Becker's Hospital Review

47 47 CEO/STRATEGY Nurse collects $6M in whistle-blower lawsuits against Banner, Christus and Renown Health By Ayla Ellison O ver the past decade, Cecilia Guar- diola, RN, has filed whistle-blower lawsuits against hospitals that have employed her in Texas, Nevada and Arizona, and those facilities have paid nearly $33 mil- lion to the federal government to settle those cases, according to e Republic. Ms. Guardiola, a law school graduate, filed the cases under the qui tam provisions of the False Claims Act on behalf of the govern- ment. If these types of lawsuits are successful, the whistle-blower collects part of the recov- ery. Ms. Guardiola has collected $6 million from settlements in the three lawsuits she filed, according to the report. All three of the lawsuits brought by Ms. Guar- diola allege hospitals charged Medicare and Medicaid for inpatient stays when the visits should have been billed as less costly outpa- tient care. In 2008, Ms. Guardiola sued Christus Health in Corpus Christi, Texas. She claimed that while working as director of case manage- ment at Christus, she discovered patients un- dergoing a cardiac blockage removal proce- dure were routinely billed as inpatient when they should have been billed as outpatient. She alleged top hospital executives ignored her concerns about the billing issue before she resigned from Christus in 2007. About four years aer Ms. Guardiola filed the lawsuit, Christus settled with the Department of Justice for $5.1 million. Ms. Guardiola col- lected $1.02 million from the settlement, ac- cording to the report. Ms. Guardiola was named director of clin- ical documentation at Reno, Nev.-based Renown Health in June 2009. She resigned in January 2012 and filed a qui tam law- suit against Renown that same year. Ms. Guardiola claimed she faced "cultural and systemic resistance" from management af- ter she alleged Renown was overcharging Medicare. Renown agreed to settle the false claims allegations in June 2016 for $9.5 mil- lion. Ms. Guardiola collected $1.7 million from the settlement. Ms. Guardiola began working at Phoe- nix-based Banner Health in October 2012 as director of corporate documentation. She resigned three months later and filed a qui tam suit against Banner. In April, Ban- ner agreed to pay the federal government more than $18 million to resolve allegations that 12 of its hospitals in Arizona and Colo- rado submitted false claims to Medicare. Ms. Guardiola will be paid $3.3 million of that settlement, according to the report. Due to her history of filing whistle-blower lawsuits, Ms. Guardiola is "virtually unem- ployable," Mitch Kreindler, an attorney who has represented her, told e Republic. "She was always someone whose resume was hot- ly sought-aer. Now, aer maybe an initial phone interview, once they start doing their background checks, the communications dry up quickly." n Nurse awarded $28M in retaliation suit against Brigham and Women's Hospital By Ayla Ellison A jury awarded a Haitian-American nurse $28 million May 23 in a lawsuit against Boston-based Brigham and Women's Hospital alleging discrimination and retaliation, according to the The Boston Globe. Gessy Toussaint, RN, sued Brigham and Women's and three of its managers in 2014. Ms. Toussaint alleged she stuck up for another Haitian-American nurse who she be- lieved was the victim of verbal abuse by a physician. After that, the hospital allegedly retaliated against Ms. Toussaint by investigating her for several instances of allegedly poor patient care. Ms. Toussaint further claimed she was subject- ed to discriminatory action by the hospital, according to the report. Ms. Toussaint resigned from Brigham and Women's in 2015 after working there for 15 years. On May 23, after more than three days of deliberation, a Suffolk Superior Court jury agreed that the hospital and one of its managers were guilty of retaliation against Ms. Toussaint. However, the jury said Ms. Toussaint failed to prove race discrimination. The jury awarded Ms. Toussaint $28 million, the vast major- ity of which was for punitive damages. "This is a monumental verdict, and it really shows the jury was outraged at the treatment of this lifelong nurse," Al- lison MacLellan, Ms. Toussaint's attorney, told The Boston Globe. It's "sending a message to the Brigham and other institutions that retaliating against someone for standing up for what's right won't be tolerated." Brigham and Women's and the manager plan to appeal. "While it is gratifying that the jury found no evidence of racial discrimination in this case, we strongly disagree with the finding of retaliation and intend to pursue all legal avenues to appeal this verdict," a Brigham and Women's spokesperson said in a statement to The Boston Globe. Ms. Toussaint and her Haitian-American colleague Nirva Berthold, MSN, RN, filed a joint lawsuit against the hos- pital, but Ms. Toussaint's claims went to trial first. Ms. Berthold still works as a care coordinator at Brigham and Women's. n

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