Wiretapped

By Amy Heydlauff

When the budding relationship between a health care fraud investigator and her boss disintegrates, deception follows. Their parallel, uncoordinated investigations lead each of them from Detroit to Chicago and finally Washington D.C. before their paths finally cross again. By then both have picked up a nasty attitude toward the other and an entourage with countervailing agendas.

All profits from the sale of this book will be donated to Arbor Hospice, an organization providing comfort and support at the end-of-life for people with life-limiting conditions, and their families.

• Language: English
• Publisher: BookBaby
• Release date: Apr 30, 2013
• ISBN: 9781626756014

Book preview

by.

Meg Lawhorn & Jazz Johnson faced the mountain of ice chunks that formed a twelve-foot high range along the winter shore of Lake Superior.

I killed a man, Jazz.

You did the right thing. Hopping up and down, he was still unable to generate enough heat to overcome the frigid northwesterly wind. You know that, right?

I can’t say I’m sorry. But I have other regrets. She turned and looked at him. He stared at the icy piles blocking his view of the turbulent waters beyond.

He rubbed his crossed arms. It’s cold out here.

So, go in. She turned away from him. I’m not quite ready. I’ll follow you in a few minutes.

Stay on this side of the ice piles, Meg. Jazz jogged back toward the lodge. She waved assent without facing his retreating form.

Damn him. The wind tore the words from her mouth so quickly she wondered if she’d uttered them. She stepped slowly along the windswept beach. The cold crept in around her upturned collar and even in her Sorel boots her toes ached. She reached up with her mittened hand and massaged the end of her dripping nose.

The weekend party inside the lodge was in full swing but Meg needed time to decide how she would handle the emotion connected with Jazz’s unexpected appearance.

She reached up with both hands and held her collar tight around her neck, straightened and faced the wind. It took her breath away, searing her cheeks and flattening her outerwear against her frame. Resisting the force of it strengthened her resolve.

Later, naked except for a strategically placed towel, she stretched out on the cedar bench in the cedar-lined Finnish sauna. The mild, 120-degree temperature would climb significantly before she left the dark, woodsy smelling room.

Her eyes slipped closed, extremities warming in the stream of the melted snow dumped on the hot black, rose and speckled rocks collected from the shoreline. She surrendered to barely controlled consciousness. Acknowledging all the pieces of last summer, Meg abandoned her steadfast hold on the moment and allowed the heat to propel her to last July in Detroit.

Meg shared a Mexican dinner with her boss. He outlined her new assignment, the biggest of her short career as an undercover investigator.

Perfect Margarita. Meg sipped the drink, on the rocks, without salt, and glanced over the rim of the industrial-size glass at the folders spread out on the table. She set her drink down regretfully. So, what do we have, Jazz?

It’s impressive. In the last fiscal year Jack Young’s companies grossed 43.5 million, reported. His personal income for the same year was just over three million. Much of his lifestyle is supported by the company – cars, travel, entertainment—the usual. Hospital Billing Corporations right hand man, Linda Taylor…

Right-hand woman.

Either way, Linda Taylor makes about one and a half million. She also has a ten percent share in the company and profits. There is too much money floating around in an industry known for tight budgets and low profit margins. He picked up a chip from a basket on the table and dipped it in the fresh salsa. When he’d finished the chip he continued.

The bulk of the money is generated from Blue Cross, Medicaid, Medicare and private insurance claims billing. Jazz pointed to the heading on the report. Hospital Billing Corporation submits hospital bills to the insurance companies. Payments are made to the hospitals and the hospitals pay a percentage to HBC. He took another chip and continued. In Michigan, an additional five million dollars has been paid to hospital Medicaid accounts billed by HBC in the past six months. Young has contracts all over the country. The implications for state and federal budgets are staggering.

Meg whistled quietly. This looks promising. Will you order for me while I review these?

Sure. He watched intently as she bent to her work, wisps of curly reddish blonde hair falling forward around her face.

