Gubernatorial Candidate in Florida Embroiled in Possible Medicare Overbilling Scandal

Created: August 11, 2010 16:32 | Last updated: July 31, 2020 00:00

Republican gubernatorial hopeful Rick Scott campaigns in Florida.

An investigation by The Washington Independent’s sister site, The Florida Independent.

Two weeks before Florida’s primary, new allegations of improper Medicare billing by Solantic, a health care company co-founded by Rick Scott, have surfaced, in addition to charges made by former Solantic doctors that their names and licenses were used without their consent. Within hours of being pressed for answers by The Florida Independent, Solantic officials and Scott held hastily arranged press conferences Tuesday to rebut the charges.

[Congress1] Two doctors** **— both former employees of Solantic, the chain of clinics launched by Scott and in which he is a majority investor — allege that Solantic repeatedly used their name and medical license information without their permission or knowledge. Both doctors state that by allegedly misappropriating their information, the company was able to keep clinics operating in contravention of state law.

One of the doctors asserts that he also came upon evidence of billing irregularities involving Medicare, which, if true, would be the second time a Scott-run company was accused of improperly billing Medicare.

The two doctors don’t know each other, and didn’t work at Solantic at the same time.

Dr. P. Mark Glencross began working at Solantic in 2003 as its chief medical officer. He filed a lawsuit in 2008 claiming the company used his information without his knowledge to license six different clinics. He states in his lawsuit that he left Solantic shortly after he discovered the incidents of “unauthorized misappropriation” in 2004.

Dr. Randy Prokes worked at Solantic from 2004 to November of 2009 as an on-site doctor treating patients at one of its clinics. He says that he saw documents listing his name on billing forms and medical records at clinics he never visited, with patients he never met. When he cross-referenced those records with patient information, he says he saw that the patients were treated mostly by doctors hired on a temporary basis. Prokes alleges Solantic improperly used his license to cover clinics without his knowledge or consent.

In interviews with The Florida Independent, Prokes did not offer documents to substantiate his claims. The privacy of patients’ records is protected by federal law. But three former Solantic employees corroborated his account. After looking into the alleged unauthorized use of his name and license, Prokes says that he also came upon records indicating that Medicare was not being billed properly when a nurse practitioner was working alone at a clinic.

Nurse practitioners are allowed to work alone at a clinic, as long as they have a collaborative agreement with a doctor to operate under his license. But if a nurse practitioner treats a patient when there is no doctor on site, Medicare will only pay 85 percent of the scheduled fee for those visits. Prokes says that the records he saw showed that Medicare was being charged 100 percent for those visits.

In some circumstances Medicare will pay the full amount when a nurse practitioner working alone sees a patient, including if the nurse is under the direct supervision of a doctor as part of a patient’s treatment plan. But generally it is not allowed. “This is a problem area that we do see,” says Marc Wolfson, public affairs director at the Health and Human Services Office of the Inspector General. “A company will bill Medicare for services not by the physician who signs a claim, but by other people working in the company. That is a violation of federal regulations.” Wolfson emphasizes he is not commenting on Solantic, and adds that only an investigation could determine if there were violations and whether they were criminal or civil.

Prokes says he’s concerned about the position in which the company put him. “I don’t think anybody could hold me liable for malpractice, because I didn’t see the patients,” he says. “But maybe I could be held accountable for some kind of fraud.”

Neither doctor states they have evidence Rick Scott knew of the alleged misuse of their names, or of their complaints to management. Several ex-employees say that Scott was a hands-on owner, who talked frequently with management and approved all major policy decisions.

Prokes would not have had access to financial records, said Dr. Nathan Newman, Solantic’s chief medical officer, at today’s press conference. He added that the allegation that Prokes’ name and medical license were used improperly is “completely false.”

GLENCROSS’ AND PROKES’ allegations come during a campaign in which Scott is repeatedly criticized for his previous role running a company that engaged in Medicare fraud.

In 1997 Scott was forced to resign as the CEO of Columbia/HCA, then the country’s largest hospital chain, while it was being investigated for massive Medicare and Medicaid fraud. Federal agents seized records from several Columbia/HCA hospitals that revealed how the hospitals kept two sets of books: one that reflected a procedure’s true costs and another with inflated expenses charged to Medicare. There were also allegations that hospitals paid illegal kickbacks to doctors for patient referrals. Four executives were indicted. Two of them were found guilty and sent to prison. The company ultimately pleaded guilty to 14 felonies and ended up paying $1.7 billion in fines and settlements.

