Originally appeared on the Lee County Bulletin website
Readers say these posts are dry and could be better informed. No one else would write about the “Travesty on Pepperell Parkway” and I was volunteered. So I am capable of taking some direction. Okay, so EAMC’s Rap Sheet was worse than I thought, fortunately several readers have contributed to our understanding of EAMC Billing Office practices; others confirmed the reality of the Interlocking Directorates of: EAMC, BCBSAL, Alabama Certificate of Need (CON) Board, Auburn University Board of Trustees, Auburn Bank, so I missed a few. We’ll share information as we re-introduce old and some new members of the EAMC All-star Roster.
1. First up All-star Ted Dobson, who operates in EAMC billing office. Our Whistleblower(WB1) says he had a colonoscopy without anesthesia but received the EAMC bill showing both anesthesia and recovery room. He asked for an itemized bill and it now included a charge for extra anesthesia. When Whistleblower (WB1) wrote Blue Cross Blue Shield of Al (BCBSAL) to ask if it had been billed for anesthesia and recovery room, BCBSAL responded that it had no record of having been charged for anesthesia and recovery room. Whistleblower (WB1) obtained a copy of the UB-04 CMS 1450 bill EAMC submitted to BCBSAL proving EAMC had billed for anesthesia and recovery room. BCBSAL colluded with EAMC to cover up the lie that EAMC Billing Office Ted Dobson told re: extra anesthesia, etc. No money out of the pocket of either EAMC or BCBSAL---just the patient’s.
Y’all know how it works. After a hospital or doctor’s visit, you get a statement from BCBSAL that shows an inflated price for the visit, then it shows the discount insurance earned you, then it shows you how much you may owe. It’s a façade, lipstick on a pig, to make you think your insurance saved you a lot of money. Does everyone believe the fictitious numbers and discounts? Surely that’s a perfect formula for collusion and theft and the enrichment of both hospital and insurance company. No matter what the bill is, you pay both parties and they have no incentive to keep your cost down.
Whistleblower (WB1) alleges that writing a dozen letters, starting with Mr. Dodson and ending up with Laura Grill and Dr. Pittard, resulted in EAMC submitting a “corrected” bill to BCBSAL where the anesthesia was removed but not the recovery room! Still waiting for EAMC to schedule his request to view his Designated Record Set (DRS) at EAMC according to HIPAA laws, the information reviewed in the DRS will help determine the next step. So far WB1 says EAMC lied about the bill for three months and then Director of Risk Management, Michelle Clayton, finally confessed that EAMC’s Director of the Business Office and the Manager of Endoscopy admit no anesthesia was administered, but, and I quote “all other charges are correct”. The charges were still not correct, the recovery room charge has not been removed. Clayton continued:
“We have contacted our coding department to investigate the reason this anesthesia charge was added to your account. I assure you we will identify where the error occurred and work to ensure it does not happen again." He has documentation to prove he notified higher ranking hospital officers but no action was taken. EAMC has not advised WB1 when the recovery room charge will be removed from the UB-04 CMS1450 bill submitted to BCBSAL.
2. Second up is All-star Terry Andrus. We’ve previously talked about Interlocking Directorates (ID), when a member of a company's board of directors also serves on another company's board or within the company's management. According to Whistleblower 2 (WB2), we neglected to fully acknowledge Andrus’ accomplishments. He is not just on the EAMC, Auburn Bank, Blue Cross Blue Shield Boards, he was on the Alabama CON Board. While we understand that interlocking directorates are not illegal as long as the corporations do not compete with each other, frankly there should be as much focus on their colluding with each other as there is on their competing with each other We know the Alabama Code promotes anti-competitive behavior by Health Authorities such as EAMC, but we likewise understand that concentration of power by interlocking directorates kills competition and increases costs for the consumer. Does anyone think that CON Board member Andrus supported the local surgeons’ application for a CON permit to open a competing hospital in Auburn? But wouldn't competition bring consumer cost down? Would anyone think perhaps EAMC made a sizeable contribution to our Governor’s campaign to improve the chance of Andrus being appointed to CON board to block competition in Auburn, a la Richard Scrushy? Does anyone think that Auburn Bank Board member Andrus wanted any other bank but Auburn Bank to operate an ATM in the EAMC lobby? Does anyone think that BCBSAL Board member Andrus will tell the truth if WB1 sues for collusion and fraud by EAMC and BCBSAL? WB1 has already informed Andrus of what happened-no response “You lie about it EAMC and BCBSAL will swear to it.” Sounds fair to them.
The State restricts competition, increasing the cost of healthcare for those able to pay, and in return medical providers (EAMC?), purportedly use these contrived profits to increase the care they provide to the poor. Hill Burton also requires EAMC to provide care to the poor. EAMC lied about the "care" it provided to WB1, so what is the chance EAMC will treat the poor well or at all? We've seen how Sam Price picks numbers out of the air, would anyone believe the numbers EAMC conjures up regarding healthcare provided to the Poor? Remember these guys have been twice busted, probably more, for FRAUD in the last few years. Lee county needs another hospital that is honest to give the consumer a choice. Without a monopoly EAMC is DOA.
We know a Health Care Authority can spin off as many subsidiaries as it wishes, take for example, Aperian Laboratory Solutions . Mr. Andrus worked for EAMC for over 30 years. The question has been asked if he was employed by EAMC when his company, Complete Rx was established in 1998. Since EAHCA spins off corporations involved with the medical field and since Complete Rx is associated with the same field, was there a potential conflict of interest? Remember, EAMC uses public funds to operate. Did public money directly or indirectly help finance Complete Rx?
3. Next up is a new member to the All-Star Roster, Chief Operating Officer Sarah Smalley Nunnelly, daughter of long term Board member Dr. David Smalley. She’s an EAMC COO and he’s on the Board of EAHCA. So surely every special hospital tax payer and every unfortunate patient receive at least two yearly Christmas cards. Be thankful, or not.
We’ve previously mentioned that local papers don’t report news that is unflattering to EAMC. The $6+ Million settlement in the Aperian Lab Solutions settlement for fraud could not be ignored so a story was produced which allowed EAMC to spin the last part of the story and state that after 5 years of litigation, they only settled to keep attorney and court costs down. Makes sense to me, but then I'm not the sharpest knife. Someone pointed out the stacks of O-A Newspapers at every Nurse’s station. Buy a few papers, get good press? Or are there more interlocking relationships we're aware of?
Don’t have space in this post for the remainder of the All-Star Roster and haven’t shared all the news from all the whistleblowers, but whistleblowers keep reporting in and we’ll share the information and concerns with our readers in future posts. I neglected to include All-Star Bob Dumas of EAMC/Auburn Bank and connect him to the Board of Trustees at Auburn University. Will start with him in the next EAMC post. Hopefully this is an improvement: less dry, more informative. If not, keep those suggestions churning.
Comments