The Qui Tam Complaint against Me

     In June 2009 a qui tam* case was filed against me, Ona Colasante, and my rural medical clinic, Hawthorne Medical Center.  My blog readers have asked to see the charges Pat McCullough enumerated when she filed this qui tam.  Pat herself is probably following my case closely, and she has good reason to do so.  The odds of winning are much better than any lottery, and the price to play is zero.  She just needs to be patient.
     Here's the link for the qui tam case, which is also listed on the first page of this blog, under "Relevant Links."

http://www.mediafire.com/view/vv1y6rq9rx7c1x1/QUI%20TAM%20COMPLAINT%20-%20Dr%20Colasante-4.pdf

     Qui tam comes from the Latin clause qui tam pro domino rege quam pro sic ipso in hoc part sequitur, which translates as who as well as for the king as for himself sues in this matter.  An equivalent term is a whistleblower lawsuit.  It's when someone points a half-knowing finger at someone else, and tells the government to investigate, hoping to get a share of the money recuperated.  Whistleblower lawsuits are about money.  If there are big bucks or beneficial publicity to be reaped for the Department of Justice, a federal prosecutor takes the case.  Like the whistleblower, the prosecutor has nothing to lose.  The government funds the case, however hopeless, and the Federal Reserve keeps printing more money to fill the void.
     Whoever initiates a qui tam lawsuit receives, when the lawsuit is settled or won, a portion of the monetary gain.  If the government decides to assume the case, using its limitless resources to press charges against the person or business being accused, the whistleblower can stand on the sidelines and watch.   Most whistleblower lawsuits end up being settled, because that's the cheapest way to go.
     In August 2013 Shands Hospital in Gainesville, Florida settled a qui tam lawsuit with the U.S. government (on behalf of Medicare) for $26 million plus interest, and with the State of Florida (on behalf of Medicaid) for $829,600.  The settlement allowed Shands to avoid a lengthy trial with associated costs and bad press.  The hospital had been "under investigation" since 2008, when the qui tam was filed.
      In a weird twist, the Shands qui tam lawsuit was filed by a consultant, Terry Myers, who had been hired to help the hospital fix its billing confusion.  Mr. Myers, like all whistleblowers, saw an opportunity for gigantic, personal financial gain, and he took it.  He is receiving a portion of the payoff:  whistleblowers get 20% to 33% of the pirates' booty in a settlement.
     It's possible that Mr. Myers really wanted to protect his government and his country from harm.  Maybe he truly believed that Shands had overbilled Medicare with deliberate intent to harm the people of America, and to profit from the electronic billing process.  Whatever his motive, he gained millions in his whistleblower suit, and it probably cost him nothing.  If Shands had been found not guilty at trial, neither would Mr. Myers have lost anything:  not his reputation, not his job, not a dime.
     We will never know whether Shands committed billing errors or not.  It's plausible that there were no billing irregularities at all.  If you are able to appreciate the complexity of the mandatory coding and billing system required for transmitting insurance claims, and if you have experienced daily the many ambiguities in Medicare's official coding guidelines, you will accept my statement (that Shands might be innocent) at face value.
     If you prefer, instead, to fan the flames of a deeply held conviction that everyone (especially doctors) is gypping the system for personal gain, you'll find plenty of statistics to fertilize your opinions.  The federal government has recuperated $14.8 billion in fraud this year, more than two-thirds from healthcare providers.  Most was collected in settlements like the one paid out by Shands.
     My guess is that Shands did not overbill, and did not have a system in place for committing large-scale fraud.  Shands settled with the government because $26 million was cheaper than the cost of a jury trial.  Shands settled because the negative publicity of such a trial would have incurred worse damage.  Guilt and innocence were irrelevant to everyone.  Mr. Myers entered a whistleblower claim because he had nothing to lose.  The government filed a claim because it was a good business decision.   Shands settled with the government because that, too, was a good business decision.  The $26 million was a payoff to get the government to leave Shands alone.  Mr Myers and his family can now buy an island or two in the Caribbean, and the government can set its sights on someone else.
     The entire system reminds me of those arbitrary taxes that feudal lords used to impose on peasants--the people who worked the land and fed everyone.  Give me one-third of the milk your cows produce!  No, give me two-thirds!  And I want half of your corn harvest!  No, three-fourths!  Give it now, or I'll take your land and ruin you!
     These are the victories of our baser instincts:  our common greed, our barely hidden presumptions of our own superiority, the petty hatreds and envies that fuel our rage even as we deny we feel it, and the urge, sometimes, to exercise brute power.  How can we advance as a species if we don't address these gross experiences of humanity in our government, in our communities, and most importantly in the deepest recesses of our selves?
 

*prounounced kee-tam (rhymes with tree jam) by most lawyers, though the formal pronunciation is kwai taem (rhymes with why, Tom?)