The Upside of Bad News

Other than maybe on Christmas day, I never pour myself a shot of whiskey in the morning. But I did that morning. I had three shots, actually. The first one I sipped in a gentlemanly fashion. The other two I downed like I was sitting on a stool at McGovern’s Tavern, a downtown Newark landmark.   

That first one was a celebration. I got a call from my only child, my son, Tucker. “Yo, Dad, you’re a grandfather!”

“How about that! And you’re a dad.” I was thrilled for my son. For years, doctors told Tucker and his wife they couldn’t have children. I was over the moon, really. I always regretted not having more children. “Boy or girl?” I asked.

“It’s a boy. We’re naming him James, after you, another James Garvey.” So, on a rainy September morning, I filled a shot glass with the best Bourbon I had. I was savoring the whiskey almost as much as the good news, taking in both, slowly to maximum effect. Tucker texted me a photo of the little guy too. My thoughts that morning. I never spent enough time with Tucker when he was a kid. Too busy building my business. I wanted a do over. Now there was James, not with us even an hour yet, I knew he was destined for great things. Would he wear a Yankee uniform? Was he a future captain of industry? I refused to picture him in politics, no glory to be had there, but the Pope, some sixty plus years from now? Well, I liked that too.   

The phone rang again. Life is funny, maybe more so when we’re riding the crest of a wave and not the least bit prepared for the undertow. “Jimmy, you better get down here right away.” It was Walter.

“What’s up, Walt?”

“FBI, they’re all over the place. They’re taking file cabinets and pulling computers off desks.”

I own a specialty pharmacy that compounds drugs, the kind that treat asthma and other respiratory diseases. I make them for hospitals and homecare companies. We also offer a billing service for some of them, mostly Medicare claims. “Did they say what they are looking for?”

“I asked.” Walter is my operations chief, in charge when I’m not around.  “But, you know, they didn’t say much. They had a subpoena. Anyway, do you know what this is about?”

“Has to be the Medicare billing thing.”

“Oh, man, that’s what I was afraid of. You think they got something, Jimmy?” Walter asked. “They’re shutting us down man, pending the outcome of their investigation.”          

“Come over to the house when you get everybody calmed down. See if you can get a few of our folks to tidy up the place after the FBI people leave,” I said. “Oh, and call our customers so they can make other arrangements to get their meds.”

“I’ve already made a couple of calls,” Walter said. “Really, Jimmy, are we in trouble here?”

“I can’t see why. But we shouldn’t discuss this over the phone.”

“Right, okay. I should be there by noon.”

That’s when I poured the other shots. I wanted to drink right out of the bottle, but I had to be able to think about what I should do next. I would put a call into my attorney, of course, and I knew what she would say. I had a good idea of what the FBI was looking for. They must have had reason to believe we were filing false claims, billing Medicare for services our customers didn’t provide.

But when it came to Medicare, we were strictly a billing service. We didn’t have any patients, not one. We made medications that our customers gave to their patients. Our only connection to Medicare was billing them for the services our clients said they provided. Was the FBI investigating one of our customers too? No doubt.

I believed we were clean, but I was worried. We had the required compliance programs in place. As far as I knew, we followed the guidelines properly, checking for a valid prescription, a certificate of medical necessity signed by the doctor, and proof that the product was actually delivered to the patient.

Of course, there’s always a chance that one of our customers was dummying up claims. These documents can be faked, signatures forged. While I was confident we would be cleared of any wrongdoing, we could still be held criminally liable if somebody on our staff was playing games, or wasn’t doing their job diligently.  

Walter got to the house 45 minutes later. He looked like a guy who had run rather than driven the 14 miles to the house. Beads of sweat covered his bald head and he was breathing hard. I was worried about him. I poured him a shot and handed it to him. He knocked it back and held his glass out for another. I complied. “Listen Walt, we need to focus on one thing here. Have we been verifying that every claim was legit before we bill it?”

“I think so, Jimmy, but Lois is the one you have to ask. That’s her department.”

Now I was really worried. Lois, our compliance officer, reported to Walter. His answer told me he was assuming she did her job. He wasn’t checking her work. If she wasn’t following the plan to the letter, if she was letting undocumented claims go through, we might be in trouble.

