Workers Testify That Hospital Interfered In Medical Billing

Dr. Tariq Mahmood routinely ducked into the billing-code office of his Renaissance Hospital Terrell to insist that other doctors’ patient diagnoses be altered to reflect more expensive treatments, a former employee testified Monday.

After Norma Longley balked, according to her testimony, she later discovered her codes for Medicare reimbursements were being altered at another facility.

Another coder, Cynthia Kennemer Plumlee, testified that she was fired soon after she refused to allow Mahmood to be “involved’’ in reviewing the codes, saying it would have been a serious breach of professional ethics.

On the first day of Mahmood’s federal trial on charges that he conspired to defraud Medicare by submitting $1.1 million in bogus claims for his troubled hospital chain, the two former employees portrayed him as pushing the boundaries on ethical practices far beyond what they had ever seen in their combined 40 years experience in hospitals.

Mahmood’s attorney, Michael Khouri, didn’t specifically address their accusations. But he repeatedly emphasized during questioning that it’s not unusual for hospitals to try to “maximize profits’’ through the reimbursement process.

Mahmood sat motionless for most of the day’s testimony, rarely speaking to his attorney and at times appearing to struggle to keep his eyes open. The Dallas businessman’s hospitals are at the center of multiple investigations for patient care failures and questionable financial dealings.

He is accused in indictments of directing employees to alter underlying diagnostic information in insurance billing claims. “In many cases,’’ the indictment alleges, “these were for patients he had never seen.’’ Authorities also say he stole patients’ identities to carry out his billing scheme.

Longley was a billing coder for the Baylor Health System before she joined Renaissance in 2008 shortly after Mahmood purchased the hospital. She testified that professional guidelines require her to base her codes for insurance bills strictly on the attending physicians’ documented diagnoses.

Yet Mahmood began frequently visiting her office asking her to change codes to reflect patient conditions of greater “severity’’ or that would pay “significantly higher,’’ she said. Her response to him, she testified: “If it was in the [attending physicians’] documentation, I could code it’’ that way.

At one point, Mahmood pressed her again, instructing her to “ask the physicians” to change the billing documentation, because “they would write whatever he wanted them to write.’’ Then he asked her to begin faxing all of her codes daily to another facility. Mahmood began centralizing all billing functions at his Central Texas Hospital in Cameron.

Longley said she began receiving regular notices from government auditors alerting her that billings for Renaissance treatments were riddled with mistakes. Baffled, she re-examined her documentation and found it was coded correctly as the auditor said it should be.

“This signified that someone went into the system and changed or altered codes,’’ she said.

Plumlee testified that when she worked at Renaissance in 2008, at least twice she observed Mahmood reviewing personal medical records. She said he also asked her to bring him into the coding process, but she refused. In 28 years as a coder no hospital owner or executive had ever asked to be a part of that process, she said.

Soon afterward, “I was relieved of my duties,’’ Plumlee said.

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