C-Suite Revolving Door, CMS Fraud, Faulty Equipment, HIPAA Violations
By Luis Robles, a 30 year legal veteran and partner in Robles, Rael and Anya, an award-winning law firm of 12 jurists located in Albuquerque, N.M. who specialize in business and corporate law.
As COVID-19 mercilessly spreads across New Mexico, McKinley County continues to lead in virus deaths with 229 as of August 13, out of 695 deaths, close to 30 percent of the state and an infection rate of 4,077, second-highest behind Bernalillo County. As the virus worsens within the Navajo Nation and McKinley County continues to be one of the hardest-hit areas, some of the reasons are apparent as the death toll and infection rate will rise in the coming weeks and months, but other reasons are lurking in plain sight.
Yes, while the virus rages, one of the only defenses for residents in McKinley County is Rehoboth McKinley Christian Health Care Services (RMCHCS), a small, rural hospital on the border of the Navajo Nation. Unfortunately, the hospital lost its Hippocratic interests and values of serving the community, treating the homeless and its many volunteer efforts.
It has instead become mired in staff infighting, fraudulent Medicare billing practices, political firings, HIPAA violations, cozy relationships with local politicians and other questionable practices exasperating the pandemic.
This change in the hospital’s relationship with its community began when former CEO David Conejo who rescued the hospital from bankruptcy in 2014, was driven out by an aggressive protest campaign led by a coterie of young doctors preoccupied with social media, demanding higher wages and a stake in management.
The group was influenced by controversial Independent publisher Robert “Bob” Zollinger who created an anti-Conejo campaign in retaliation over Conejo’s lack of advertising in his newspaper. In the past, Zollinger assaulted Harry Mendoza, the former mayor of Gallup, in a bank parking lot brawl resulting from his accusations in his newspaper that the major raped a minor without any evidence while in yet another episode he assaulted women on his own newspaper staff.
Zollinger published weekly articles with the help of Board Chair Laura Hammons designed to create fear, uncertainty and doubt among residents and hospital staff to drive Conejo out. However, Conejo has launched a six count lawsuit against the hospital. Conejo has also been absolved of any allegations of mismanagement by the federal government’s Centers for Medicare and Medicaid Services (CMS). https://roblesrael.sharefile.com/d-sbb48fa71f3d4cda9
C-Suit Revolving Door
Meanwhile additional lawsuits are being launched against RMCHCS. Interim-CEO Mary Bevier returned to her former position as Chief Financial Officer (CFO) allowing Steve McKernen, a part-time consultant with MARKA Strategic Financial Services to be named as the latest interim-CEO. Bevier will shore up the hospital’s financial department as long-time Comptroller Linda Reado also announced her departure.
Chief Medical Officer Valory Wangler has also resigned to take over the hospital’s family residency program. Wangler is named as a defendant in Conejo’s lawsuit. She led protests at the hospital in a coup to take over as CEO while patients there were dying of COVID-19.
Former Chief Operating Officer (COO) and 32 year veteran Michael Nye abruptly resigned in early August. From 2009-2014, RMCHCS had six CEOs until Conejo brought management stability to the hospital. Since his departure in May, the hospital in on its second interim-CEO in two and a half months.
Casandra Lopez-Martinez was a 23 year veteran. She cited the chief medical officer and chief nursing officer who led a rebellion against Conejo as the reason for her resignation. In a meeting with New Mexico Department of Health investigators which she attended, the chief medical officer and chief nursing officer lied about the functionality of COVID-19 ventilators. “David Conejo was a good man who cared about the community, the homeless and the Navajo. The hospital is now run by greedy people out for themselves and I want no part of it,” she said.
Operating Room Director Angela Wheeler also recently resigned. Her resignation letter describes a hostile work environment such as surgeons discussing departmental political issues such as surgery staff and surgeons not following protocols set in place, surgeons yelling at employees in front of other staff.
