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article imageLawsuit claims scheme bilked taxpayers, targeted poor women

By Megan Hamilton     Apr 20, 2015 in Health
Indianapolis - A lawsuit claims that Indiana's largest health network bilked taxpayers out of millions of dollars, according to charges filed by the U.S. government and a local doctor.
The lawsuit alleges that IU Health and HealthNet, which serves poor patients through several inner-city clinics, shuffled high-risk pregnant women to nurse midwives, but billed them as though doctors had treated them. A local health care insurer MDwise, which processed many of the claims by HealthNet's patients, is also named in the suit, The Raw Story reports.
Dr. Judith Robinson, who filed the lawsuit, is a former employee of HealthNet. She says she began raising questions regarding patient safety at HealthNet in 2013. She wound up being fired for her trouble.
Robinson sent an email to her employers in the spring of 2013, and, as cited in the lawsuit, she raised concerns about a "broken system." She noted 14 cases in which the lives of mothers and/ or babies were endangered. Two of these cases occurred within a period of six to eight months and had "terrible outcomes."
HealthNet Chief Medical Officer Donald Trainor responded that her request to fix the problem was "premature," the lawsuit reports.
It wasn't long after that when she was fired.
In the suit, she alleges that doctors often didn't see HealthNet patients who were high-risk pregnancies, or the doctors were only called in on an emergency basis, when it sometimes was too late, The IndyStar reports. It's also alleged that a lack of doctor involvement may have contributed to one woman's death, and brain damage in babies.
"I went to everybody and anybody I could because I was concerned about these patients," Robinson said. "Why is it that it seems to be OK to have this population of indigent patients ... get less care? It is just not right."
This is not the first time this has happened. In 2002, Columbia University paid $5.1 million fine because it allegedly billed New York Medicaid for services that midwives, doctors-in-training, and other non-Medicaid providers performed. Two years after that, New York University Downtown Hospital paid $2.1 million in a similar incident, The IndyStar reports.
Robinson says she decided to act after seeing three cases of permanent damage to babies and mothers and 17 near misses, she told WTHR.
"The most egregious part is that these babies and their mothers suffered and didn't need to," Robinson said.
She said she was shocked at how low-income women who were high-risk pregnancies were not getting appropriate doctor care under the watch of IU Health and it's network.
"IU and HealthNet wouldn't allow us to," she said.
The midwives who treated the women at HealthNet Clinics had less training, and federal medicaid rules state it "does not permit treatment or referrals to non-physicians for high-risk pregnancy-related services," WTHR reports.
Mothers and babies were harmed for life, Robinson said.
"This would not happen at IU North, IU West, suburban hospitals," she said. "We don't have this type of process. Why is it allowed? Why is it okay for the people there?"
"I went to everybody and anybody I could because I was concerned about these patients," Robinson said, per The Raw Story.
In a 2011 email that's included in the suit, Trainor explained the reason behind employing more nurse midwives than obstetrician-gynecologists, saying it was "largely financial." He went on to say that while midwives are paid one-third to one-half of what doctors earn, HealthNet is "paid the same amount by Medicaid (our primary payor) regardless who provides the care."
The average salary for midwives was $108,632, while that of a doctor was $349,976, the lawsuit reports.
The three organizations face up to $100 million in fines and penalties if they lose in court, The Raw Story reports.
More about Whistleblower, Pregnant women, bilked taxpayers, Indiana, IU Health
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