Scott was never charged, or even interviewed by authorities. Columbia/HCA paid Scott about $10 million, along with roughly $300 million worth of stock, to leave the company. He has previously said he had no knowledge of the wrongdoing and would not have condoned it. But people familiar with the case, like John Schilling, a former Columbia/HCA employee who reported the abuses to the feds, have stated that Scott’s aggressive emphasis on profits and cost created the environment for the fraud to develop.

Because Scott has never held public office before, he is running for governor on his record as a businessman. On his campaign website, he states: “I’ve made mistakes in my life. And mistakes were certainly made at Columbia/HCA. I was the CEO of the company and as CEO I accept responsibility for what happened on my watch. I learned very hard lessons from what happened and those lessons have helped me become a better businessman and leader.”

Solantic was Scott’s first major attempt to get back into the health care business after his ouster from Columbia/HCA. He co-founded the company in 2001 with partner Karen Bowling. The company’s first medical director Dr. David Yarian, has said that all decisions, including hiring people, had to be approved by Scott. (Yarian sued the company during a contract dispute in which he alleged he was fired for opposing Scott’s discriminatory hiring practices. Solantic settled with him.)

Glencross joined Solantic in 2003 as medical director, responsible for designing, implementing and delivering Solantic’s clinical services company-wide. At the time the company did not accept Medicare patients. In his lawsuit, he states that he was “secretly” named medical director of six of the company’s clinics in 2004, to comply with new state regulations requiring that each clinic designate a medical director who agreed to accept legal responsibility at each site. “A clinic’s failure to employ such a Medical Director constitutes grounds for emergency suspension of the clinic’s license,” the lawsuit states. Solantic exposed him to personal liability he never agreed to accept, according to the lawsuit, and when Glencross discovered it, he left the company.

Solantic settled the case with Glencross in May. Glencross declined to comment for this article. At today’s press conference, a lawyer for Solantic would not discuss the Glencross case, calling it a “private matter.”

Dr. Grant Tarbox took over Glencross’ job as the company’s chief medical officer from 2004 to 2006. Tarbox says Scott was an involved owner who was aggressive about running an efficient company. “I’d talk to Rick a couple of times a week, easy,” Tarbox says. “He was actively involved.” But Tarbox says that Scott never pushed him to make any decisions that were unethical or compromised patient care, and that he never knew of any doctors’ licenses being misappropriated.

Solantic CEO Karen Bowling says that Scott talked to her for quarterly board meetings and monthly operation reviews.

Prokes joined Solantic in 2004 as a doctor treating patients in the company’s Beaches clinic in Neptune Beach. He says that in 2007, shortly after the company began accepting Medicare patients, he was asked to take part in a quality control program that required him to review patient charts from different clinics, and to make sure the medical care provided and the prices charged were consistent with a patient’s condition. That’s when he discovered the allegedly unauthorized use of his name.

“I was at the Beaches office and they sent me a bunch of charts from the Northside office,” Prokes recalls. “All of a sudden I see my name popping up on charts. I see my name with patients I had never seen. I never gave them permission to do anything like that.” He says he saw his name used without his permission at least 15 times on the charts he reviewed. “It’s just a really unethical practice.”

Prokes says that he complained widely to the company’s operations managers. “As soon as I brought it up, it was brushed under the carpet and ignored.”

One former operations manager, who asked not to be identified, recalls that Prokes “raised the question to me,” and in response he looked into the matter. “It was pretty easy to see; when a patient came in to pay a bill, you would see the doctor’s name and his NPI [national provider identifier] number, but when you pulled up the medical information in EMR [electronic medical records], you’d see that it was actually someone else who saw the patient, and the doctor was at a different location.”

Another operations manager and a nurse practitioner, who both asked not to be identified, say that Prokes complained to them as well. They separately reviewed the records Prokes was talking about and confirmed that his name was on patient records at times he was not at the clinic.

Newman, Solantic’s chief medical officer, says he has no knowledge that Scott was aware of Prokes’ and Glencross’ allegations.