No Chain of Command
“There was a chain of command change twice since I arrived. I had a new boss two days after I arrived with no official notice of change in chain of command and a total lack of communication between my two bosses, consistently being caught between clinical and operational directors. These conflicts have affected my ability to manage my team and have left me and many of my direct reports feeling uncertain,” Wheeler stated.
She cited air handling equipment which was out of compliance during her tenure, dangerously causing room temperatures and humidity to be out of a safe range. She also identified negative air pressure issues not being resolved, putting staff and patients at risk. However, surgeons continued to do surgery pretending it was normal. Wheeler felt her only option was to resign due to many of these unresolved issues that prevented her from performing her job to the best of her ability.
“It is getting to the point that if you bring violations to the CEO or board chair you will be fired, so the only safe solution is to quit and work at a real hospital,” said Wheeler. Wheeler was backed up by a former manager of the operation and recovery rooms, who left RMCHCS at the end of June, citing similar issues as Wheeler.
Unsafe Work Environment
One of the manager’s chief complaints was that the hospital has been using its “Green Room” for patient operations despite not having the appropriate number of electrical outlets in the room. He brought this to the attention of interim-CEO Mary Bevier, but there was no response. “It is plain awful that this poor excuse for a hospital is still risking patient’s lives and pretending to provide medical services,” said the former manager. “CMS needs to come in and close it down.”
Surgeons and staff complaining about unsafe practices were told not to report it to Human Resources. They were unable to hire additional or replacement staff caused by employee strikes at the hospital causing staff shortages. There was also a lack of security in the unit that caused supplies to be taken and moved without proper authorization and non-necessary staff in sterile areas without the proper attire.
Camarota Files Suit, RMCHCS Insurance Provider Hires Own Legal Team
RMCHCS’s insurance company Berkley Insurance recently brought in their own legal team to manage the mounting lawsuits as William Camarota has filed a three-count suit against Chief Nursing Officer (CNO) Felicia Adams and her husband Dean Adams, former chief engineer/director of plant operations. The duo is charged with breach of confidentiality/invasion of privacy, retaliatory discharge and defamation of character. Dean Adams was fired by the hospital in May for destroying a company truck while drunk.
The charges have been filed in McKinley County District Court by the plaintiff’s Attorney David Jordan, P.C. who is planning a jury trial against the defendants. This is the second lawsuit filed against RMCHCS for retaliation firings which stemmed from hospital protests led by Hammons, Chief Medical Officer Valory Wangler and CNO Felicia Adams amidst the raging COVID-19 pandemic. Adams is also a defendant in a six count lawsuit filed recently by Robles, Rael and Anya of Albuquerque who is representing Conejo.
Allegations of “Racist” Artwork
In another retaliatory tactic, Conejo lawsuit defendant Dr. Neil Jackson has even gone so far as to call for the hospital to remove children’s artwork from its College Clinic pediatric facility. The popular paintings were donated by world-renown New Mexico portrait painter Jacquelyn Cattaneo who is a Gallup resident. Hospital doctors have called the 76-year-old artist’s popular paintings of Navajo and other ethnic children “racist and disgusting”.
“How can anyone say my paintings of children are racist and disgusting?” said Cattaneo, a Gallup resident known for her children portraits. “My paintings are without prejudice. They depict young children of all ethnicities; black, white, Latino, Navajo and others. Will doctor’s Lindsey and Jackson now say their pediatric patients are disgusting? Maybe they should not be around children. I wonder what other prejudices they are hiding.”
The paintings were hung last year by Cattaneo and Judy Conejo, Conejo’s spouse. At a ceremony at the College Clinic which attracted almost 200 people, Cattaneo auctioned off some of the paintings on display to raise funds for RMCHCS.
Numerous unsafe building conditions have also been uncovered leading to patient danger, making it ill-equipped to meet minimal safety conditions. The director of building operations was recently fired for allegedly showing up to work drunk.
