Canned for Reporting Fraud, Kaiser Nurse Says
DENVER (CN) - A Kaiser employee was fired for reporting fraud and because of her race, she claims in federal court.
Karen Nelson, a native of Jamaica, began working as a Nurse Manager for Primary Care at the Rock Creek Medical Offices in September 2010, according to her complaint. In December 2011, she moved to Perinatal Hospital and Home Care Services.
Once there, she says in her complaint, she discovered an ongoing pattern of fraud by nurse practitioners who billed for hours they had not worked, recorded billable mileage they had not driven and submitted inflated reimbursement for claims for office equipment. The practice was harmful, according to Nelson, who says the cost of the fraud is always passed on to patients.
"Because nurse practitioners are considered to be 'providers,' on-going and regular fraud, although relatively small in individual instances, amounts to larger monies being billed to patients, and to the government for Kaiser Medicaid patients, in violation of laws prohibiting fraud in Medicaid programs, the False Claims Act and others, as well as a violation of Kaiser policy, which states that fraud, waste and abuse, including falsification of expense reimbursement claims and time records, constitute serious offenses that may warrant immediate termination," the complaint states.
Nelson was met with threats, however, when she approached her supervisor, Lisa Bland, who told her to ignore reports with "irregularities" under $1,000 and that she "was not asking her to kill young babies."
"It was Ms. Nelson's understanding that she was to sign off on fraudulent time and expense reports or lose her job; in fact, Ms. Bland told her that Ms. Bland could sign off on the fraudulent reports herself, in which case, she 'would not need' Ms. Nelson," the complaint states.
Nelson then took her complaints to Senior Director Beth Martin, who likewise refused to take action, prompting her to take them to Kaiser's Compliance Department in April of 2012. Once again, no action was taken.
In March 2012, despite her having received a $7,000 performance bonus, Nelson became the focus of disciplinary action and unwarranted performance reviews by both Bland and Martin. She received a "corrective action" document, which was later retracted for an "orientation or goal plan."
Bland also prepared a report titled "Documenting Karen Nelson's Behavior," where she describes Nelson's "ethical" behavior as "alienating" staff, and criticizes her for "(i) double checking every line item on expense reports and (ii) TPCs required to document their time on a spreadsheet," according to the complaint.
Nelson was disciplined in April for "acting outside of her scope of practice,' when she told a nurse practitioner to "follow her instincts."
In August 2012, she was notified her position was being terminated.
Nelson says she was qualified for three other job positions and applied for them, but that she had become blacklisted for her refusal to sign off on fraudulent time cards, according to the complaint.
"Under Kaiser policy, transitional employee candidates are to be hired over other equally-qualified internal or external candidates," according to the complaint.