19 Sep Deaths, Fraud Allegations and an Inquiry Into a Long Island V.A. Hospital
Along the winding drive through the 300-acre compound of Long Island’s only veterans’ medical center, banners line the road stating the presumed values of the institution: integrity, commitment, advocacy, respect and excellence.
But in recent months, a series of troubling failings and allegations of wrongdoing have called into question the care being provided to thousands of the nation’s military personnel by the Northport Veterans Affairs Medical Center, in Northport, N.Y., with charges of abuse that include widespread billing fraud and the failure to report the death of a patient for months after his body was found in a building on the complex.
The problems plaguing the medical center first drew attention after all five of the hospital’s operating rooms were shut down in mid-February, because sand-grain-size black particles had begun falling from the air ducts. Veterans in need of surgery had to go to other hospitals for care, often leading to further delays in their treatment or postponed operations.
The closing of the operating rooms was first reported by The New York Times in May. Representative Lee M. Zeldin, a Republican who represents the First District on Long Island and is a member of the House Veterans’ Affairs Committee, then collected information from whistle-blowers and others and turned it over to the committee, which will hold a public hearing at the medical center on Tuesday.
The problems at Northport come two years after whistle-blowers revealed widespread dysfunction and corruption at a V.A. hospital in Phoenix, where it was reported that veterans were dying while waiting for care. It soon emerged that there were systemic problems at medical centers operated by the Department of Veterans Affairs around the country.
Despite calls from the White House for the department to be “restructured and reformed,” two years later problems remain and the topic has become fodder for the presidential campaign.
At Northport, the failure to properly maintain the operating room facilities may be the least of the issues that the congressional committee will take on.
Hospital officials, including the facility’s director, Philip Moschitta, have been called to testify. According to a person familiar with the investigation, who was not authorized to speak and requested anonymity, they will also be asked about allegations of widespread fraud, including the collection of thousands of dollars in fees to care for veterans who were never actually treated.
According to internal emails, and current and former employees familiar with the alleged scheme who spoke on the condition of anonymity because they feared retaliation, nurses were directed to make cold calls to veterans and then code those calls to look as though they had been solicited by the patient, not the practitioner, in order to enhance revenue.
One former hospital employee likened the practice to your private physician calling you out of the blue to check up on you, then billing your insurance company for the call. The former employee, who asked to speak anonymously to avoid reprisal, said the practice was a means of padding the numbers.
The goal of the calls, according to the internal emails, was to contact around 2,000 veterans and thus raise enough money by the end of the current fiscal year, Sept. 30, to patch a large hole in the hospital’s growing deficit, of more than $11 million.
In all, the calls apparently generated roughly $1 million in payments for more than 200 veterans, according to the emails.
A number of the nurses directed to make those calls appeared concerned about the activities, and a package of their email correspondence was turned over to the House Veterans Affairs’ Subcommittee on Oversight and Investigations. A copy was obtained independently by The Times.
Instead of receiving overtime pay for the hours spent logging calls, which might have raised suspicions, the nurses earned comp time, according to the emails.
One nurse wrote that the veterans were being used as “cash cows,” which the hospital administration wanted “to milk for $9 million.”
The worth of each veteran in the scheme: $4,285.71.
“Lots of questions that make me a little uneasy,” one nurse wrote. “What would be the best place to get accurate information on whether this is an ethical move?”
Another email complained about the workload. “I also find it unfair to expect this amount of work on already overburdened nurses,” it said.
A response read, “Notice how management is tracking the R.N.s and tallying their calls. This will no doubt be used to retaliate — keep track of that. Notice how only comp time is being issued vs overtime to hide any $ going to support said telephone encounter billing fraud.”
At another point the same nurse was even more blunt. “I would advise against engaging in this telephone billing fraud,” the nurse wrote. “Nothing has been put it writing and no written guidance/instructions have been disseminated to obfuscate the fraud.”
Some of the nurses, on the other hand, boasted of their activities at a meeting of clinical service directors, proudly proclaiming the efforts to re-engage 2,000 patients and bring them back to Northport.
When asked who had authorized the efforts, Walinda West, deputy director for media relations at the Department of Veterans Affairs, said only that it was a recommended practice for primary care teams “to follow up with patients who are due for care, or who have preventive care needs.”
But according to the emails from the nurses, management was asking “clinical staff to make phone calls that count as appointments with NEW patients, to increase access.”
The committee is also looking into the circumstances surrounding the suicide of a veteran, Peter A. Kaisen, 76, in a Northport parking lot on Aug. 21, and why the death in March of Anthony J. Cox, 51, a veteran who was working at Northport and enrolled in a drug rehabilitation program, was not reported even though his body was found on the campus.
The circumstances surrounding Mr. Cox’s death and the discovery of his body remain murky. The autopsy report, obtained by The Times, said he had died of a fentanyl compound overdose; fentanyl is a synthetic opioid more powerful than heroin and, according to a recent government report, is responsible for an increasing number of overdose deaths in New York and across the country.
According to the police report, Mr. Cox stopped responding to phone calls on a Friday; his body was discovered on a Monday morning.
When Mr. Cox’s mother, Judith Wood, 77, a retired nurse and a United States Air Force veteran, arrived from South Carolina to claim her son’s body and learn what had happened, she said she was met with systemic silence at the Northport campus.
“No one would tell me anything,” Mrs. Wood said. “I was not allowed to go where he lived; we kept getting the runaround. Everyone shut us down. There’s something screwy about that place.”
The death of Mr. Cox was never formally announced by the medical center, and it was not reported to the group that accredits and certifies health care organizations, or to local congressional offices as what is known as a sentinel event, an unanticipated death or serious injury.
For two months after Mr. Cox was found dead, the medical staff continued to make notes on his chart as if he were alive.
“Patient will see me on 5-23. Patient was a no-show. No testosterone will be filled unless he follows us in the clinic,” one clinician wrote in Mr. Cox’s electronic medical records, which The Times obtained from his family. Other notes indicated that offices at Northport had made calls to Mr. Cox.
A spokesman for the Northport medical center declined to comment, and said in an email statement that “we look forward to participating in Tuesday’s hearing and providing the committee with information about the high-quality care provided at this facility.”
Representative Zeldin expressed frustration with the Department of Veterans Affairs, which he said was “stonewalling congressional efforts to investigate.”
In July, congressional investigators submitted questions for Mr. Moschitta, the medical center’s director, but have received no response.
Representative Jeff Miller, Republican of Florida and chairman of the House Veterans’ Affairs Committee who will lead the hearing, said in a statement that “with or without the Northport V.A.’s cooperation, we will continue working closely” with Mr. Zeldin’s office “to investigate this matter until all the facts are at hand.”