Some of this was my fault. I had become an absentee owner, more or less. We were making a lot of money. Everything was going really well and Walter was a very good manager. I had grown comfortable spending more time on the tennis court than in the office. Regular exercise and a low carb diet kept me looking fit.

“Was Lois in the office today?”

Walter shook his head. “She’s in the Cayman Islands for two weeks. She won’t be back until the first of the month.”

“How can a single mother with three kids afford to go to the Cayman Islands for two weeks? Where’s she staying?” I reached for the bourbon, but thought better of it.

Walter removed his glasses and rubbed his bearded face hard. He covered it. “The Ritz Carlton.”

I looked at him, not wanting to believe what I was hearing. I Googled the hotel number and called. There was no answer in her room so I left a message. “You think she might have screwed us?” Walter asked.

“Do I think one of our customers paid her to look the other way? It’s possible Walt, but I doubt it. I’ve known Lois for, how long now, seven years? I can’t believe she would ever do something like this.” I had indeed known Lois a long time. Six months after I hired her we started seeing each other.

Tall, and winsome, I found her dark Mediterranean features intriguing. She was separated and I was divorced. We were together for about a year. Then she decided to give her marriage one last shot, something I wholeheartedly encouraged. She had three daughters, all under the age of ten. I was quite fond of them, but felt they needed their father. We ended things on good terms. By the time her reconciliation ended, I was seeing someone else, a woman who’s name I can’t now remember.  

My phone rang. It was the FBI. “This is Special Agent Duncan. We need you to come to our office. Can you be here by two o’clock?”

“I’ll have my attorney, Kathleen Nora, get in touch with you Agent Duncan.  She’ll set up a convenient time.”

“You do that,” he said. “I hope you can explain some things. Just a quick look at your claims documentation indicates you are in serious trouble. In my experience, sir, a delay doesn’t work in your favor.”

“I’ll mention that to my lawyer,” I said.

Walter and I decided to grab lunch while we waited for Lois to return my call. We speculated on whether she had taken a wrong turn. I asked Walter a pointed question. “When was the last time you actually audited some files?”

“It’s been a while,” he said. Walter had been working for me for a dozen years.

As I said, he was an excellent manager. When I responded with a stare, he offered more. “At least a year, maybe more.”

“When was the last compliance team meeting?”

“I’m not sure, but I know you were there.”

That would have been at least 18 months ago, probably longer. We were at Rutt’s Hut in Clifton. We both ordered two, all the way, same as always. The place is famous for its hot dogs. We ate our food without talking. Walter would probably have preferred to be anywhere but with me. No doubt he was struggling mightily with guilt. He should have checked the claims. Too much was at stake not to be conscientious.

As I was about to take my last bite of hotdog, Lois called. “I haven’t heard from you in months, Jimmy. This better be important. I’m getting a tan that’s even better than the time we went to Key West.”

“Sorry, Lois, but this is urgent,” I said. “There’s no gentle way to broach this subject. The FBI shut us down this morning. They are going to want to talk to everybody.”

“Why us? We don’t get any money from Medicare. We just bill for our providers. I check every claim. The documentation is all there, I swear, Jimmy.”

I waited a bit before responding. I learned a long time ago that guilty people will usually add something if they suspect you don’t believe them. Lois didn’t say a word. “Lois, I probably ruined your vacation. I’m sorry about that, but if the Feds are right about this, somebody destroyed my business.”

“Should I come home?” she asked.

“I’ll let you know.”

I turned to Walter and filled him in. “What do you think?”

“If the billing is bad, it has to be her,” he said. “If one or two billers were doing it, and Lois is telling the truth, I’m sure she would have caught it.”

I knew there was another possibility, but I wasn’t ready to discuss it with Walter.
“We better go back to the office and clean up any loose ends. I need to speak with Tony about our finances going forward.” Tony was our chief financial officer. I found him in his office working on exactly what I needed to know. Lucky for me I owned the building, but there would still be bills to be paid.

“Your reserves are solid,” Tony said, “but with no revenue coming in, we’re in for a rough ride, sorry.” I felt obligated to pay the staff for a while at least. It would be months before I could open the doors again. If it took too long, my employees would move on and pharmacists especially, were at a premium.  I had to face facts. I could be out of business.

