Whistleblower rocks county hospitals

(3/27/07 - KTRK/HOUSTON) (KTRK) -- A whistleblower steps up and stirs up a real problem for Harris County's public hospitals. The allegation involves of millions of dollars in fraud.

It involves billing irregularities that added up to $15 million in fraud of the Medicare and Medicaid systems.

This settlement agreement, involving the Harris County Hospital District, is one of the largest ever in the Southern District of Texas. One employee turned whistleblower is helping the government recover millions of dollars in taxpayer money.

In 2001, Robert McCaslin was hired as a patient account representative by the Harris County Hospital District. He worked on claims from hospitals including Quentin Mease and Ben Taub.

But the former law enforcement officer and grandfather says he quickly noticed some health insurance claims were not being filed correctly.

"It turned out this claim had been mishandled and I took it to a supervisor who informed me that's the way they did it there," said whistleblower Robert McCaslin.

McCaslin says he repeatedly went up the chain of command a dozen times in a year. After getting nowhere he filed a lawsuit.

"There are very few people, that when their supervisor says, 'Go back to your desk, thank you for telling us but you're wrong,' that they'll take it to the next level," said McCaslin's attorney Mitchell Kreindler.

According to this lawsuit, employees weren't following the law, which requires them to first seek payment for a medical claim from a third party or private insurance companies before filing directly with Medicare and Medicaid.

"In the long run it's a lot easier to bill Medicare first and just take the money, but in the long run the third party payers will pay more money," said McCaslin.

"It's not only local taxpayer dollars but federal dollars they were being used to pay these claims improperly," said Kreindler. "Taxpayers were getting hit in all directions on this one."

Court records say the hospital district charged Medicaid for medical care of jail and prison inmates. By law that's not suppose to happen.

The settlement agreement, unsealed today, says the hospital district will repay more than $15 million.

The district declined an on camera interview because the settlement isn't finalized yet, but did say in a statement from CEO David Lopez.

"As soon as we learned of the possible errors, we instituted changes within our business processes to ensure that we were in compliance and will continue to be in compliance with Medicare and Medicaid regulations."

They point out there was no allegation or finding of criminal wrongdoing

Robert McCaslin says he is satisfied with the efforts his employer has made and He encourages others to stand up and blow the whistle.

"It's important to do the right thing and have that motivation and courage to step forward," said McCaslin.

Under the false claims act, Robert McCaslin will receive a cash reward that could total more than $2 million for coming forward. He is still employed here at the Harris County Hospital District.

There is legal protection for anyone who feels compelled to report fraud.

Whistleblower links:
Blowthewhistle.com
Taf.org
Whistleblower.org
Pogo.org
(Copyright © 2007, KTRK-TV)

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