Executive Sick Days

by Maria E. Schneider

  "Yeah, at least for now." He grinned. "Huntington had this job for me. Guess you're working for him again too?"

  Radar seemed to like working for Huntington and didn't mind the possible danger. "Did Huntington tell you about the three patients we're supposed to be watching?"

  Radar nodded and seated himself at a console. "I found the records in question. And I can tag patients that are currently admitted to see if their records get tampered with once they are discharged. In the case of Mrs. Olsen," he typed quickly, "and these other two," he pointed to the computer monitor, "there's an interesting pattern, but not exactly proof of illegal activity."

  "What pattern?"

  "The charges are remarkably similar."

  I looked over his shoulder at the Excel spreadsheet he had created. He switched back to the bill and then to the records. I read down the bill. "Check in, fluids, x-rays...wow and a few thousand dollars later, checkout."

  "Yeah, the bills have a bunch of different diagnosis codes, but the tests that were ordered look remarkably similar. I couldn't make heads or tails of the medical record." He looked over at me. "Be careful with this history stuff. It belongs to a specific someone, and we wouldn't want it to fall into the wrong hands. It is a breach of their privacy to have access to these records."

  He, who could hack into any computer system faster than I could walk through a doorway, was warning me? It wasn't as if I would be standing here staring at them without his help. "The wrong hands?"

  "Yeah," he agreed, missing my pointed glare.

  I surveyed the spreadsheet again, but didn't see how it was going to help. "How can anyone tell if these services are fake?"

  Radar grinned up at me. "That's the point, right? I'm guessing you take a patient who has a slight heart condition and check him in a few extra times for "heart events." Run some tests, some x-rays and check them out. Then for some old lady like Olsen, well, she didn't drink enough, got herself dehydrated and needed a few days of recuperation. This other guy, who knows why he was checked in initially? He got fluids, looks like a couple of inconclusive tests, x-rays and then out."

  "And nothing on the bill is enough to get anyone's attention."

  "Except the patient. If the patients know they weren't in, they'll notice."

  I agreed. But Mrs. Olsen wasn't young and just because she complained loudly, didn't mean she actually sat and read her bill. Of course if she had found some way to profit from it, she certainly wasn't going to say anything. "I'm not sure how we're supposed to figure this out, but if you see records that indicate these three are admitted again, now that I'm here, I can find out if they are physically here or not."

  "Mrs. O is supposedly in right now," he said.

  I nodded. "Yes, she's on my floor."

  "We can watch the discharge date and the itemized charges," he said.

  My stomach rumbled its displeasure. I glanced at my watch and decided to get a move on because I wasn't supposed to stay clocked out forever. As a volunteer, I could take all the time I wanted for lunch, but the other volunteers were very interested in collecting a certain amount of hours for college credit. In order to fit in, I couldn't be too lax. "Do you know of any good places to eat around here?"

  "There's a sandwich place right next door. It gets a lot of the hospital business. There's a pizza place across the street next to The Pavilion physician complex and a place down from there that has great gyros."

  I grimaced. "Impossible. There is no such thing as a great gyro."

  "I guess you'll want to go with sandwiches or pizza then."

  "You could say that."

  "I can live with that."

  He grabbed his coat and followed me out.

  The sandwich shop was already crowded so we settled for the pizza parlor. I ordered a pasta salad and Radar got a calzone that looked like an eighteen-inch pizza folded in half. If it had been anyone other than Radar, I would have assumed most of it would go to waste, but he dug in like it had legs and was trying to escape.

  "So what do we know so far?" I asked.

  Radar raised an eyebrow and chewed. "Does Huntington ever tell you what is going on when he hires you or is it always like this?"

  Last time Radar had helped me with a case, he had come to me for answers, answers he mistakenly thought I had since Huntington had hired me. "Maybe we'd better compare notes," I hedged.