A week later my attorney and I met with the FBI. “We have an airtight case,” Agent Duncan said. “I have hundreds and probably thousands of claims you processed with insufficient, or suspicious documentation. And the Medicare numbers of some of your patients are questionable to say the least.”  

“What about our customers, the hospitals and homecare people, are you investigating any of them?”

“That’s where we started, Mr. Garvey. The provider in question, South Mountain Healthcare, is cooperating fully with the investigation,” he said.  

“How long has it been going on,” my attorney asked.

“We think about a year, maybe a little less, like nine months or so. If our projections are correct, we’re looking at least $650,000 in fraudulently billed Medicare claims.”

Agent Duncan looked at me. “Anything you want to tell us?”

“He has nothing to say,” my attorney said.

“Except I didn’t do this,” I added. Kathleen gave me a cold stare. She specifically warned me to say as little as possible. If I was caught lying to an FBI agent, I could be charged with perjury too.

That night my son Tucker stopped by with his wife and baby James. I had managed to see him the day he was born for a few minutes. In just a week’s time, he looked to me like he had already grown. I had been busy, desperately trying to figure out what happened. I went to the office every day. I managed to salvage our supply of pharmaceutical compounding ingredients, selling them to competitors. I was exhausted. Being so busy, I didn’t even have time to go out and buy a baby gift. So I took my son’s family shopping.

Tucker didn’t ask many questions, but he knew what was going on, of course. Everyone did. My little company made the nightly news and the local papers. It comes as quite a shock to suddenly discover that your livelihood and your reputation can be devastated simply because you may have done something wrong. We are not presumed innocent. People assume the opposite. Even if it turns out you didn’t break the law, the stain is permanent.

We live in a world where reputations are held cheap. Maybe a celebrity can make the rounds, express their pain and sorrow on talk shows, (or brazen it out) and emerge seemingly whole, but it doesn’t work like that for guys like me. And I was innocent.

Whatever happened in our billing office happened because someone got greedy; they did a foolish thing and brought everyone down. If I was guilty of anything it was trusting the wrong people. But in the middle of the night when I couldn’t sleep, I could not wrestle away the fact that I was also guilty of neglect. I should have been at work.

After a $500-dollar shopping trip at the mall, Tucker drove me home. It was dark by then so I didn’t see Lois sitting on my front porch until I was half-way up the walk. She was shivering in the early fall, cool air. I hadn’t heard from her since the call I made ten days ago. “You cut short your vacation?” I asked

“Only one day. I was afraid there would be crime scene tape surrounding your house,” she said.

“No, but I’ve been haunted by thoughts of doing the perp walk in handcuffs,” I said.

“Jimmy, I’m so sorry about this. I’ve been over it in my mind a million times. I always made the billers show me every claim to be sure we had the documents in order.”

“Any ideas of who might be behind this?” I asked. “One of your billers?”

We walked into the house. For some reason, maybe just the situation, or a flashback to what once was, we embraced and kissed. Lois walked into the kitchen and opened the refrigerator. She pulled out a bottle of wine that was already opened and poured each of us a glass.

“My billers? Please, none of them is nearly that sophisticated. Remember they would have to do a deal with at least one of our customers, someone who could find a way to funnel the money to them. Way out of their league, trust me.”   

“Who then?”

She placed her wine glass on the granite countertop. She walked behind me and started rubbing my neck, something she knew I loved. “You and Walt, or just Walt. Nobody else had access to the hospital and homecare executives we service.”

My heart sank. I knew she didn’t think for a moment that I might be in on it. But Walter? I paid him well with a nice bonus every year. Walter had been instrumental to our growth. “How would he have done it, even if he was so inclined?” I asked.

“Well, like I said, none of my billers could do it by themselves. But I’m sure he could have turned one of them. We only pay them about twelve dollars an hour. The extra money would be enticing.”

I thought about that for a moment. “Come on, we pay them the going rate, maybe a little more, right?”

“Don’t be defensive Jimmy. We’re just talking here,” she said. “You know what? I just thought of something. I was in his office one day a couple of months ago and I noticed something odd.”

“What?”

“The pictures of his wife and kids in his office, they’ve been there for years. They were gone,” she said. She refilled her wine glass. “You don’t mind do you?”

“Of course not. So what about the pictures?”

“I asked him that. You know what he said?”

I shrugged. “He never talks about his home life.”

He said, “I can’t stand looking at her face anymore.”

