The files for Seguin and Lufkin, the other two towns that the hospice served, had identical formats, with fewer patient listings—understandably, since the towns are much smaller. Each file had maybe a couple of dozen entries highlighted in yellow, a smaller number in pink. Scanning the entries in all three files, I could see that these records had been updated the previous Friday, which was a surprise, since I distinctly remembered Janet Parker telling me that Kelly had left the hospice a few weeks before.
Which made me wonder just when and under what circumstances Kelly had created these files. I went back to the main page, clicked on the “File” tab, and looked at “Properties.” I was even more surprised to see that the file I was looking at had been copied at 11:42 p.m. on Saturday. Saturday night? Wasn’t that a little unusual?
No, it was more than unusual—it was downright strange. Why in the world would Kelly be copying hospice patient records at nearly midnight on a Saturday night? But the instant I asked that question, I knew the answer. She did it at night because she didn’t want anybody to know she was doing it.
But why would she want to do it at all? What was she getting at here? I opened the “Notes” file, hoping to find an answer. But there were only three text entries, numbered, and several hyperlinks to articles on the Internet. The text entries looked like a simple description of the highlighting in the files:
Pink: over-stays
Yellow: potentially unqualified patients (check certifying doctors and signatures)
Blue: unnecessary general inpatient care?
Okay, that was helpful, sort of—except that I didn’t understand the significance of over-stays in the first item. Why did the length of the stay matter? In the second item, the word unqualified, which Kelly had mentioned on the telephone, still had me stumped. And the third item was a total mystery.
I picked up a tortilla chip but passed on Bob’s salsa (it’s hot enough to melt tonsils). Maybe the links would help. Bob gives his regular customers passwords so we can use his Wi-Fi. I logged in, clicked on the first link, and brought up an article entitled “Medicare Pays Billions to Cheating Hospice Firms.” So while the Sons of the Pioneers sang “Cool Water” and “Empty Saddles,” I got a quick lesson in the services that hospices offer—and ways that hospices are cheating Medicare.
According to the writer, hospice care provides medical services, emotional support, and spiritual resources for people who are in the last six months of a terminal illness, and their families. They offer care in the patient’s or caregiver’s home or in a hospice center, nursing home, or hospital. For these services, the hospice receives a standard “reimbursement.” This was $172 a day when the article was written, and up to four times more if patients qualified for a stay in a treatment facility. They get this money whether the patient is visited daily, once a week, or even less often.
It turns out, though, that some hospices cheat by admitting “unqualified patients”—people who are not only not knocking on death’s door but are healthy enough to walk several miles a day or go out to dinner or attend a grandson’s wedding. (The writer offered several eyebrow-raising examples, like the “terminally ill” patient who was photographed shopping for a hunting rifle. The guy had been “qualified” by a doctor who received a kickback for his referral.)
Hospices also cheat by claiming the Medicare reimbursement for patients who live longer than six months. In one case, for instance, a hospice billed Medicare nearly five thousand dollars a month for weekly one-hour visits to a “terminal” patient—for over two years. Other hospices fraudulently billed Medicare for bogus “general inpatient care” at a hospital or other facility, to the tune of nearly seven hundred dollars a day. And still other hospices were facing criminal prosecution for submitting documents with stolen Social Security numbers, forged doctors’ signatures, and fake patient histories. Obviously, Medicare fraud was a booming business. And it paid off big-time.
Ah. So that’s what this was all about—or some of it, at least. By the time I finished reading, I thought I understood what Kelly had uncovered, and I had a fairly clear idea what kind of whistle she had been planning to blow, and on whom.
And then I thought of something else. I brought up my browser, searched for the Pecan Springs Community Hospice, and found its website—a very attractive one, with a montage of photographs of appealing patients and helpful nurses in pleasant settings, all wearing pleasant smiles. But I was looking for something more, something very specific. I clicked on the “About Us” tab and brought up the names of an advisory board, a dozen of them, as well as the hospice’s owner and manager, Marla Blake, and the physician “team,” three local doctors: Cynthia Harris, Christopher Burgess, and Gene Gulling.
As it happened, a year or so ago, I had met Christopher Burgess, a charming young man, tall, dark, with an angular face, a dimple in his chin, and a wicked grin. He had one arm in a sling—a hang-gliding accident, he said. We had met over the refreshment table at a Friends of the Library fundraiser, and when he’d found out who I was and what I did for a living, he’d asked me several questions about medicinal herbs. We’d gotten into a conversation about opium poppies—an interesting topic for a casual chat.
And I knew someone else on that page. Charles Lipman was a member of the advisory board.
I sat back, reflecting. This was his conflict of interest, or a piece of it. There might be more, of course. The hospice was a for-profit organization. Was he a behind-the-scenes investor, too? Did his law firm represent the hospice? But even if he was just an advisory board member and nothing else, that was probably enough right there to require him to refuse to take Kelly’s whistle-blower case. And once again, reluctantly, I thought of Charlie’s old Dodge pickup, his burnt orange pickup. I hated to say it, but Charlie had been known to drink and drive. Had he—
“Hey, China. Sorry to be a little late. I got caught by the telephone just as I was leaving.”
I looked up to see Jessica Nelson, a frosty margarita in her hand. “Hey, Jessica,” I said, and closed the files, then closed my laptop. “Thanks for meeting me.”
“Well, I’m intrigued,” Jessica said, pulling out a chair and sitting down. In her mid-twenties, she is a petite young woman with boy-cut blond hair and freckles, an easy-going manner, and a soft Southern voice that’s at odds with the watchful, intent expression in her brown eyes. She was wearing jeans, a University of Texas sweatshirt, and white sneakers. She pushed up her sweatshirt sleeves and folded her forearms on the table.
“I want to know how you think we might work together on this thing, China. But before we get to that, I’ve just been on the phone with a friend who works in the ER, over at the hospital. The officials are mum, as usual, but my friend says that Kelly Kaufman is still on life support.”
Bless energetic reporters with friends in the ER. I leaned forward. “How is she?”
Jessica shook her head, her expression sober. “It’s looking grim, I’m afraid. There’s been no measurable brain activity since an hour or two after she was brought in. When her mother gets here from out of town and there’s a little time to say good-bye, she will likely be taken off life support. Barring a miracle, of course.”
“It’s so sad,” I said, remembering the lively young woman who had rented my cottage, ready to begin a new life on her own.
“Yes.” Jessica sighed. “Life is fragile.” Another shake of her head. “That’s a cliché, but it’s true. And when something like this happens, all we can think of are clichés. There’s just never any new or striking way to say how sorry we are.”
Bob Godwin appeared at the table, order book in hand. “What’ll you ladies have tonight?”
I didn’t need a menu. “Cabrito fajitas for me,” I said. “And a go-box.” I wouldn’t be able to eat the whole plateful, but I could take the rest of it home.
“Tortilla soup,” Jessica said. “But cut the cilantro,” she added sternly
. “If there’s cilantro in it, it goes back to the kitchen.”
“Yes, ma’am,” Bob said, looking offended. He made a couple of notes on his order pad and left.
“Woman after my own heart,” I said. I am not a fan of cilantro, and Bob’s cooks seem to think that tortilla soup isn’t perfect without a hefty dressing of chopped cilantro on top. “Somebody told me the other day that I should try a cilantro margarita,” I added. “I thought it sounded unspeakably bad.”
“Amen to that,” Jessica said emphatically. She picked up her margarita glass, licked salt off the rim, and glanced at the closed laptop on the table. “You’ve been doing some research. On the Kaufman case?”
I waggled my hand with a maybe-yes, maybe-no gesture.
Jessica tilted her head, frowning. “Well, I have one more thing to tell you about Kaufman. But then you’re not hearing another word from me until I hear something from you. Something I don’t already know.” She narrowed her eyes. “Deal?”