  He shrugged. "Okay. Basically Huntington wants me to scour the records for suspicious transactions tied to any particular doctor."

  "How in the heck are you going to figure that out? That can't be easy."

  "No, it's not. I have to compile all kinds of statistics about which doctors order what medications or treatments more often than others--the expensive stuff like MRIs or CAT scans. It's hard to do because those things generate a separate bill, and I have to match the bills with the doctor's orders. Then there's the fact that for accidents, the emergency room doctor is likely to order more of those procedures than another doctor anyway. It doesn't make pointing a finger easy."

  "So what about patients like Mrs. O being overcharged?"

  "My fancy statistics won't show anything at all if that is the case." He was well over halfway through his calzone.

  "You aren't actually going to eat all of that, are you?" Not even my brother Sean could devour food like Radar and if he did, he wouldn't stay skinny.

  He shook his head. "No. I've been cutting back. I'm going to save a sliver for later so that I don't have to cook tonight. This place is great," he said happily. "I can get a large pizza and still have leftovers."

  The large pizza was a twenty-four inch dynamo designed for parties of six. "Uh-huh." My salad was large enough that I would be taking part of it home. "I'll ask Brenda again about the billing. We need to figure out at what point these things are entered into the computer so we have a better idea of who is doing the entering."

  "Good call. Hey, I saw Mark around the hospital other day. What is he up to?"

  My heart stuttered a bit, but I made sure my voice didn't. "No idea. He…doesn't usually work by day from what I've seen."

  "Heh, heh, heh."

  I didn't like his knowing little laugh. "What is that supposed to mean?"

  He just smiled and took another giant bite of pizza.

  Chapter 5

  After lunch I was assigned to help Dr. Brian Staple. It didn't take long to figure out why none of the technicians had volunteered to go on rounds with him. Dr. Staple looked like a mature version of a handsome surfer, right down to sunburned cheeks and dark hair that lightened before splitting into frazzled ends. The resemblance ended with his looks though; he snapped orders like a drill sergeant with constipation. Maybe it was just me, but it seemed that all his patients had blockages too. Not a one of them smiled, and Dr. Staple spent an inordinate amount of time asking questions about bowel movements. Maybe all surgeons were like that, or maybe it was some sort of disease that people caught whenever they were around the doctor. Even Paul, the nurse on rounds with us, looked haggard. He already resembled a fish, and walking around with his lips pursed didn't improve his image any. A constipated fish was not a pretty sight.

  I stayed out of the way. The most attention I received was when Dr. Staple looked up, stroked the perfect cleft in his chin and barked, "Isn't it your job to give sponge baths?"

  His icy blue gaze was on me, but I knew the routine. Never look a vampire directly in the eyes, and you won't lose any blood. I bravely stood my ground, avoided his killing stare and mumbled an unintelligible answer.

  Eventually he gave up frowning down at me and proceeded to his next patient. He was marginally nicer to the frail lady in the bed than he was to the hired help, but his very lack of conversation was unsettling. Everyone knows that vampires hold very still right before extracting blood. I could easily picture this man adding charges to bills to siphon money out of patients.

  Before we were halfway through rounds, I managed to trail far enough behind to slip into the visitor r
oom instead of following. "Yeesh." There had to be an easier way to spy on people. This wasn't going to prove anything. Dr. Staple gave orders and lots of them. He could easily slip in orders for things that weren't needed and who would know? Paul certainly wouldn't question anything, because it wasn't his job to do so. If he tried to ask an innocuous question, Dr. Staple would probably cut him to pieces.

  I needed more information about how doctors’ orders translated into money. I knew the perfect person to educate me. It was close enough to the end of my shift for me to visit her too.

  My pasta salad, when I went to retrieve it on my way out, had vanished from the fridge. "Unbelievable." Not only was homemade lunch not sacred, leftovers, things I had already had a fork in, were not off limits. The nurses' station was supposed to be for nurses and other employees only. Who would walk back here and take my lunch?

