Two former executives filed a federal whistle-blower lawsuit claiming they were fired from their jobs at Anchorage-based Alaska Native Tribal Health Consortium for making accusations about improper billing, the Anchorage Daily News reported.
Seven things to know:
1. The lawsuit was filed by Joan Wilson, who served as chief ethics and compliance officer within Alaska Native Tribal Health Consortium's CEO office, and Paul Franke, MD, who served as CMO of the Alaska Native Medical Center, which is operated by the tribal consortium. ANTHC employed Dr. Franke from January 2013 to June 2016. Ms. Wilson was employed from September 2014 to May 2016.
2. The former executives allege they were fired in retaliation for making internal complaints about various violations of ANTHC policy and state and federal law.
3. Ms. Wilson and Dr. Franke accuse the tribal health organization of receiving millions of dollars in improper Medicaid and Medicare payments due to improper billing. They claim the entity billed twice for certain drugs, according to the report. They also claim the tribal consortium billed Medicare and Medicaid for oncology visits where care was provided by ineligible providers. Additionally, the lawsuit states Dr. Franke identified $7 million in services that ANTHC improperly billed for, as they were not appropriately authenticated by providers.
4. The lawsuit claims the former executives notified ANTHC executives about the billing practices, but they "took no action to return funds received as a result of the improper billing" and "these practices are still occurring today."
5. The tribal health organization denies the allegations. It told the Daily News: "Our staff and outside auditors routinely and thoroughly review our billing practices to ensure compliance and correct any inadvertent errors that are found."
6. Hospital officials said the claims by Dr. Franke and Ms. Wilson — who also allege problems involving EMR security — are misleading and not correct, according to the report.
The tribal health organization also said the hospital did not retaliate against the executives, calling the choice to end their employment "justified and proper." Attorneys for the nonprofit would not provide the Daily News reasoning as far as why the former executives were fired but said the nonprofit backs its personnel decisions.
7. The lawsuit was initially filed in 2016 under the False Claims Act. According to the report, Dr. Franke and Ms. Wilson wanted the U.S. Department of Justice to hear the case, but it declined to do so.
The Daily News reported federal attorneys did not provide reasoning for that decision but asked for an opportunity to be heard before the judge approved settling or dismissing the complaint. Dr. Franke and Ms. Wilson have continued the lawsuit, which now focuses on their wrongful termination claims, and want a jury trial.
Read the full report here.
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