The waitress, seeing a lull in the conversation, came and took the order: quesadillas for Jazz and firecracker shrimp for Meg. She was still for two or three minutes, then she looked up, animated and excited.

This is huge. Why did the Attorney General pick me? Her chestnut brown eyes were glistening.

I told her you’re in a perfect position – in the industry, medical background, and smart. He leaned back. Besides, maybe Young’ll hire you because you’re energetic and pretty. The State maximizes every advantage. He smiled and dipped his head.

She broke into a grin, concentrating to quell a pleasant but unsettling deeper physical response to his praise. Tipping her head she stared intently. Jazz, this is big. Doesn’t the state want a more seasoned investigator?

He leaned toward her and spoke earnestly. I trust you, and I’m in charge of the day-to-day operations.

You won’t be sorry, Jazz. I’ll make sure this is done right.

Chapter 2

Early on Monday morning, after befriending a secretary, Meg spoke to Jack Young on the phone.

Hello, This is Jack.

Mr. Young, I am Meg Lawhorn. Young seemed to be trying to place the voice or name. Meg prompted his memory. We met in the lobby of the Michigan Hospital Association last Thursday.

Oh, yes. What can I do for you? His voice conveyed a smile.

Meg explained that she agreed with his points in the article he’d written for the Michigan Business News. The changes in health care would require aggressive billing if hospitals were to survive. She worked for a small competing company, T.J. & Associates, doing hospital revenue recovery, like his company, but for private insurance carriers. She paused.

Young responded. Thanks. Unfortunately, hospitals don’t always respond quickly. What can I do for you Ms… he paused to search his memory for her name.

Lawhorn.

Thanks, Ms. Lawhorn. What can I do for you, today.

I wonder if we could talk about working together. I…

I know your company and I doubt your company would have anything to offer HBC.

I’m not interested in working with my company. I’d like to work for you. She waited, feeling the knot in her stomach tighten, afraid of the half-expected rejection.

Let me be frank. There was a pause. I’m not interested in discussing the work my company does only to have you return to your company and share valuable information. Are you really interested in leaving your present position?

I never signed a non-compete agreement, and I’m not happy with the direction they’re going. The top brass isn’t knowledgeable enough to compete in the healthcare industry over the long haul.

"Most companies aren’t. He inhaled deeply.

Yours is. Everything I read indicates you are on the cutting edge. That’s where I want to be. If you aren’t interested in hiring me I will pursue work with another one of your more aggressive competitors. But, Mr. Young, I’d rather work for you.

Really? He paused, inhaling again. Well, then I’d like to meet you for breakfast in the morning. Say, 8:30 at Cassidy’s?

I’ll look forward to it. She hung up, pleased and knowing Jazz would be pleased, too.

Tuesday morning on the way to Cassidy’s Meg thought through her approach. By reputation, Jack Young was the life of the party. His balance sheet showed he was an astute businessman, but how astute? She knew the truth was her best weapon. She was a surprisingly bad liar for an undercover investigator. Still she was effective, living a role until she almost believed it herself.

When she arrived, Jack was seated under the lush green plants hanging in the atrium. The room was flooded with sunshine. He was wearing a short-sleeved denim shirt and she felt overdressed in her pale plaid, summer-weight wool suit.

He stood, pulled out her chair, and summoned a cup of coffee for her. A perfect gentleman.

Thank you for seeing me, Mr. Young. Meg nodded her thanks for assistance with her chair and made herself comfortable.

He sat down across from her, elbows on the table and arms crossed.

Please call me Jack. And may I call you Meg? I’m curious about your call. He looked her directly in the eye and asked again. Do you really intend to leave your current position?"

There would be no small talk. He was on a mission.

So was she.

Without question. If you don’t have a position for me I will look elsewhere. Any work I care to do with my current company I’ve already done. It’s become tedious. As I expressed in our brief phone conversation Monday, I don’t believe they’ll last through continuing healthcare reform – industry or government initiated. I want to work with a company that views reform as change and change as opportunity. Your reputation suggests HBC might be that kind of company.

