EAST ST. LOUIS - A former nurse practitioner with SSM Health Care claims she was instructed to bill for services that were traditionally a offered for free.
Carol Clark-Kutscher filed a federal lawsuit on Nov. 17 in the District Court for the Southern District of Illinois against SSM Health Care Corporation.
The lawsuit alleges retaliation in violation of the False Claims Act 3730 and retaliation in violation of Section 20 of the Illinois Whistleblower Act 740 ILCS 174/20.
According to the complaint, Clark-Kutscher worked for SSM Health Care Corporation as a nurse practitioner (NP) with job duties that included diagnosing patients, reading lab results, writing prescriptions and billing Medicare. SSM assigned coder Debra Wilkins to Clark-Kutscher to assist with billing and ensure compliance with regulations.
After the COVID-19 outbreak, Clark-Kutscher’s main role became handling advance directives, which involves explaining likely outcomes to family members of SSM patients and helping families make complex, end-of-life decisions; a free service offered by SSM. Clark-Kutscher alleges she was told by her supervisor to bill Medicare for the services, which was immediately stopped upon the discovery of Wilkins. The supervisor also instructed Clark-Kutscher to do phone calls for consultations requiring personal contact due to lack of PPE. In a later meeting, Clark-Kutscher alleges that her supervisor once again instructed her to bill for advance directive and any other way possible as that was how SSM made its money. Clark-Kutscher refused, knowing to do so was illegal, the suit states.
The supervisor allegedly instructed Clark-Kutscher to improperly bill Medicare six or seven times following the meeting. Each time Clark-Kutscher claims she refused and forwarded the email to Wilkins. In response, the supervisor allegedly issued a pretextual corrective action. On Oct. 9, 2020, SSM issued Clark-Kutscher a final corrective action and terminated her employment, the suit states.
Clark-Kutscher seeks reinstatement, two times the amount of back pay, interest on back pay, special damages sustained as a result of the discrimination, litigation costs and attorney’s fees. Clark-Kutscher is represented by Scott Oswald of The Employment Law Group PC in Washington, D.C.
U.S. District Court case number 3:21-cv-1446