In addition to fraudulent patient billing practices and questionable Medicare charging processes, other unethical business practices include surgeon a provider who received a Paycheck Protection Program (PPP) loan when in fact she is an employee of the hospital and does not qualify. She was overheard in the operating room discussing plans to buy a condo with the money.
Another questionable arrangement is Hammons family medicine office at 2022 E Aztec, Gallup, NM 87301. Her office is located in the building owned by New Mexico State Senator George Munoz who complained about Conejo to the media. Hammons recently appointed Munoz to the RMCHCS Hospital Board.
RMCHCS continues to bleed staff as more employees resign or are fired by Hammons. As she roots out Conejo supporters, the hospital continues to deteriorate physically and morally. “Hammons sent an email to employees on May 8 urging truth tellers and whistleblowers to contact her directly regarding any wrongdoing at the hospital. It appears this was a trick to fire people who took her up on it,” said Miller who was fired for this very reason.
As Camarota filed his HIPAA complaint against RMCHCS, an investigation was conducted by Miller and an independent panel of credentialed hospital employees. The investigation concluded that Dean Adams should be fired for a Level 4 violation. Miller presented the case to the hospital board’s attorney and RMCHCS’s attorney who also concluded that Dean Adams maliciously spread word about Camarota’s illness and both investigations recommended he be terminated for it.
However, the hospital’s board conducted yet a third investigation and found there were grounds for termination. Dean Adams even admitted to violating Camarota’s HIPAA rights, but was never fired for it. “Despite two investigations that concluded Dean Adams be fired, a third investigation by the board agreed he should be fired, but wasn’t. Furthermore, the board never provided Camarota with any results of the investigation to this day,” said Jordan.
Hammons fired Dr. Phyllis Miller, its Health Information Management Director (Ph.D., RHIA, RHIT, CHPS, Lean Six Sigma Green Belt, AHIMA ICD-10-CM/PCS Trainer). “I was accused of not being truthful in my investigation and outcomes reporting, and that my investigative findings were being rejected.” Miller abruptly resigned her HIPAA Privacy Officer position at the meeting. She also reported the violation to the New Mexico Nursing Board, the New Mexico Medical Board and Office of Civil Rights.
CMS Billing Fraud, $25,000 Bribe For Silence
Miller also uncovered patient medical billing irregularities that would invalidate the hospital’s invoices. The billing errors would be considered fraudulent by the federal government’s Centers for Medicare and Medicaid Services (CMS) and insurance providers such as Blue Cross/Blue Shield, leaving the hospital vulnerable to lawsuits and potentially owing the federal government and insurance providers millions of dollars in refunds.
For many years, the hospital billed patients and submitted invoices to Medicare and Medicaid using medical procedure codes that were not verified with providers’ signatures which guaranteed that the procedures, tests, exams and other medical work being charged was actually done. This system of checks and balances is used routinely by U.S. hospitals and is approved by professional organizations such as the American Health Information Management Association (AHIMA).
“I filed a whistleblower complaint about the fraud with the hospital which protects employees from retaliation such as firing,” said Miller who has more than 20 years of healthcare experience as HIM director, auditor, and revenue cycle management. “Instead of honoring their own policy, they claimed I sent out a ‘rude’ email to my manager in addressing this issue.”
RMCHCS offered her $25,000.00 to “leave quietly”. “Part of that money was salary owed me. They can’t even bribe someone correctly,” said Miller who plans to sue the hospital for wrongful termination and possibly other charges.
The irony of this situation is that RMCHCS was fully prepared to fight COVID-19. It had the necessary staff, finances and supplies, but now it has increased deaths instead. The hospital was all set as any hospital facing a pandemic could be. All of the Independent’s stories that led to David’s firing were false and created so defendant’s such as Chief Medical Officer Valory Wangler and Chief Nursing Officer Felicia Adams could conspire with Board Chair Hammons to drive Conejo out of his position.