Best Place to Die

by Charles Atkins

  ‘So, based on some anonymous tip –’ his attorney’s tone incredulous – ‘you decide that my client, a highly respected attorney, is somehow involved with a plot . . . no, a conspiracy, to defraud the Feds. And yet other than badger him with irrelevant questions about paperwork and Medicaid claims you’ve not brought up a single shred of real evidence. I have to say, gentlemen, no judge is going to buy this.’

  ‘Mr Warren.’ Agent Fitzhugh’s jaw twitched as he tried to make eye contact. ‘Are you aware that over three hundred of the residents at your facility, Nillewaug Village, receive Medicaid long-term-care benefits? Which, considering they’re not in long-term care, and judging by the cost of their units – unlikely to be eligible for Medicaid at all – is fraud, thousands of counts of it.’

  Jim kept his expression blank, sizing up the two agents, both in their thirties. One white, Agent Fitzhugh; one black, Agent Connor. They reminded him of chess pieces, someone’s pawns, nothing higher in value. Not like him. They think they can capture the king . . . we’ll see how long that lasts. Since his arrest early Sunday his only words: ‘I’m not saying anything until my attorney gets here.’ What sort of idiots did they take him for, and their feeble attempts to intimidate him into self-incrimination? Yes, of course he knew all about the numbers and it was four hundred and twenty-seven on the Medicaid rolls. And no, he’d not be sharing that with this pair of morons. Of course the real issue, that bitch; it had to have been her. Fuck you, Delia! He looked up at his attorney. Windham leaned his head close. Jim whispered. ‘They don’t have a fucking thing. My name’s not on anything. I signed nothing. Get me out of here!’

  ‘Gentlemen, I appreciate the gravity of the situation and what you erroneously believe my client was involved in. But . . . unless you have any real evidence, I insist you release Attorney Warren and we forget this entire unfortunate incident. If there were any billing irregularities at Nillewaug – as you allege – it’s not anything my client would have had knowledge of.’

  ‘How is it, Mr Warren,’ Fitzhugh persisted, his broad face showing signs of strain, his lips tight, ‘that so many wealthy people, people who paid hundreds of thousands of dollars for the amenities at your facility, were on the Medicaid rolls?’

  Jim looked up, a half smile on his lips. ‘As I said before. I don’t know.’

  Attorney Windham looked at the digital camera that had been recording the interrogation and sighed. ‘Agent Fitzhugh, Agent Connor, with all due respect that is the seventh or eighth time you’ve asked the same question. My client has answered that he does not know how any of the residents at Nillewaug were on Medicaid, and you have brought forward nothing to refute that. Unless you have any real evidence, you need to release my client, or I will be forced to bring a wrongful imprisonment suit.’

  Agent Connor, who’d been silent for the past hour, looked over his shoulder at the dark mirrored surface behind him. He shook his head, and, turning back to Warren and his attorney, began to speak: ‘You are aware of the fire at Nillewaug early yesterday morning?’

  Jim glanced at his attorney. But really, he thought, sensing a shift in the wind, now they’re going fishing. ‘Yes.’

  ‘I believe,’ Agent Connor continued, ‘there are five confirmed dead, and quite a few more who remain unaccounted for.’

  Jim said nothing, his thoughts skittering back to his early morning arrest, clearly they’d been waiting for him . . . had him under surveillance. How long had they been there? Had they been there Saturday night? Say nothing, let them show their hand. All her fault. You bitch!

  ‘Your point, Agent Connor?’ Windham broke in. ‘Yes, we’re all aware of the tragedy at Nillewaug. And if you weren’t holding my client he’d be able to assist in helping those poor displaced elderly.’

  Agent Fitzhugh appeared at his breaking point. ‘By flying to Grand Cayman?’

  His colleague shot him a warning look, and then added, looking first at Warren and then his attorney, ‘I think the judge will be interested in that detail, as well. Might consider Attorney Warren a flight risk.’

  ‘And what possible difference will that make,’ Windham replied, ‘when it comes on top of your flimsy, unsubstantiated and totally erroneous allegations?’

  Agent Connor’s dark eyes revealing nothing. He looked straight at Jim Warren. ‘When were you last at Nillewaug Village?’

  Jim met the agent’s gaze, the one question spinning through his mind – how long had they been following me? ‘I don’t remember.’

  ‘I see,’ Connor said, his tone free of emotion. ‘More than a week ago?’

  ‘Possibly.’

  Agent Connor leaned on the table, his eyes fixed on Warren. ‘Possibly. Hmmm. Possibly less than a week?’

  ‘Yes.’

  ‘What about Saturday night?’ Connor asked.