  Who would want to?

  Perplexed and disgruntled, I stopped wasting time. Since my shift ended at three, Sean would still be at work, and I wanted to talk to Brenda about the billing before he even thought about going home.

  I made it to her house in record time, but it was for naught. Brenda wasn't much help. "I don't know how someone would be able to make a lot of money from extra hospital charges," she mused from her relaxed position on the couch. Her feet were starting to swell frequently so she kept them elevated. Maybe keeping them up might offset the effect of the salty snacks she was chomping on.

  Around a handful of cashews she said, "All the various charges get entered from different computers. For example, if I get items from central supply, like gauze or toothbrush kits, there's a sticker on it and that gets put on the patient card. At the end of each day, central supply picks up the cards and scans them in. As for medications, the pharmacy enters the medications before they even come up to the floor. Admitting starts the charges for the bed on the day the patient checks in."

  "Couldn't you enter a bunch of charges for toothpaste whether or not it was used?"

  She shook her head and then nodded. "I guess I could scan in the toothpaste code six or seven times, but I don't know how much each item costs because I only see the code for toothpaste, not the price." She looked worried. "I enter all kinds of things that result in a charge somewhere. Technicians use supplies all the time too. Do you think it's one of the nurses? Or a technician in on it with the patients?"

  I shook my head. "I don't think so. But I don't know who is doing it. And I can't see a nurse or a technician making much money by racking up Tylenol and gauze charges. How would they get the money from the insurance company anyway?"

  Brenda looked slightly relieved. "You're right. Mrs. Olsen would have to get the money and then turn some of it over to the nurse or technician. I don't think she would be willing to share profits with anyone."

  "What about a doctor?" The doctor charges were the highest, and if charges were fabricated for a patient visit that never happened, it could really be a large amount of money.

  "The doctors don't enter the information or the supply stickers. They don't even enter their own orders. Clerks transcribe all the doctor orders, and one of us nurses has to sign it to make sure it all makes sense and is correct. You'll never see a doctor actually sitting at the computer entering sticker information. They will enter medical notes, but that's about it."

  "But after a patient is admitted, doesn't the doctor have to know about it?"

  She nodded. "Sure. When a patient is admitted, the doctor has to examine the patient. But for actual admitting process, someone else does all the entry work on the computer. The doctor just shows up and orders tests."

  "So if a doctor were the perpetrator, he might have an accomplice to enter patient data and charges." I switched to a specific example. "If Mrs. Olsen wasn't in the hospital on those days you noticed, someone from admitting would have to be involved, right?"

  "I guess. Someone has to input that the patient was there and someone else has to generate a request for a test and normal supplies, otherwise the bill would be flagged. Admitting admits the patient, but they don't enter test requests or supplies."

  Interesting. If Radar could find one computer where false information was being entered, perhaps we could pin down a single person breaking into the system for the sole purpose of entering false records. Otherwise, there had to be two or three culprits and that meant even more money would be needed to keep everyone happy. "Thanks. Oh, and don't tell Sean I was here. Remember, you aren't working on this."

  "Of course. You didn't happen to bring any cookies, did you?"

  "Brenda, Sean would know I was here!"

  "Nonsense. I bake cookies sometimes."

  There was no winning that argument. I wasn't going to tell her that Sean could easily distinguish my cookies from hers.

  At home, I called Huntington at his condo. To my relief Mark answered. I knew it was him from the hello because my toes tingled. "Hi Mark."

  "What are you so happy about?" he asked.

  "You answered instead of Steve," I said reflexively.

  There was a pause followed by a quiet chuckle. "Okay. What can I do for you?"

  Now why did that sound like he wasn't talking about the case? I grinned, hoping his attitude meant that he wasn't still annoyed about me helping with the case. "I was talking to Brenda about how hospital charges are generated and trying to piece together who could profit from over-billing." I proceeded to explain how if a doctor were guilty, the doctor was either hacking into the system or he had someone helping him enter charges.

