One woman who works for Halifax Hospital Medical Center in Volusia County sits at the helm of what could be the largest whistleblower case of its kind in the nation.
It’s not a seat she enjoys.
Whistleblower Elin Baklid-Kunz, 47, of Enterprise, alleges that she witnessed more than a decade of billing fraud, unnecessary hospital admissions, inappropriate spinal surgeries and illegal kickbacks to doctors, which could amount to more than $200 million in damages.
Most of the bills defrauded federally funded programs such as Medicare and Medicaid.
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“I kept hoping someone else would do it,” said Baklid-Kunz, who has worked in compliance and revenue services for the hospital, “but sometimes you have to be that someone.”
In a nod to the size and extent of the alleged fraud, the federal government made the rare move to join the lawsuit prosecuting the 764-bed Daytona Beach hospital.
Damages for only the illegal kickbacks, those paid to physicians for their referrals, could exceed $178 million, according to court documents.
If the government wins, it would amount to the largest whistleblower case of its kind in the nation, said Marlan Wilbanks, a whistleblower attorney in the case.
Dave Davidson, general counsel for Halifax, disputes the charges.
“We disagree with the allegations and have been vigorously defending the case,” said Davidson.
“All our physician relationships are appropriate,” Davidson said.
Halifax has not changed its compensation arrangements with physicians since the suit was filed, he said. “We haven’t changed anything. We are confident in the way we conduct our business.”
Halifax Health, the hospital’s parent company, has a medical clinic in South Volusia, and an oncology clinic at Bert Fish Hospital, in New Smyrna Beach. The health care organization is looking to broaden its reach in Central Florida, and is in negotiations to partner with Bert Fish Medical Center, a 112-bed independent hospital, by investing $71 million in the hospital and making it part of the Halifax system, said Davidson.
Halifax has filed two motions to dismiss the case, since the original filing in 2009. Both have been denied. Depositions in the case are winding up this month at the U.S. District Court in Orlando, and parties are preparing for a November trial.
In an exclusive interview with the Sentinel, whistleblower Baklid-Kunz, who has worked at Halifax for more than 15 years, described how between 2000 and 2011 the hospital allegedly admitted thousands of patients who did not meet the necessary medical criteria for admission.
The allegedly unnecessary admissions resulted in more that $30 million in fraudulent billings to Medicare and other payers, said Wilbanks.
One of several audits conducted internally by the hospital, and included in the complaint, alleged that during one month of 2008, 82 percent of patients who were admitted to the hospital for chest pain did not meet the criteria for admission.
After finding what she believed was a pattern of overbilling, Baklid-Kunz said she questioned her supervisor about why they weren’t refunding the money.
“I was told, my loyalty has to be to the hospital, not the government,” she said.
In 2008, the hospital moved Baklid-Kunz out of the compliance area and into the position of director of physician services, a role she still has. There, she reviewed physician contracts and found compensation arrangements that she believed violated federal kickback laws.
Six oncologists and three neurosurgeons at Halifax received “illegal kickbacks,” or incentive bonuses tied to their performance, the suit alleges.
Two of the neurosurgeons received annual bonuses well over $1 million, according to the complaint.
One of those surgeons, Dr. Frederico Vinas, allegedly also performed spinal fusion surgeries that weren’t medically necessary, according to the lawsuit.
“I knew pretty quickly we had an issue regarding paying physician incentives. I thought someone could go to jail here, maybe me,” said Baklid-Kunz.
“I struggled morally with what to do,” she said. “I need to work, and didn’t want to lose my job. I thought they would listen to me, but they never did.”
Article Date: April 15, 2013