She sat back. So did Jack. They looked at each other for at least a minute. His face gave no indication of what he was thinking. Finally she spoke again.

I have references. She wanted to control how he checked on her background.

He smiled, but continued to sit back in his chair and said nothing. He was irritating her. She hadn’t expected smugness. She leaned toward the table and added cream to her coffee, although she didn’t care for cream. The stirring gave her something to do. She needed an indication from him before she could continue. Finally he leaned forward.

Tell me what you do now. His voice was low and serious.

I’m an Auditing Director. And I’m a registered nurse. She looked up from the table. I travel from hospital to hospital managing our contracts. I started as a medical record auditor, but was promoted after three months. I’ve come as far as I can. There is one lateral move and only two men above me. Neither of them is going to let me in. She set her coffee cup down with a thump and sat back. I’m bored.

I don’t doubt it. What payers do you handle?

I know a great deal about private insurance. I recently became involved with a Blue Cross outpatient billing audit.

Have you ever worked with Medicaid or Medicare?

Meg smiled contemptuously. Jack, the men I work for are afraid of anything they don’t understand, which is most everything. They have no intention of broadening their billing services. All they know is ‘fee for service’ billing and that’s not enough.

Jack eyebrows were raised, and he seemed impressed. He laid an unlit cigarette in the ashtray next to his coffee cup.

You’re right. Fee for service billing has outlived its usefulness and is all but dead. Insurance companies won’t pay for care just because the doctor ordered it. And government payers aren’t interested in fee for service, anymore.

Meg spoke again. I can learn anything. I’m a quick study and I’m anxious for a challenge. I need a mentor. She looked at him and her face softened.

Jack returned her gaze, forehead wrinkled in thought. Abruptly he nodded his head once as if responding to a question he had posed to himself silently. Pushing his coffee and ashtray aside he replaced them with his crossed forearms and began to speak to Meg energetically.

I have no intention of giving anyone information on my latest, and probably greatest, billing project, unless they work for me. Your open approach impresses me, and I need some help implementing the project. He looked directly at her, speaking firmly. "If you come to work for me you will sign a non-compete contract and other legal restraints as well. And, I will enforce them."

She nodded.

Meg, I don’t care about your references. I generally hire on instinct and it rarely fails me.

She nodded again.

I’m planning to start a new company. This company will just do Medicare billing. If you are interested, you can be the Chief Operating Officer. That means I will expect you to run it, once I’m sure you’re ready. We will incorporate and I will keep 80% of the stock. My stock will be split between my wife Wendy and me. The COO and CFO of HBC will each control five percent and I will give you ten percent. Your starting salary will be $150,000 plus annual profit splits. You will have an expense account and a car. You’ll work hard, but it will be worth it. He picked up his cigarette and rolled it between his fingers. What do you say? He was smiling again. He knew what she would say.

She was speechless. She felt her cheeks flush and looked at the table to conceal her confusion. She was out of her league and loving it. Concentrating to control the muscles in her face, she looked up and said I can start Monday.

Jazz didn’t think it was logical.

Meg offered references and Young didn’t even pick them up from the table. What kind of executive hired someone without a background check? Without consulting his partners? And with an annual salary of $150,000? What if he didn’t check her references because he already knew who she was? But how could he know? Jazz stood up from his desk, closed the file and walked to his window.

Jazz’s office was in a strip mall. The traffic was incessant and the area was run down. Most of the block consisted of businesses, a third of which were boarded up. Other businesses, like convenience stores, sold their products at inflated prices knowing the neighborhood occupants lacked transportation. They were captive consumers. In return the owners of the shops kept bars over their windows and guns under the counter. In many ways each victimized the other.

Jazz was a chief inspector. He directed operations investigating fraud and abuse of state-funded healthcare programs, primarily Medicaid. This office had been established to manage Southeastern Michigan, a small but fertile area in fraud and abuse investigation. Most of the work consisted of investigating physicians who billed clients for care never rendered. In such cases undercover investigators went in as patients. Investigators also used computer programs to track fees and procedures according to specialty. If a provider – clinic or doctor – didn’t fit the profile for the specialty, an investigation was triggered.

