The law firm that’s overseeing taxpayer-supported Broward Health’s compliance with conditions imposed by the U.S. last year when it paid $70 million to resolve alleged lawbreaking has concluded the troubled hospital district is in a state of “cultural civil war.”
Baker Donelson was hired in December to serve as the “Independent Review Organization” (IRO) under the terms of a five-year Corporate Integrity Agreement between the North Broward Hospital District (NBHD) – Broward Health’s legal name – and the U.S. Department of Health and Human Services.
The IRO’s 137-page annual report, obtained by Florida Bulldog using Florida’s Public Records Law, lays out what it says are Broward Health’s “numerous systems deficiencies” while also defending itself from anonymous, yet widely distributed accusations that it was not truly independent and was hired thanks to insider connections.
The report, often citing unnamed sources, is highly critical of Broward Health’s recently departed Chief Compliance Officer Donna Lewis for refusing to produce, among other things, requested information about employee complaints. Also singled out for criticism: Broward Health’s Interim CEO Pauline Grant and Chief Information Officer Doris Peek, who, along with Lewis, are accused of planting “negative articles regarding the IRO in the local media.”
Grant and Peek both denied the accusation on Sunday. “I never planted any negative articles,” said Grant. Lewis could not be reached for comment.
The report and its exhibits can be downloaded here.
“There has been a pervasive pattern of personal destruction in which former and some current members of the senior management team use public meetings, the media, self-serving reports disguised as work product, and frivolous ‘anonymous’ complaints through the disclosure program as a means to falsely attack the character of, pressure, or aid in the termination of NBHD’s Board of Commissioners, senior management, and others,” the report says. “In other situations, it appears the methods are used to enhance the influence of senior management’s departmental fiefdoms.”
The report goes on to assert that management actions “appear to be routinely based upon self-interest, protection of position and department, not for the betterment of the system.” That “lack of professionalism” fails “not only the patients the system services, but the taxpayers who help fund it.”
Anticipating the report’s release, Broward Health’s board voted last week to authorize management to request up to 60 days to respond to the IRO report which will be sent to a federal monitor and could lead to further government action against Broward Health.
A new CEO coming soon
Who will author the response is unclear. The board recently has interviewed several candidates to become Broward Health’s permanent President/CEO. A meeting to make that selection is set for Oct. 31.
Broward Health, with four hospitals, three outpatient facilities and nearly 9,000 employees all north of Griffin Road, is the ninth-largest public health system in the country. It is a special taxing district overseen by a board of commissioners appointed by the governor.
The report says Broward Health suffers from “operational mismanagement” to include “considerable understaffing” in key areas such as physician services and the compliance and ethics office. Likewise, the report notes, two seats on the governing board of commissioners remain vacant. (On Friday, Gov. Rick Scott appointed Parkland’s Bev Capasso, a former chief executive officer of Jackson Memorial Hospital, to one of those seats.)
The report traces Broward Health’s “cultural war” to the hospital district’s “pervasive physician-centric tradition, in which senior management and staff instinctively defer to physicians, particularly regarding compensation.”
Allegedly illegal pay deals between Broward Health and its physicians was the focus of the False Claims Act lawsuit brought by whistleblower Dr. Michael Reilly that led to the $70 million settlement in September 2015. Allegedly violated in the scheme: the Stark Law, which generally prohibits physicians from referring patients to hospitals with whom they have a financial relationship, and the Anti-Kickback Statute, which prohibits paying physicians for healthcare referrals.
Without naming names, the report says some physicians are involved in “repetitive upcoding,” or assigning improper billing codes for medical procedures to increase their Medicare and Medicaid reimbursements. Baker Donelson says it has “encouraged” Broward Health to hire “expert coders” to handle coding for it doctors “to help remove even the appearance of a conflict of interest in coding.”
The report is similarly critical of Broward Health’s “ineffective response to the implementation” of compliance monitoring and auditing procedures, notably the lack of what’s known as a “Focus Arrangements” database that can track government-reimbursed physician referrals and sales.
‘Lack of commitment to compliance’
Baker Donelson’s report, prepared under the direction of attorney J. Scott Newton, accuses Broward Health of a “lack of commitment to compliance” both before and after the embarrassing federal investigation and costly settlement. It says problems began after Lewis was hired as chief compliance officer in April 2011.
One month later, a federal subpoena announced the start of the government’s fraud probe. It sought a multitude of records about physician contracts and other matters, yet appears to have had no “impact whatsoever on the operation or effectiveness of the compliance program,” according to the report.
The report’s litany of deficiencies, however, neglects to note that Broward Health’s compliance troubles pre-date Lewis’ arrival. For example, for more than a decade both management and the board ignored a lobbyist registration policy adopted in 2004. The district finally implemented a policy requiring lobbyists to register last month as a result of a Florida Bulldog story in May.
Baker Donelson’s report praises the “outstanding work” of Broward Health’s controversial General Counsel Lynn Barrett and her Legal Department in making important changes to the district’s poorly crafted compliance program by re-writing its Code of Conduct and ethics policies. The problem: the implementation of those measures was “seriously deficient in many critically high risk areas,” the report says.
The report, however, makes no mention of various controversies that have swirled around Barrett. They include allegations Barrett improperly attempted to block the public from meetings, steered millions of dollars in legal work to law firms with strong ties to Gov. Scott, and failed to cooperate with the FBI during an ongoing federal grand jury investigation into allegedly corrupt purchasing practices at Broward Health.
The report also details Baker Donelson’s annoyance at an article published in Medicare Compliance Review that “impugned the IRO’s qualifications.” The report suggests Interim CEO Grant, Compliance Chief Lewis and Chief Information Officer Peek planted the story.
A newsletter’s upsetting story
The story apparently at issue was published in June by a newsletter with a different name, Report on Medicare Compliance. Among other things, the story quoted Donna Lewis as criticizing the board’s efforts to identify the author of the anonymous email that raised questions about Baker Donelson’s independence and other matters. She told the newsletter that anonymous allegations are “routine” compliance matters and that the board’s high-profile hunt for the author had “eroded” trust.
“I have never seen a compliance complaint take up so much time from a governing body,” she said.
At a subsequent meeting by Baker Donelson with top Broward Health management, “it was emphatically noted to Grant that what appeared to be senior management-placed negative articles regarding the IRO in the local media would not deter our work. We advised Grant that we did not believe any articles or public comments were made without her authorization.”
The report adds that anonymous employees had told the law firm that Grant, Lewis and Peek “were overheard in Peek’s office discussing” what later became the article.
“Contacting the media, particularly because of the Florida Sunshine law, appears to be used as a common weapon in the cultural war at NBHD as a means of asserting false allegations and/or pressure on those who would refuse to change the culture of corruption,” the report says.
“Here, while it is certainly beyond the scope of our review, the IRO questions whether tax dollars were used to publish the ‘Medicare Compliance Review’ article and if so, if that constitutes an improper misuse of public funds. We will leave that determination for state officials, should they undertake a review.”