Abington Hospital accused of submitting false claims for Medicare reimbursement

By Jim Boyle | Aug 12, 2014

A Montgomery County woman says she lost her job at Abington Memorial Hospital as

retaliation for her blowing the whistle on the health care center's alleged practice of submitting false claims for reimbursement of the federal Medicare program, according to a suit filed at the U.S. District Court for the Eastern District of Pennsylvania.

Joanne Cleighton, of Roslyn, says that lab technicians doctored orders for blood work in order to receive money from a third party lab contracted by the federal government. She claims that after she notified her supervisors about what was happening, they terminated her employment.

Cleighton started working in Abington Memorial Hospital's registrar's office in 1988, working her way up to patient access manager in 2004, a position she held until her termination in March 2014. Among Cleighton's duties was the management of patient billing and insurance information.

According to the claim, most patient blood and laboratory testing was performed at the hospital, with a well-established method of using coded numbers and computer matching to determine billing for reimbursement from either the patient or insurance company.

When doctors ordered testing for patients insured by an Independence Blue Cross/Keystone plan subsidized by Medicare or Medicaid programs, a red sharpie pen was used to note that the sample had to be taken to an outside lab. Abington Memorial Hospital was then reimbursed by Medicare or Medicaid for the testing, the suit claims.

Cleighton alleges that in May 2013, she overheard a lab employee say that routine bloodwork specimens were being marked as "STAT," or emergency, so that the testing could be performed at Abington Memorial and Medicare would send reimbursements. According to the suit, if a Medicare eligible sample needed testing immediately in order to determine the course of medical care, the hospital could perform the work and still get reimbursed from the federal program.

According to the complaint, Cleighton notified the lab supervisors and a human resources director about the situation. A meeting was held in the summer of 2013 with lab management where it was acknowledged that mistakes had been made in the billing process, the suit says. In the ensuing weeks and into the fall, Cleighton appeared at weekly meetings to report the continued problems with the billing reimbursements. Finally, a promise was allegedly made that the billing procedure would be fixed at the start of the new year.

Cleighton says that pledge was never completed and that she overheard the same employee in January 2014 instructing another employee to mark routine blood samples as STAT. She sent an e-mail to the next chain of command in late February, and was told another meeting would be held on March 6.

That morning, Cleighton was informed that not only had the meeting been canceled, but she was being suspended over accusations that she violated HIPAA laws by accessing patient medical records and that she used a racial slur during a conversation.

On March 17, the complaint says, Cleighton's managers said that the investigation did not turn up any proof of wrongdoing, but the plaintiff would not be returned to her position. When asked for her resignation, Cleighton refused, and a few days later was informed that her employment had been terminated.

Cleighton claims she maintained a spotless employment record since 1988, with nothing but positive feedback from her annual performance reviews. Therefore, she says, the termination was in retaliation for her reporting the false claims generated by the hospital lab.

The plaintiff seeks compensatory and punitive damages from the hospital based on three counts, including violations of the Pennsylvania Whistleblower Law and the federal False Claims Act and one count of wrongful termination. Cleighton claims that her reporting of the wrongdoing was protected activity under the laws and the hospital's retaliation violated her civil rights.

Cleighton is represented by Stephen Console, Laura Mattiacci and Susan Saint-Antoine of Console Law Offices in Philadelphia.

The federal case ID number is 2:14-cv-04695.

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