the management, the supervisors to potential criminal prosecution," said Swafford.
On Monday afternoon, our station sent Bingham Memorial the facts presented and specifics of the allegations for a comment on the story.
The hospital's Board of Directors released a statement on Tuesday based on the information and time they were given to respond.
They said Rammell's former supervisor and co-workers denied being asked to act improperly relating to length of stay.
They did not respond to McLean's allegations of filling out Medicare ER forms years later.
In a letter from his attorney, CEO Louis Kraml denied any wrongdoing.
Also in the statement, the Board said Bingham Memorial recently participated in a Medicare survey. They said findings released early in 2012 ranked the organization above state and national averages across the board.
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