PROKES SAYS THAT after he looked into the matter he discovered a separate issue: what he thought were suspicious billing procedures. Solantic was repeatedly charging Medicare 100 percent of a scheduled fee when patients saw nurse practitioners while there was no doctor at the clinic he says. He complained about this practice to the operations managers as well.

Newman, Solantic’s chief medical officer, dismisses Prokes’ accusation: “Dr. Prokes would never have been involved in billing.”

The first operations manager says he confirmed Prokes’ charges by cross-referencing billing records showing that Solantic charged Medicare 100 percent for a patient’s visit under a doctor’s license, with EMR records showing that the patient was treated by a nurse practitioner while the doctor was not in the clinic.

“They would bill as a physician visit,” the former manager says. “They weren’t billing for an N.P. [nurse practitioner]. It was very clear. We had to do daily audits.”

Newman says that any incident where Prokes’ name was used when he didn’t see a patient was because he was the supervisory physician. Nurse practitioners only worked alone “on occasion,” Newman says. It was not general Solantic practice.

The former manager says he brought the issue up with his superiors.”The response was, ‘We’re correcting it on the back end.’ I don’t have proof it wasn’t corrected on the back end, but I never saw proof it was.”

The second operations manager the doctor complained to, who was responsible for two clinics, says that when he looked into it, he found evidence that the billing discrepancy was never corrected on the back end.

“My experience there, as far as the Medicare discrepancies, it was pretty rampant,” this former manager says. “This would be tens of thousands of dollars a month. And if they did correct it on the back end, it would show on the monthly statement. And I had to review the monthly statements for the clinics I was responsible for.” He adds that there was never any downward adjustment made to the monthly receipts, which would indicate the charges had been reduced when the bills were sent to Medicare.

“When we did question our supervisors about this, we were told it was brought to the attention of senior management and that we should focus on more important things,” the second operations manager says. “I witnessed this for more than a year, until I left.”

The nurse practitioner who worked with Prokes says she worked alone at clinics a couple of days a month. She says that she never saw billing information and had no idea how Medicare visits were being billed until she reviewed the same records Prokes did. “I saw them charging the full fee when I was working alone,” she says. She adds that when she heard it was being corrected on the back end, she never saw information either proving or disproving that.

Solantic fired Prokes on Nov. 23, 2009. He says he can’t discuss the matter, because he hired a lawyer and settled with Solantic. The nurse says that Prokes was fired shortly after he began questioning the records discrepancies. Solantic officials say that he was fired for violating the company’s policies by seeing a patient outside the office and writing a narcotic prescription that wasn’t properly recorded.

The Florida Independent first contacted Prokes in June, after a former Solantic employee had seen earlier stories about Solantic and put the Independent in touch with him. Prokes initially agreed to speak with a reporter off the record. After two interviews, Prokes decided he wanted to report what he knew to the authorities so they could investigate. He called a Medicare hotline in early July, but says he was kept on hold for four hours. He then tried to get in touch with state authorities who he says were not responsive.

Out of frustration, he sent an email on July 16 to the campaign of Bill McCollum, Rick Scott’s opponent in the heated Republican governor’s primary, explaining what he saw while at the company. Within days, a political operative arrived in Jacksonville to interview Prokes. Campaign officials acknowledge receiving this information and say they referred his allegations to the appropriate investigative agencies. The operative wrote up a report, which was soon leaked to different media. But Prokes declined to be interviewed, and no outlet published his allegations. He tells the Independent the McCollum campaign violated a verbal agreement to conceal his identity.

Monday, Steven Andrews, a Tallahassee medical malpractice lawyer, filed a lawsuit requesting a videotaped deposition Scott gave in the Glencross case under a public records law, stating that Scott’s stewardship of health care companies in Florida posed a public hazard. Andrews included Prokes’ name and allegations in the lawsuit. Andrews says he was motivated because, “I routinely sue hospitals and medical facilities and I believe this sort of information should be public.”

When Prokes’ email was first leaked to the media, the Independent spoke with him about the likelihood of his name becoming public. He agreed it was likely and, after going over quotes he gave the Independent, said, “Well, I don’t have a problem with that; that’s true.”

Andrews’ lawsuit: