A former employee of Abington Memorial Hospital (AMH) in Pennsylvania has filed a federal lawsuit that alleges the hospital laboratory committed Medicare and Medicaid fraud and that she was retaliated against and wrongfully terminated after she informed hospital administration of the lab’s actions.
Ms. Joanne Cleighton was hired by AMH in February 1988 to work in the registration office. Two years later she was promoted to supervisor and fourteen years after that she was promoted to manager. During the entire course of her employment at AMH, Ms. Cleighton claims her disciplinary record was “spotless”.
One of the responsibilities of the registrars at AMH was to enter patient insurance and billing information for outpatient tests, including laboratory tests, and generate an encounter number. After doing this, the registrar would forward the physician’s orders for laboratory testing to the lab. Lab employees would append the appropriate CPT code, which would then be used for billing claims.
If, however, the registrars received orders for routine blood work for a patient covered by Medicare Advantage (Part C) or Medicaid, the registrars did not generate an encounter number. Instead, they were to simply highlight to which outside laboratory the specimens were required to be sent per the Medicare/Medicaid administrator.
Around May 2013, Ms. Cleighton overheard a lab employee state AMH lab employees were marking orders for routine blood work as STAT so that AMH could perform the testing instead of an outside lab. AMH was apparently permitted to perform STAT testing for Medicare/Medicaid patients so long as the physician ordered it STAT.
Ms. Cleighton informed the employee this was improper, and also informed the lab manager at the time. A month or so later, a meeting attended by Ms. Cleighton, the lab manager and a hospital administrator was held, and AMH reportedly admitted there were some things being done incorrectly in the lab and that “changes would be made”.