Bob McCaslin is a patient account representative at the Hospital District, and noticed that his agency was improperly billing Medicare and Medicaid for treatment of car wreck victims who should have been covered by private auto insurance.
"What's required is that when there's an automobile accident and there's a third-party potential payer, that the hospital pursue the third party first before filing against Medicare. And we were doing that just the opposite. And that was the practice there and had been for several years."
McCaslin took his concern up the management chain.
"And I was just told that I was mistaken, that the regulations weren't enforced, that I was mistaken about the regulations, that...and that's just the way they did it and they hadn't had any problem with it, so..."
McCaslin filed a whistleblower lawsuit in federal court. Mitch Kriendler is McCaslin's attorney.
"To some extent this really is a textbook False Claims Act whistleblower case. Mr. McCaslin did all the right things before filing the suit. He wasn't a guy who said 'Ooh, I can make some money, I'm gonna go file a lawsuit.' His interest was really getting the bad conduct corrected and prevent taxpayers from being ripped off. So he did what an employee should do."
The Hospital District settlement with the government requires it to pay back $10 million for unjustified billings and a $5 million penalty.
"The District deserves some credit here because initially, of course, they took the position that the allegations were incorrect. and they took that position based on the information that Mr. McCaslin's supervisors were giving them. Well, it became clearer to people higher up the chain that indeed, these managers were incorrect, that they were doing it the way they'd always done it 'because that was the way we always did it,' so those people ended up being removed from their positions."
As the government investigated, McCaslin was able to continue working at the Hospital District in relative anonymity because court actions of this type are under seal. He still works in that same office.
"Well, I'm glad I did it. It's something I had to do just from an ethical point of view. I just couldn't let it go by because it was just flat wrong. I just couldn't participate in it. My co-workers are mostly supportive. At the next level of supervision, there are a couple of people that made a couple snide remarks. They referred to me, you know, as a troublemaker or a snitch or whatever."
McCaslin says he'll be paying off all his bills. Ed Mayberry, Houston Public Radio News.