Jazz’s refined and professional approach to investigation was considered a reform. The old guys were cowboys, bursting into buildings and yelling at people to stay where you are! Jazz knew that dishonest providers and their lawyers had become more sophisticated and that investigators needed new techniques – including deceit. Jazz struggled with the end justifying the means. Deep within him a gnawing sense of betrayal of his own values threatened to chew through to his consciousness. Could he justify any means if it served the greater good of the people of his state? His parents railed against government intervention in areas like business and education. They believed government should control defense, currency and interstate commerce. After that, people should be left to make their own decisions; then be expected to live with the consequences, good or bad. The national application of the tough love theory.

He looked around his new office. He had been here two months, initially hoping it would be temporary space. Yesterday he had been informed they would be staying indefinitely. At least he was going to repaint and bring a few pieces of his Native American art. He pulled out a requisition and began shopping with the taxpayer’s money. Nothing to extravagant: a decent desk, one comfortable chair for visitors, and carpeting.

The phone rang. The state attorney general, Joann Schiller, greeted him cordially.

Jazz. How’s my most promising chief inspector? She didn’t wait for an answer. We sent a press release to the Detroit news outlets and business websites. The governor wants the public to know how hard we’re working to stop healthcare billing crimes. In two or three weeks we want to make a statewide announcement of an indictment. I expect you’ll have one for us.

Exasperated, Jazz responded.

If we uncover fraud there will be indictments. I can promise no more. Are we indicting just anyone or do we want someone who is actually breaking the law? Jazz challenged, then conceded. Meg Lawhorn is inside HBC. She started this morning. Jazz didn’t always like Joann’s tactics, but he acknowledged that her goals and expectations were clear.

Joann responded dramatically. I knew I could count on you, Jazz. Terrific. Meg had made a name for herself in the department. She was unpretentious, smart, and remarkably believable as an undercover. Still, Jazz knew Joann didn’t particularly like her. Meg’s wholesome demeanor contrasted sharply with Joann’s businesslike sophistication and occasional sophisticated flirtation.

Call me as soon as she uncovers anything. This is a priority, Jazz.

Of course. I’ll be in touch soon. He hung up.

Jazz turned his attention to a case of a laboratory charging for blood tests they hadn’t actually done. Tomorrow he would get a search warrant and take his team into the lab’s home office and secure all the records and computer files.

Chapter 3

Joann Schiller needed quick action. Her best bet was Jazz Johnson. Thorough, efficient, productive – everything you could want in a subordinate. If she could temper his virtue he’d be perfect. She twisted to and fro in her leather office chair, carefully tapping a solon-applied nail on the arm of her chair. She considered her options.

If Jazz Johnson indicted Young, charges would stick. No one, including Young’s attorneys, could prove the investigation had been bungled. Johnson wouldn’t vie for credit in this huge case with national implications, so she could take virtually all of it.

Alternatively, Johnson wouldn’t recommend indictment until he was sure the case was airtight. Most irritating when you’re in a hurry. Her directives had been clear. A huge indictment by the middle of August. No holds barred. And Young looked like a very real possibility.

Joann sat forward, leaning over her spotless desk, rubbing her temples. People she wanted to impress in Washington thought an arrest was imminent. Joann’s tenacity in cases of fraud and abuse had earned her a wicked reputation. Hated by defense attorneys, she knew the bureaucracy adored her. The continuum from right to left wing extolled her indictments and prosecutions, claiming her as their own. She was a zealot, and rarely proceeded without a plan. Today she was determined to see what Jazz Johnson could offer within 21 days. That would leave much of August for an alternative plan, if necessary. The remaining days would not be a great deal of time, but she could think of some justifiable shortcuts. And, Mark Smith would step up if she needed assistance.

