CASPER, Wyo. —Wyoming Medical Center fired a hospital worker after she informed federal authorities about possible billing fraud, she alleged in a lawsuit unsealed this week.
In the complaint, whistleblower Gale Bryden claimed the hospital retaliated against her after receiving letters from two government offices indicating WMC was the subject of a federal investigation. Comments from the manager who fired her suggested she was terminated for supplying authorities with information, the lawsuit states.
Bryden also accused WMC of submitting charges to Medicare and Medicaid for canceled surgeries.
Hospital officials dispute Bryden’s claims.
“WMC strongly denies any intentional wrongdoing and will vigorously defend itself against these allegations,” the hospital said in a written statement released Wednesday afternoon. “WMC believes that the complaint completely mischaracterizes its actions.”
Bryden’s attorney, Jeff Gosman, did not respond to a message left Wednesday at his office.
Bryden filed the lawsuit in 2007 under a federal whistleblower law that kept it under seal while authorities investigated the matter. She amended the suit with additional allegations in 2009.
A judge unsealed the original lawsuit in October after federal attorneys notified the court that the government wasn’t prepared to intervene in the case.
On Tuesday, a different judge unsealed the amended lawsuit as part of a normal court process. The documents were publicly available on a federal court database Wednesday morning.
In the suit, Bryden said she observed hospital workers submitting claims to insurers that differed from the services that were actually provided. She claimed records were altered to collect higher reimbursements rates from government insurers Medicare and Medicaid.
The changes concerned the admission status of patients, which according to the suit, were changed without a doctor’s order.
Bryden also accused hospital management of failing to act on her concerns after she raised the issue in the fall of 2006.
In the revised portion of the lawsuit, Bryden accused the hospital of billing the federal government for canceled surgical procedures.
“The (hospital) routinely submits billing for canceled surgeries to Medicare for more than the diagnostic testing related to the cancelled surgery,” the suit states.
Bryden also maintained she was fired in June 2009 in retaliation for supplying the government with information about the hospital’s allegedly fraudulent activities.
The same month as Bryden’s firing, the U.S. Attorney’s Office forwarded a letter demanding WMC retain all records relative to a government investigation, the suit states. Shortly after, hospital management told some employees that the investigation stemmed from a whistleblower inside the organization.
At the time she was terminated, Bryden was satisfactorily preforming her job duties, according to her lawsuit. She was told she was being fired for not being a team player.
When asked, hospital officials declined to comment specifically on the retaliation claim because the suit is still pending. In the statement, WMC said it continues to cooperate with the government and hopes to have the matter resolved soon.
“At no time have there been any questions regarding the quality of care provided to patients at Wyoming Medical Center,” the hospital wrote.
According to the WMC statement, the government investigation relates to the hospital’s “compliance with complex Medicare reimbursement rules relating to the timing of physician admission orders and the medical necessity of certain inpatient stays that served to qualify patients for Medicare coverage at skilled nursing facilities.”