Serious "Upcoding" Count in Rayme Edler's Lawsuit Against Escambia County Dismissed

A significant part of the Qui Tam lawsuit against Escambia County's EMS division by Rayme Edler was dismissed today by Federal Judge M. Casey Rogers.

From the motion:

"Plaintiff-Relator Rayme M. Edler filed a qui tam action in part pursuant to the False Claims Act (“FCA”), 31 U.S.C. §§ 3729(a)(1)(A), (B), (G), alleging that Defendant Escambia County submitted fraudulent claims for reimbursement to the federal government.  The United States has declined to intervene.  See ECF No. 7.  Now before the Court is Escambia County’s Motion to Dismiss Count II of the Second Amended Complaint.  ECF No. 91.  Having reviewed the matter, the motion to dismiss is granted."

 Read the full document here  

Why Conflate Two Separate Issues?

Sometimes no matter how much spaghetti is thrown at a wall---none of it sticks.

The recent article by Jim Little of the PNJ had an appropriate headline and summary of a recent scandal at the county:  Someone stole information from the county's servers illegally, this issue is being investigated by the FBI, and currently Jonathan Owens, my former political opponent who I dispatched in the 2020 primary and who worked as former lighting-rod commissioner Doug Underhill's secretary--- has publicly proclaimed he has this stolen property.  Doubling down, I'm told he(Owens) went on the radio and was giddy about explaining how he read all the personal, private, privileged and confidential information that was contained within this stolen data file.  Going further, he even admitted to disseminating this stolen property.  

Now, he does not say how he came to possess it other than providing a flimsy, unbelievable story that this file magically appeared on his desk.  Abracadabra!  But really, who would buy that explanation?  It is unbelievable, and that's the polite way I will put that.

So yes, the story got that aspect of the issue right.

But then came a huge part of the story that was about an unrelated issue:  the now settled cases of alleged, purported misconduct at the county's EMS division from four years ago.  

No doubt, there were some problems with record keeping and organization and multiple persons were alleged to have been a part of some falsification of certifications and mismanagement of call logs.

But here is the fact:  Six personnel from the county all but had their careers destroyed with these allegations from a former medical director who herself is now gone.  Of these six, only one was adjudicated guilty.  The other five settled their cases and WERE NOT CONVICTED.  The county paid a $5,000.00 fine, we got new medical directors, we got new leadership, and our EMS department moved forward.  Case closed.  Ever since that witch hunt by a former medical director--which it was--we have been cleaning up the mess, paying huge settlements and legal bills for the abyssimal way these former employees, now exonerated, were treated by the county.  No due process, allegations that were untrue, and careers ruined.  

But all that is in the rear view.

So why conflate this current case of theft and mishandling of protected information with the ancient history of that case?  

Now, this same former medical director did file a Federal Qui Tam claim post-employment with a couple of lawyers who specialize in this.  But that is a separate case from the falsification of records case.  

But MOST IMPORTANTLY:  The personal, private, priviledged and confidential text messages these lawyers so desperately want to keep, the ones allegedly provided to them outside of the normal discovery process, the ones that were stolen, the ones that cannot be verified as accurate, and the ones that are being investigated by law enforcement for the way they were inappropriately obtained---have no bearing on that Qui Tam case.  None whatsoever.  I am a part of the legislative in this county--I have no day in-day out operational oversight of any department--let alone EMS billing.  I'm not a fact witness to any of these overbilling allegations, and any discussion of the former Medical Director contained within these stolen text messages from my personal phone would be irrelevant hearsay and not a part of any case--let alone this particular one.  This is all setting aside the fact that these files were not provided as a bonafide records request, they were obtained unlawfully and there is no way to discern whether or not lines have been added into this particular file nor whether or not other lines have been deleted or manipulated.  Bottom Line:  There is no way to authenticate what Jonathan has given to these lawyers in this Qui Tam case.  So why are the lawyers burning up the taxi meter, running up costs, on chasing this issue down a rabbitt hole?

So now comes the news journal-- conflating a serious, major theft with a closed case and a current case for which the stolen files have no bearing?

I know why the plaintiff's lawyers are doing this---they are running up the check hoping for some settlement of this case to cover these exhorbitant fees, throwing spaghetti at the wall, making tons of discovery requests, then modulating them and moving them around.  They are grasping at straws and hoping to find something to help their case.  So they are doing what these sorts of lawyers, working on contingency, do.  Doing what lawyers do--It's why they are so dang popular and beloved 😀.  

But why is the PNJ carrying these lawyers' water--instead of separating the real from the faux as they should?

Accusations, Insinuations, Allegations and a Federal Qui Tam Lawsuit from Former Medical Director....Someone is Looking for a Payday!

 

Someone is looking to score a payday!