“And?”

And, he probably has a girlfriend.” She raised her hand and smacked her head. “I think I know who it is.”

I tossed my wine in the sink. “I’m going to need something stronger,” I said.

“It’s Deidre, I know it. She’s always looking for reasons to go into Walt’s office, usually when I’m on the phone or in the ladies’ room. I look up and she’s not at her terminal.”

“You think it’s serious? I mean serious enough for him to get a divorce?”

“I don’t know. It could be. She’s a nice girl, but not very bright. I shouldn’t have hired her, I guess.”  I patted her hand. “I know she broke up with her boyfriend right after the Holidays,” she said.

I nodded. “Almost a year ago. The timeline the FBI gave me would fit.” Assuming Lois’s theory was correct, Deidre could process the claims after hours or on weekends when no one was around. Walter would have to establish a dummy account that wouldn’t show up on our daily billing reports, not a problem for him.

“Now what?” Lois asked.

“We go to the FBI, tell them what we think. Let them interview Deidre. If we’re right, she will panic. Believe me she will talk. Another hour with that guy Duncan and I would have confessed.”    

I walked Lois to the door. We hugged and this time our kiss was lingering. I gave her Special Agent Duncan’s number and asked her to call him the next morning. I was scheduled to have breakfast with Walter. I couldn’t wait.

Our breakfast ran long. I had spent several sleepless hours trying to decide how to get Walter to confirm his marriage was over, without arousing any suspicions. It turned out to be easy. We were having our second cup of coffee when I said, “You know Walt, I envy you. We’re about to go through hell. I’m all alone in this, no wife and no girlfriend. It must be a great comfort to you to have Bunny with you.”

“Well, I probably should have mentioned this sooner, but Bunny and I are on the outs.”

“Meaning?”

“We’re separated. I’m still in the house, though. She went with the kids to live with her mother.”

“Sorry to hear that. When did that happen?”

He shifted in his seat. I could see he was really uncomfortable now. “A while ago. Can we change the subject Jimmy? I need to know what to tell the staff about getting paid. How long can we pay them for?”

“I’ll get back to you on that,” I said. “Listen, Walt, let this miserable situation be my excuse for asking, but I wasn’t completely surprised to hear about you and Bunny,” I said. I took another sip of coffee to see if Walter would react. “There’s a rumor going around about you and Deidre.”

“Not true, Jimmy, not true!” He slapped his palm on the table as he said this.

“I didn’t say it was, Walt. It’s a rumor. In any case the Feds are going to talk to her today.”

Walter’s eyes got wide for a moment. He slumped in his seat. He looked defeated, no other word for it. “She won’t be able to handle that, Jimmy.” Tears formed in his eyes. He took a huge breath and let it out. “Bunny was really putting the screws to me. She knew about Deidre. That’s why she left.” He reached for a paper napkin and wiped his eyes. “I never planned to take that much, but her lawyer was trying to wipe me out. Then it turned out to be so easy, it was hard to stop,” he said. Another deep breath. “The guy who runs Mountain Healthcare was in on it.”

I sat there looking at him. I wasn’t angry. I wanted to cry right along with him. “We’ve been working together for years. We built this business, you and I. Did you think about what you were doing to me?”

“You kind of retired, Jimmy, you weren’t there anymore. You still got paid, though. You got yours.”

And that was good enough for Walter. Good enough to do me in. Good enough to try to throw Lois under the bus. He let his life take a wrong turn and decided to take us with him. Still, I couldn’t hate him. He looked small and pitiful. “What now Walt? How do you want to handle this?”

“The FBI guys want to see me this afternoon. I’ll make a statement. I’m sorry Jimmy.”

Walter pleaded guilty and got a lighter sentence, but he will spend the rest of his life after he gets out, making restitution.  To his credit, he made sure that his plea deal included a free pass for Deidre. Mountain Healthcare’s chief executive decided to fight. His trial is set for later this year.

Six months later I’m back in business, but just barely. I am short of pharmacists and I lost some customers because of what happened. Needless to say, my tennis game is shot.

I might be better off in the long run, though. Bad news can have an upside. My business will certainly survive, but I don’t want it to be as big as it was. I need to spend more time with my grandson. And Lois and I are back together, marriage a distinct possibility. Fatherhood beckons again. Perfect timing.