“Deal,” I said promptly, since I already had that something in mind. “What’s your one more thing?”
“I checked with one of my informants at the police department. The cops are now saying that the van Kelly was driving was definitely struck from behind. The paint flecks on the van itself aren’t quite large enough for analysis, but Sheila sent a tech out to the scene of the crash. He prowled around and picked up several larger chips of paint, which means that they may be able to identify the make, model, and year of the vehicle that hit her. He even found a couple of shards of glass, maybe from a broken headlight. They may have come from an earlier wreck, though.”
“Interesting,” I said, “but circumstantial.” The prosecutor was going to need much more than that to make a case that a good defense attorney couldn’t knock down. That is, assuming that the cops were able to locate the vehicle and its driver, which was certainly no slam dunk.
“Yeah. Circumstantial. Nevertheless . . .” She took another sip of her margarita and pulled the basket of chips toward her. “Your turn.”
I paused for dramatic effect, holding her gaze. “When Kelly telephoned me last night,” I said at last, “she said she wanted to talk to me about a murder.”
I thought that would get her attention. Jessica’s eyes opened wide. She stopped in mid-motion, her hand poised over the basket of chips. “She did? Omigod! What else did she say? What—”
“Whoa.” I held up my hand. “That’s all she said. We didn’t get to have that conversation, remember? She was on her way to my house when the accident happened.”
“It was no accident,” Jessica said grimly. She picked up a chip and dipped it into the salsa. “Kelly had a story to tell and somebody didn’t want her to tell it.”
“Granted,” I said, “although it was a pretty clumsy effort, wouldn’t you say? Maybe even opportunistic. If you’re serious about shutting somebody up, there are more definitive ways to make sure it happens.” I helped myself to a chip. “But that’s not the point, at least at the moment. The point is that I don’t know what ‘murder’ she was talking about—or even if there was one. That’s where you come in.”
“I do?” Jessica’s eyes were watering from the superhot salsa. She took a big gulp of her margarita. “That’s good to hear. What do I do?”
“You’re a kick-ass researcher.” It wasn’t an idle compliment. Jessica possesses the bulldog tenacity that is the hallmark of all dedicated researchers—and of truly good investigative reporters. She never stops digging until she gets answers. I added, “And you have easy access to information from the Enterprise morgue.”
That was a big thing. Given what I was after, I would have to do lots of online searches, and they’d be hit-and-miss. Jessica could get into the back issues of the newspaper through the in-house Enterprise computer files.
She nodded eagerly. “Both true. What do you need?”
Carefully, I went through what I wanted her to do and how I thought she might go about it, stressing the need to keep everything as confidential as possible. By the time I was finished, a large serving of fajitas, flour tortillas, fixings, and a dish of fragrant black beans was in front of me. I picked up a warm flour tortilla, laid it flat on my clean plate, then added a streak of guacamole down the center, with a strip of sour cream alongside, just two-thirds the length of the tortilla.
Jessica was dipping her spoon into a bowl of tortilla soup—with no cilantro—and still thinking about her assignment. “I’ll be glad to see what I can do.” She gave me a straight, hard look. “As long as you guarantee that I’ll get an exclusive.”
I had been thinking about this. I needed to protect Kelly’s rights as a whistle-blower and make sure that her evidence was preserved for presentation to the court, where it would be sealed—if the case got that far, that is. But a murder—assuming there was one—was a criminal matter, and a different thing entirely. That was where Jessica could help. And that was where she could earn the right to the story.
“Yes,” I said, “you can have an exclusive on this part of the case. If you’re able to dig up the murder that Kelly was talking about—assuming there was one, of course—you’ll get the story.” I looked up at her. “You don’t have to figure out whodunnit,” I added. “All I need is the victim’s name and circumstances.”