The board was made aware late last week of a recently filed complaint against the county in Federal Court.  This complaint is being made under the Federal False Claims Act.  The allegations and insinuations are numerous and wide-ranging.  Everything but the kitchen sink is thrown into the complaint--which initially was filed under seal with the court back in September of last year.  Like a Jackson Pollock--stuff is thrown all over the place in this filing.  like spaghetti all over the wall....The Angst oozes from the pages of the complaint (currently being redacted in the legal office) which I will post once it is scrubbed of any sensitive, HIPPA or other confidential information which cannot be released.

I've read all 58 pages.  

It reads like the manifesto of an angry, scorned former employee short on facts and long on allegations and requests for data--which is probably why the Federal Government took a "hard pass" on joining this suit. I'm sure the former medical director and her Miami and Pennsylvania lawyers were hoping the Feds would join--but they didn't.  Which may be telling.  Language like this, below, directly from the complaint--sounds a lot like a "fishing expedition"...

"With respect to allegations made upon information and belief, Relator has, based upon Relator's knowledge, data, and prior experience, a reasoned factual basis to make the allegations herein but lacks complete details of them. While Relator has significant evidence of the fraud alleged herein (the details of which follow), much of the documentary evidence necessary to prove these allegations is in the possession of Defendant.."

Meanwhile-the staff that remains in billing and EMS will have a Herculean "Data call" coming:  They will have to compile the billing and call coding information from different billing systems over a long period of time where multiple personnel have come and gone over the timeframe indicated (2014-2020).  Multiple EMS and Public safety employees, multiple budget directors, multiple EMS and public safety directors, three IT directors, and at least four current and former Interim and permanent County Administrators have been employed over this time.  

When this was dropped on the legal office's lap just last week-- on January 18th-- by our Insurance-company assigned Law Firm--we were given only 9 days to answer this nearly 60 page complaint--even though our "insurance company assigned attorneys" knew about this complaint since November.  so there are issues with that, too, that I'll get to in some additional, follow-on posts.....meanwhile, we have subsequently received an extension which will allow us until February 10th to file a response.  But as it pertains to the allegations, this post will be about that.

In a nutshell, the former Medical Director has teamed up with a couple of  Lawyers to accuse the county of systimatically, purposely and illegally over-billing the government for EMS transportation services provided in our county over nearly a seven year period.  In addition to that, they are claiming the county billed for ALS services while only providing BLS services.  They also claim some of the personnel were allegedly not certified properly for the reimbursements requested.   The allegations are all listed one by one after a narrative that names a lot of names and lists a lot of serious allegations these individuals are alleged to have engaged in during the course of their employment with the county. (Interesting that most of the individuals named are no longer employed by the county, and the "sinister allegations" made in this complaint do not mention the fact that the lion's share of these employees have now moved on with their respective careers elsewhere after  disproving or settling the allegations of this former medical director hurled at them. I do not believe any of these individuals named in her complaint has been adjudicated guilty of her allegations.  Most of these allegations and charges have been dropped and settlement agreements made allowing these former employees to all to continue their careers in public safety).  

The most interesting thing about this suit is that if successful, the plaintiff (former medical director) and her lawyers can collect a portion of the fees owed to the government--which could amount to a lot of money if every allegation is proven--because Qui Tam complaints, I'm told, allow folks to sue on behalf of the government. If successful, a finding can be made forcing a party (in this case the county) to repay the government and the complainant.  Looks to me like someone is looking for a payday!  Ka- Ching!!

Interesting to me is the fact that she, the former medical director, was essentially in charge of this department for a multi-year period---and among all the drama, requests for training, requests for other things, bigger budgets, "we must have Rescue 1" etc. and even more drama-rama complaining--I don't recall this medical director once, not once, letting the board know she saw a problem with the billing/coding.  Not once.  She came to meetings, she complained about everything EXCEPT anything having to do with the billing.  So she was in charge, never mentioned this as an issue, and is now suing for this issue? Why is that, I wonder?

Too many questions.....

Much more to come on this in the days, weeks, and months to come.

Initially, I'm told at least one employee intimately familiar with the coding and billing issue has stated unequivocally that the allegations are untrue and that coding was/is always done conservatively--meaning the lower cost transport was the default billing unless it is/was known that the call was an acute call which bills at about $100 more than the rate for a routine transport.  But the county's staff will have to compile reams of data in order for a defense to be constructed and prior to a cogent response being drafted to this wide-ranging complaint.  Staff will have their work cut out for them over the next three week which will go by quickly.....

From the complaint:

"1.            Plaintiff-Relator Dr. Edler brings this False Claims Act Complaint on behalf of the United States, and on her own behalf. 31 U.S.C. §§ 3730 et seq.

2.             Medicare and other government programs pay for certain necessary and reasonable medical services, but services are not reasonable when they are performed by uncertified and unqualified personnel. Escambia County knowingly filed claims for medical services performed by uncertified and unqualified personnel.

3.            Further, Escambia knowingly filed claims for emergency transportation when it provided non-emergency transportation, and it filed claims for advanced life support when if provided basic life. These up-codes are false claims."