UF whistle-blower alleges threats
By BARRY KLEIN
© St. Petersburg Times,
A doctor whose whistle-blowing led to a federal investigation of the University of Florida teaching hospital -- and an $8.6-million settlement -- says he was threatened by his bosses after he complained about fraudulent billing practices.
In a civil complaint unsealed last week by a federal judge, former UF ophthalmologist Robert Mames says he was attacked for not being a "team player." He says he eventually was forced to leave his full-time position at UF because of persistent harassment.
Mames, who now has a private practice in Ocala and Gainesville, declined to be interviewed. So did Curtis Margo, a former UF ophthalmologist who also complained of pressure and ridicule after he objected to UF's billing procedures.
It was their allegations that spurred an eight-year investigation into an alleged scheme by the hospital to defraud the government of millions of dollars in Medicare, Medicaid and other federal health care programs.
In his complaint, Mames said he and Margo were among the faculty physicians who were expected to sign records indicating they had performed patient services that actually were done by lesser-trained resident physicians.
In some cases, he alleged, faculty physicians were not in the room when the procedures were performed. In other cases, they weren't even in the hospital.
The resulting investigation involved a grand jury, criminal subpoenas and almost $2-million in legal bills for UF.
It has not, however, included any admission of guilt.
Despite agreeing to pay the state and federal government $8.6-million to close the case, UF officials insist their doctors were guilty of nothing more than sloppy paperwork.
No fraud was committed, they said -- at least not intentionally. And certainly no patients were ever harmed, they insist.
Mel Rubin, chairman of UF's ophthalmology department during several of the years under investigation, said he has never seen Mames' lawsuit, which has been under seal since 1993.
But he said he did nothing to harass or intimidate Mames.
He notes that he was formally cleared by the U.S. Department of Justice of any criminal charges.
"This was a nightmare for me," said Rubin, who retired in 1997 and is now an eminent scholar emeritus at UF.
And apparently for Mames, as well.
In the early 1990s, according to the lawsuit, Mames and Margo complained repeatedly to supervisors about the billing practices, which they considered unethical and illegal.
They were then "criticized and ridiculed repeatedly by Dr. Rubin and other department employees for allegedly not being team players and not acting in the alleged best interests of the university (by) failing to falsify medical records and time records."
Margo, 53, left his tenured position in July 1992.
He is now in private practice in Lakeland.
Mames, 41, said he was told that unless he signed a settlement agreement forbidding him from suing the school, he would not be given a good job recommendation.
He refused and left in 1993.
Ken Berns, who became UF's medical school dean in 1997, said he has no knowledge of the circumstances surrounding the departures of Mames and Margo.
But in no instance, he said, did UF commit intentional fraud or fail to provide patients with adequate treatment.
He said the university was guilty only of not being able to meet the government's cumbersome paperwork requirements for Medicare and Medicaid reimbursement.
The $8.6-million that UF is paying, Berns said, represents charges "the university agreed were not supported by the medical records, or other documents that did not agree with the government's interpretation of billing regulations."
Because most of the investigative records remain under court seal, federal and state prosecutors involved in the case said they are barred from commenting.
But as recently as 1999, according to records separate from the investigation, at least some of the violations still were occurring at UF.
This is clear from a memorandum written by Timothy Flynn, the surgical service chief at the VA Medical Center in Gainesville.
The VA hospital is across the street from Shands at the University of Florida, which is home to UF's medical school.
Many of UF's faculty physicians practice in both hospitals.
"It has come to my attention that some of you are not abiding by the absolute rule that says you cannot be attending on a case at the VA and on a case at Shands at the same time," Flynn wrote.
"This means that it is illegal, and a clear case of fraud, if you are listed as the attending and the surgical times at the VA and Shands overlap. I would caution you to be very careful about this as the ongoing investigation at the VA is looking into this very aspect of our practice."
As part of the settlement, UF must better educate its doctors and staff on proper billing procedures. The university also has agreed to beef up its internal auditing.
Mames, meanwhile, is waiting for a federal judge to sign off on the settlement agreement.
As a whistle-blower, he could receive up to 15 percent of UF's payment to the federal government.
But some of the money might be split with a second whistle-blower who raised separate allegations about billings for clinical pathology work at the college.
And much of whatever he gets, Mames said, already has been earmarked for legal fees.
In a prepared statement, Mames said he is ready to put "this matter behind me."
"The events that were the subject of this lawsuit transpired over 10 years ago when the department of ophthalmology and the University of Florida were under different leadership," he said.
"At the time, I attempted to resolve my objections to the department practices within the confines of the university's hierarchal system.
"I'm sure much has changed since then."
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