PHILADELPHIA – A Montgomery County woman who said 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 to Medicare has settled her lawsuit.
Judge Eduardo C. Robreno, of the U.S. District Court for the Eastern District of Pennsylvania, had ruled in January the case be stayed until April 15 and a status and scheduling conference be held on April 17, but court records indicate the case was instead settled April 15.
Despite inquiries to both plaintiff and defendant counsel, exact terms of the settlement were not disclosed.
In her complaint, Roslyn resident Joanne Cleighton alleged lab technicians had doctored orders for blood work, in order to receive money from a third party lab contracted by the federal government. She claimed 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, she claimed.
Abington Memorial Hospital was then reimbursed by Medicare or Medicaid for the testing, the suit claimed.
Cleighton alleged 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 lawsuit, 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 during which it was acknowledged that mistakes had been made in the billing process, the suit said.
In the ensuing weeks and into the fall, Cleighton appeared at weekly meetings to report the continued problems with the billing reimbursements, she said. Finally, a promise was allegedly made that the billing procedure would be fixed at the start of the new year, she said.
Cleighton said 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 email up the chain of command in late February 2014, and was told another meeting would be held on March 6, 2014.
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, she said.
On March 17, 2014, the complaint said, 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, she claimed.
Cleighton claimed she maintained a spotless employment record since 1988, with nothing but positive feedback from her annual performance reviews. Therefore, she said, the termination was in retaliation for her reporting the false claims generated by the hospital lab.
The plaintiff sought 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 claimed that her reporting of the wrongdoing was protected activity under the laws and the hospital’s retaliation violated her civil rights.
The plaintiff was represented by Stephen Console, Laura Mattiacci and Susan Saint-Antoine, of Console Law Offices in Philadelphia.
The defendant was represented by Christopher J. Moran and Kristen E. DiMaria, of Pepper Hamilton, also in Philadelphia.
U.S. District Court for Eastern District of Pennsylvania case 2:14-cv-04695
From the Pennsylvania Record: Reach Courts Reporter Nicholas Malfitano at firstname.lastname@example.org