She leaned back, visibly relaxing. Joann’s thoughts turned to her old friend, Mark Smith. Early in her career she’d worked in Lansing as a prosecutor for the state attorney general. That’s where she met Mark. He was a powerful player in Washington. As Chairman of the Senate Finance Committee, and with 17 years of political experience and Washington connections, he carried a lot of clout. She’d been an astute pupil and he became an eager mentor. She was also aware her rapid climb to state attorney general was rumored to be a result of his powerful influence, brokered by Joann’s seduction of the willing senator. She didn’t deny it. In her experience, most men could be controlled with sex. It was one of the things in life that truly amused her.

Senator Smith’s latest focus was fighting white-collar crime and corporate greed; particularly health care related. He and the current governor wanted their reelection bids to rest on it. Recently Joann met with Mark. The current idea was big, with potential for greater things to come, he explained. He would have been surprised to hear she was already familiar with the plan.

She relived the conversation, picturing herself sitting in the wicker couch on the verandah of his Harbor Springs summer home, sipping champagne and watching the sunset over Lake Michigan. A smile slowly played across her face. Her veiled power was the aphrodisiac in her relationship with Mark – another piece of information that would surprise him.

Targeting white collar greed is important at the federal level too, Joann. He stroked the back of her neck and ran his hand slowly through her hair. If you can get a major healthcare indictment sometime this summer we can use it to get me reelected in the fall. And there’s something in it for you, too.

She took another sip, then slowly let her head fall back with the gentle teasing of her hair. He kissed the front of her neck, then sat back.

Someone important is concerned about the difficulty the FBI and federal prosecutors have getting Title III wiretaps and wireless searches approved for domestic cases. They have to be approved by the Justice Department unless it’s a foreign threat that can be approved by the National Security Administration. Even if wiretaps are approved, occasionally federal district court judges throw them out at the local level. Violation of civil rights.

She shifted to face him as if eager for more information. He continued.

The Justice Department can count on some judges to uphold the orders. We need someone in a position to recognize judges who cooperate and consistently allow results of searches and taps in their courtrooms. Judges like Fretenbaugh and several others in Detroit. Usually the cases are against gangs, organized crime, or suspected terrorists. He paused and looked her in the eye. If you break something big later this summer, it will pave the way for your appointment to the Office of Intelligence Policy and Review. You’ll have the power to review and approve all FBI surveillance requests.

At the Justice Department? She sat up straight, eyes shining like a child whose parents just said Disney World. The Justice Department? she repeated, as if it were more than she could take in. Mark laughed and grasped her around the waist.

You’re beautiful when raw ambition plays across your face.

Joann pulled herself from her daydream. HBC had been identified as her shot at the big leagues. Jack Young and his companies were ripe for the picking. Once the national press was fed the story she would be catapulted to the Justice Department. It was a masterful plan and Jack Young was a meaningless sacrifice.

Chapter 4

On Monday morning, before Meg arrived, Jack sat at his desk, rocking in his usual way. He was restless, driven by an unidentified source of energy. He was thinking about Meg. She might be just the injection of life HBC needed. Jumping up from his chair he swiftly left his office and walked down the hall and into Bryan Bennett’s office. The Chief Financial Officer of HBC was on the phone.

… It has been my pleasure. I’ll look forward to receiving the contract later this week. Thank you Maria. Bryan hung up the phone.

Jack smiled, more to himself than Bryan. Bryan knew his numbers. He was a CPA and understood tax laws as well as any CPA Jack ever worked with. Bryan impressed clients with his prematurely graying hair and warm, dark good looks. It was rare the ladies didn’t watch him overtly when he entered and left a room. He was good for public relations, likable and seductive.

But, Bryan was timid. Not with people but with life. Change frightened him and Jack didn’t respect his reticence. Jack sat in the leather wingback chair next to Bryan’s door, throwing his leg over the arm, noting again the contrast between Bryan’s elegantly furnished office and his own sparsely outfitted, functional office. As always, Jack addressed Bryan as an equal and important part of the business they seemingly ran together.

