Nearly a decade ago, Donna Shalala, then president of the University of Miami, fired a top executive at the UM School of Medicine, saying in a recent statement that “his leadership was destructive to UHealth,” that he “mishandled” layoffs during tough financial times and that “destroyed morale” among faculty.
Jonathan “Jack” Lord, former director of operations and compliance at the School of Medicine, claims in a lawsuit against the university that Shalala retaliated against him after he repeatedly informed him of her efforts to investigate $10 million overbilling to the Medicare by an organ testing laboratory for the UM transplant program at Jackson Memorial Hospital.
A federal judge in Miami has ruled that a jury will decide which version of Lord’s firing is true in a trial scheduled for September 12. Earlier this month, District Judge Cecilia Altonaga denied the university’s motion to dismiss the case, mocking UM’s claims that the fired Medical School second-in-command lacked evidence to support his claim.
“An extensive analysis of the evidence reveals that these arguments are very weak,” Altonaga declared in his 40-page ruling. “Finally, this case must go to trial; or resolved amicably between the parties.
But so far there is no agreement, according to lawyers for Lord and UM.
After a decade of litigation, Lord’s wrongful termination claim will likely come down to the credibility of Shalala’s justification for firing him in early 2013.
“There are reasons to doubt his credibility; there are also reasons not to doubt her,” the judge said of Shalala’s testimony in a pre-trial statement. “But [UM] he knows well that the courts cannot declare a winner of credibility contests on summary judgment.”
Shalala, a former cabinet member in then-President Bill Clinton’s administration and a former federal lawmaker, is not listed as a defendant.
Lord already scored a legal victory last year when his False Claims Act case against the university resulted in a $22 million UM settlement with the Department of Justice to resolve civil allegations of inflated billing to Medicare by the drug lab. School pathology and other infractions. As a whistleblower, Lord received about $4 million from the settlement as a reward for bringing the lawsuit against his former employer.
Lord’s attorney, Jeffrey Sloman, said his client “is looking forward to having his day in court” over his firing, claiming he has suffered some $38.5 million in damages, including lost wages and benefits over the past decade. .
UM attorney Eric Isicoff said the university has no interest in settling before trial and disputed Lord’s damage claim.
“The university always intended to take this case to trial if the court denied its motion for summary judgment,” he said. “The denial simply means that there are questions of fact for the jury to resolve.”
When Lord was fired in January 2013, the veteran medical pathologist and administrator had been earning $914,000 a year as the number two executive at the UM School of Medicine. In a July 2012 letter to the dean of the Faculty of Medicine, Pascal Goldschmidt, he praised Lord’s leadership in driving “both fiscal and cultural change” of the entire university health network, known as UHealth.
In his lawsuit, Lord claims he was expelled just six months later because he discovered inflated Medicare claims for transplant testing services at the UM Department of Surgery and approved an independent audit of his dubious billing activity.
Lord alleges that Shalala ordered her firing after he informed her, Goldschmidt and the board of directors that the UM Department of Surgery was billing the federal Medicare insurance program for unnecessary organ transplant tests at Jackson, warnings that, as compliance officer at the School of Medicine, they should have “protected” him from being fired in retaliation, under federal law.
However, according to the former university president and other officials, Lord lost the trust of the UM hierarchy after making budget reductions and faculty layoffs, difficult decisions that were also supported by Goldschmidt and Shalala due to persistent financial problems. from UHealth.
running the curtain
Lord’s lawsuit, along with Judge Altonaga’s detailed ruling, offers a rare glimpse into the power struggles of a leading South Florida university and medical school, seeking national recognition while racking up debt and falling into conflict. with Medicare laws.
Lord was not only a UM-trained pathologist, but also a veteran hospital administrator. He was Chief Operating Officer of the American Hospital Association from 1997 to 1999, and in the following decade he was Chief Innovation Officer and Senior Vice President of Humana Inc., where he helped create a joint research center between Humana and UM.
In 2010, he returned to the university to help develop the Tissue Bank and later became the university’s Director of Innovation and Professor of Pathology in the School of Medicine. In March 2012, Lord was hired as Chief Operating Officer of UHealth, the hospital and clinic network of the Leonard M. Miller School of Medicine. He was tasked with multiple responsibilities including the budget, union negotiations, the joint operating agreement with Jackson Memorial Hospital, organizing the medical departments, and enforcing Medicare and Medicaid policies.
But Lord and the dean of the Goldschmidt School of Medicine also had to deal with mounting debts, leading to the layoff of some 900 full- and part-time workers in May 2012. Hundreds of doctors at the school called for their dismissal. in a petition to Shalala.
Lord soon discovered heightened tensions between UM’s Surgery and Pathology departments over lab tests of organs for the Jackson Transplant Institute. The department of surgery, led by veteran UM surgical oncologist Alan Livingstone, had taken over transplant testing services from the Department of Pathology years earlier, leading to a turf battle.
Lord and Goldschmidt discussed conducting an independent audit of the surgery department’s organ testing services and replacing Livingstone as director of the Miami Transplant Institute at Jackson.
Then, in September 2012, UM received an anonymous letter about transplant testing services that had been sent to the federal Department of Health and Human Services Office of Inspector General hotline. The letter detailed a scheme to commit “fraud” by overbilling Medicare for medically unnecessary transplant pathology tests, which the author likened to “organized crime” and a “strand of American greed.”
University leadership reported receipt of the anonymous letter to the inspector general’s office.
As head of Operations and Compliance for the university, Lord ordered an external audit with the support of Goldschmidt, as well as Shalala. In October 2012 he hired the Transplant Management Group consultancy. Two months later, TMG issued a preliminary report identifying that the Department of Surgery’s organ testing laboratory “engaged in duplicate billing” to Medicare and “engaged in improper, unnecessary, and redundant testing.”
Goldschmidt, Lord and other senior administrators concluded that TMG’s findings “raised serious concerns” about the Department of Surgery’s Medicare claims and ordered a full billing audit. Lord personally briefed Shalala on the consultant’s findings.
But in late December 2012, Shalala shut down the external audit and ordered UM auditors to take over the billing investigation. The UM president then ordered Goldschmidt to fire Lord.
“From these facts, a jury can infer that [Shalala] considered the potential liability for fraud of millions of dollars to the federal government to be a particularly unwelcome development,” Judge Altonaga said in her decision to deny UM’s motion to dismiss Lord’s case.
The judge then pointed out that Lord was not the only high-ranking UM official who faced potential retaliation. The director of the Compliance Department of the School of Medicine, Jennifer McCafferty. who had been hired by Lord, was moved to a “side” position in the chancellor’s office after she spoke with FBI agents about excessive billing practices at the UM organ testing lab.
“The university’s retaliatory treatment of McCafferty after he cooperated with the FBI investigation lends further support to that theory,” Altonaga wrote.
Criminal charges for Medicare fraud have never been filed against any person; however, the Justice Department ended up pursuing Lord’s false claims case against the university, which led to his $22 million settlement with the government.