  Mark never got frustrated with my meandering way of providing information. He just waited patiently while I backtracked and explained all my theories.

  When I was finished he said, "That's interesting. You know the hospital was owned privately until a few years ago. Makes you wonder if this was going on all along or if it started after it went public."

  "Hmm. Do you think that someone is trying to make the hospital appear more profitable by adding charges? Would that be enough to goose the public stock price?"

  "I doubt any one person would bother. I was thinking that it might be easier for a few individuals to profit now that the hospital is public. New auditors were hired, and the public doesn't have the records for the hospital prior to it going public. It would be the optimal time to insert changes because no one would notice if profits or patient stays went up.”

  “Ah, and as long as profits are high, no one is going to look too closely at past statistics.”

  "The board has already turned the audits over to Huntington. He's also been going over the other finances. Have you told Radar your suspicions yet?"

  "He's the one who found similarities in the three patient bills, but we haven't discussed how patient charges are entered. Radar is monitoring the three patients that Brenda mentioned. If they get admitted again, I will find out if they are physically in the hospital."

  "I'll make sure Steve is updated. You keep Radar informed."

  Seemed like more than a fair split to me. "Excellent," I agreed with a smile.

  As I put the phone down, my euphoria evaporated. It occurred to me that despite the friendly conversation, Mark hadn't brought up going out to dinner again.

  I sighed. Apparently, I couldn't have my cake and eat it too.

  Chapter 6

  Who knew that even in the medical field, they had pep rallies? I thought such meetings existed only in computer companies and were designed for the sole purpose of providing executives with a captive audience. Apparently Dr. Johnson, the Chief of Staff at the hospital, shared a bond with computer executives. He had almost the same mantra, only instead of "propelling the company to number one in profits," he wanted to reach number one "in patient care and eliminate inefficiency and waste." The hospital marketing gurus probably couldn't find a way to discuss profits tastefully.

  The old, "number one in customer satisfaction" didn't change at all, which I thought odd since customer satisfaction in health care might mean different things to
Dr. Johnson versus the patient. Was his intention to keep all patients healed and happy or was he after profitable, chronic returning patients? Theoretically, the most dissatisfied customer was a dead one, but that customer wasn't likely to affect satisfaction surveys. On the other hand, no one was going to reap additional proceeds from the dead guy either.

  In the computer industry, executives set unreasonable goals, but promised bonuses if by some quirk of fate the goals were achieved. The bonus program at the hospital was different, but just as impossible.

  Dr. Johnson offered, "You lose, you win." He chuckled as though he had told a fabulous joke. "No, seriously folks, thanks to a great suggestion by one of our newest head nurses, Sally Rendal, we are instituting a weight loss program. If health professionals lose weight, it sets a good example for patients and," he stopped to wiggle his very large, menacing white eyebrows, "Crestwood will pay you for every pound you lose!"

  What if a person gained weight? Could someone end up owing the hospital a bundle? I scanned the room, but no one raised a hand to ask if a "fat" fee would be charged.

  Dr. Johnson droned on to his next topic. "A week from Friday is team player day. Mark your calendars!"

  I would have marked mine and planned to be out, but I had promised Brenda I would volunteer on the days she worked, so I was on the hook.

  Because the rally meetings were done in shifts to ensure the floors were always staffed, Dr. Johnson couldn't talk as endlessly as some executives. As soon as we were released, I headed for the stairs, thinking it would look bad to hop on the elevators after the "be healthy" lecture. There were only three of us pretending we cared.

  I ran into Brenda as she headed downstairs to attend the rally. She looked rushed, but she stopped to ask, "Did you bring your lunch? It's really hard on days when we have these meetings. I forgot to tell you that you end up using your lunch hour for the meeting. And what with the," she looked around quickly and then whispered, "that person, you can't leave your lunch in the fridge!"