To my fajita, I added a couple of thin slices of cabrito and a generous spoonful of salsa borracha, then the onions and the cheese, just enough of each, and finally a strip of green pepper. Then I folded the bottom up and sides over, constructing a tidy, ready-to-eat package, guaranteed not to drip.
Jessica is sharp. Frowning, she went back to her soup. “This part of the case?” she asked thoughtfully. “You mean, there’s another part?”
“Yes, but that’s not part of the deal. And no, I can’t tell you why. At least, not yet. I will when I can. I promise.” I bit into my fajita, closed my eyes, and chewed. It was wonderful. After a moment, I opened my eyes. “For Pete’s sake, Jess. Isn’t murder enough to move you?”
She had to chuckle at that. “Okay. You’re on. I’ll get back to you with a progress report as soon as I’ve done enough research to know where we are. And I’ll wait—impatiently—to learn the other part of the story. How’s that?”
“That works,” I said. Holding my fajita in my left hand (rule number one when you’re eating a fajita: never put it down, or it will come apart and you’ll have to reconstruct), I began on my beans, which were also terrific. Both of us fell silent as we worked on our food.
Silent, that is, until my phone went off, and every head in the room swiveled toward me. Reddening with embarrassment, I grabbed for it. If it was McQuaid—
But it was only a nuisance call, and I clicked off immediately with a mutter.
“What’s with the ringtone?” Jessica asked curiously. “It is fierce.”
“Brian put it on for a joke,” I said. “I can’t figure out how to delete it. I’m hoping he can do it when he gets home this weekend.”
“That’s easy,” she said, reaching for it. “I’ll show you.” But after a moment, she frowned and handed it back. “I can’t get it off, either. Hope it’s not some sort of malware.”
We went back to our food until, finally, I pushed my plate away. “I think I’ll never eat again,” I said. Then I picked up the go-box. “But just in case I’m hungry tomorrow . . .”
We didn’t linger after we finished our meal. Bud arrived promptly with the check. We put our credit cards into his leather saddlebag and completed the transaction when he trotted back to the table. For a tail-wagging tip, I gave him the bit of cabrito I had saved on my plate and an extra pat on the head. I waved good-bye to Bob as we left and went out into the April evening. The sun would be setting in another ten minutes, but the sky was still light and the air was scented with spring. Across the street, a band at the Old Fire House was just getting warmed up for the night. The place is a hangou
t for the kids from CTSU, and they have live music almost every night.
Jessica’s blue Volt was parked next to my Toyota in the lot. “Headed home?” she asked as we reached our cars.
I looked down at my watch. It was just seven thirty. Winchester was good for another hour, and Caitie wouldn’t be home until nine. “Yes, but maybe not right away,” I replied. “You?”
She grinned as she got into her car. “I’ve got a research project to get started on. I’m going back to the Enterprise. Don’t go to bed early. If I find something interesting, I’ll call you.”
In my car, I pulled up Lara Metcalf’s number on my cell and phoned her. I caught her just as she was leaving Kelly’s mother in her daughter’s hospital room. They were saying a final good-bye before Kelly was taken into surgery for organ donation.
“Oh, it’s just so awful, China,” Lara said, in tears. “The brain stem tests confirmed that there’s been no brain activity at all for over eighteen hours. It’s heartbreaking.”
“Lara, I’m so, so sorry.” I took a deep breath. “How’s her mom?”
“Trying to be brave, but not carrying it off very well. And Rich, too. He seems terribly broken up. And of course, it’s worse because, as her husband, he’s the one who has to give the final order.” She sighed. “You know, if this hadn’t happened, I believe they might have gotten back together again. In spite of everything, Kelly still loved Rich. She wasn’t the one who wanted the divorce, and I believe, down deep in my heart, that Rich didn’t, either. If it hadn’t been for the other woman—” She stopped, and I heard her blow her nose. “Well, the less said about that, the better. It’s all water under the bridge. There’s nothing to be done about it now.”
Blood Orange: A China Bayles Mystery Page 17