I’m excited about Lawhorn running the Medicare project. It’s growing fast, and Linda isn’t inclined to deal with it.

Linda doesn’t have time, Jack.

I realize that. He was tired of Bryan and Linda making excuses for each other. They’d lost their edge somewhere along the way. Maybe this Lawhorn woman would be hungry like Linda used to be. Like Jack still was. That’s why I hired someone new. I think you’ll like her.

Did you have to cut her in before we know if she’s any good?

I offered you a percentage when you started. Jack stood, masking his irritation. She was involved in revenue recovery with her previous company. She has experience and that’s worth something to me. He turned to the door. Bryan stopped him.

Are you sure she isn’t trying to get information for them?

I can’t be sure. He looked over his shoulder. I don’t think so, but we’ll watch her carefully if that will make you feel better.

Jack went to his office at the end of the hall. The south and west walls were windows overlooking the Detroit River, and most of the ‘renaissance’ of the city, and Canada. Jack was proud of the fact his offices spanned the entire thirtieth and top floor of the building formerly referred to as the Rust Bucket. Many of the old buildings in Detroit had succumbed to the wrecking ball. For whatever reason, Jacob Goldman, the man who owned much of the valuable real estate in and around Detroit as well as other cities nationwide, had decided this building should stay. He dumped millions into renovation. No expense was spared in the common areas of the building. Most of the office space was decorated to suit individual wealthy clients.

Jack leased the space on the top floor, insisting on standard drywall. Three dozen employees shuffled hospital accounts from ‘unbilled to billed" piles in the large central room where each occupied a computer workstation. The far north end of the suite contained a large office for the sales and support personnel and a staff lounge. South of the workroom a long hall ended at the conference room. Right of the hall, internal offices ran the length. Jack’s office was the last of three executive offices along the left side of the hall.

Jack Young and his group of companies managed insurance billing for hospitals around the country. Hospital Billing Corporation was the parent company. Disability Billing Corporation, housed in Chicago, analyzed unpaid claims and medical records to see if patients qualified for social security or Medicaid disability coverage. The third company was a collection company. Unpaid claims, generally for balances not covered by insurance, were sent to Billing and Collection Corporation by hospitals hoping to realize part of the payment due by the patient. BCC was on the twelfth floor of the Goldman building. In the large, single room employees with only desks, phones, computers and files aggressively sought payment for hospital clients.

Today Jack would start a fourth corporation. The new company’s purpose would be to evaluate medical records and bills of Medicare patients taken to surgery. It was highly specialized. Jack had discovered some exciting facts about surgery and recovery room billing. They seemed so obvious, yet they had gone unnoticed for years. Millions, maybe eventually billions of dollars had gone unclaimed because of a missed – or misunderstood – billing regulation. The thought of it made Jack’s pulse race.

He was nearly forty, an average-size man, fit and trim, with long legs. His rugged face was lined from sun exposure and heavy smoking. He smiled perpetually. There was an underlying appeal, probably more related to his dynamic attitude than his general good looks. His manner of dress was unorthodox for corporate America. He only wore a suit when business required. He preferred jeans and soft, comfortable shirts.

He was astute. He reviewed the Federal Register’s weekly releases on the national website. He watched clients and competitors intensely when they spoke and read every industry publication. He and his wife, Wendy, entertained lavishly, inviting attorneys, politicians, and professors knowledgeable in healthcare policy. He knew his industry absolutely. People liked him, and he had a way of making others feel valuable. Colleagues rarely detected his impatience with slow wit and mundane conversation.

He was especially well liked by his office staff. From the receptionist to the office manager, he talked to each individual as if they were the piece that made the company run. In truth, he liked most of them better than the executives and policymakers with whom he generally associated. His staff was made up of nice people. They wanted to please him by doing a good job.

He picked up the phone and called his wife. The answering machine clicked on. This is Wendy Young. We are unable to come to the phone. Please leave a message.

Jack was brief. "Hi Babe, it’s me. I won’t be able to get home