  Jim gave his attorney a worried look. They know! And for the first time since his arrest over twenty-four hours ago, Jim Warren felt fear. You bitch! Delia, you fucking bitch! Was her office bugged? She sure as hell wasn’t wearing a wire.

  Agent Connor placed a form sealed inside a plastic evidence bag on the table in front of Warren. ‘Do you recognize this?’

  ‘No.’

  Connor shook his head slightly. ‘Look at it more carefully, Mr Warren. You can pick it up if you’d like.’

  ‘I told you I don’t know what it is.’

  ‘Really?’ Fitzhugh’s tone was skeptical. ‘It’s a Medicaid treatment plan for Betty Grasso. Please, look at it carefully.’

  Warren looked at his attorney, who nodded slightly.

  ‘Fine.’ Warren picked up the document. ‘So?’

  ‘Look at the signature, and please read the names.’

  Attorney Windham interjected. ‘What is the point of this?’

  ‘The point,’ Agent Connor said, nearing the end of his patience, ‘is this is a treatment plan that generated payment for nursing-home services for an individual at Nillewaug, who was not in a nursing-home level of care. And that’s just to start. I need your client to read the names of the people who signed this form. After that, there will be a series of questions about those two individuals. Regardless of your objections, the questions will be asked and answered. The amount of time it takes is entirely up to the two of you.’

  Mattie and Jamie watched the interrogation of Jim Warren from behind the two-way glass.

  ‘They can’t really let him go?’ Jamie asked, intent on the scene before them.

  ‘They might have to,’ came Mattie’s reply. They’d had only a few minutes to speak with the agents prior to the interrogation in the small observation room. Fitzhugh and Connor had admitted they’d not wanted to bring Warren in yet, didn’t have enough to make what they believed were millions, possibly tens of millions of dollars worth of fraud allegations stick. But the attorney’s run to the airport had forced their hand, and quite possibly blown the case. For the past week he’d been under surveillance. The Nillewaug scheme, which she still didn’t fully understand, had been tipped anonymously by a female caller through the Medicare and Medicaid fraud-abuse hotline. What was now abundantly clear, and possibly a motive for murder, was that a very frightened Delia Preston – ‘scared shitless’ according to Fitzhugh – was in the process of trying to save herself and hand over Jim Warren.

  ‘These investigations usually take months, sometimes more than a year to unravel,’ Connor had explained. ‘It’s all about tracing the money, and figuring out was this the result of stupidity and ignorance – people who just didn’t know the rules – or was this a deliberate attempt to bilk the system. But this . . . we’ve never seen anything quite so calculated. And if the tip hadn’t come in, it could have gone on indefinitely.’

  ‘I don’t get it,’ Mattie had said. ‘If so much money is being falsely billed, how could it go unnoticed?’

  ‘Easy.’ Fitzhugh had said. ‘Whoever’s behind this did their homework and knows the system. To start you have to understand that the Medicare and Medicaid progra
ms are massive with hundreds of billions of dollars disbursed annually, most of it for necessary medical services. Most billing irregularities get flagged electronically, whenever something goes above or below a predetermined value.’

  ‘You lost me,’ Jamie had said. And Mattie had been grateful as she was on the verge of losing the train herself.

  ‘Cut-off points.’ Fitzhugh had explained. ‘If you’re one of the top billers for a particular service, a cursory review is automatically triggered. If there’s even a hint of impropriety, the Office of the Inspector General begins an investigation. If in the course of that investigation it appears that something was being done deliberately it gets shifted to Department of Justice and that’s where we come in. The Nillewaug scam is unlike anything we’ve seen, and certainly never on this scale.’

  Connor had then explained: ‘From the time this facility was created someone had this in mind. From the three cases we’ve started in on it boils down to this, although there seem some variations throughout. Essentially someone buys into Nillewaug at considerable cost, and pays a monthly fee. These are people of means – not impoverished Medicaid recipients.’

  ‘I thought all old people get Medicaid,’ Jamie interjected.

  Mattie shot her a look. ‘No, that’s Medicare. Medicaid is for the poor.’

  ‘Yes,’ Fitzhugh said, and to Jamie: ‘Most people don’t know the difference, until they actually try to access one of the programs. But with Nillewaug the Medicaid benefit they were billing was for nursing-home care. You can only be eligible for it if you fall below the poverty line for at least three years. Which, considering the buy-in for an apartment at Nillewaug is a quarter million on up, and then you have monthly fees of about three grand . . .’

  For Mattie this was familiar territory. Her own mother, with early Alzheimer’s and advanced diabetes, had been in a nursing home outside of Bridgeport for the past three years. And yes, Medicaid picked up the tab for her mother whose only remaining material asset was a modest burial plan. ‘How could they possibly qualify for Medicaid?’ she asked. ‘Anybody who can afford a quarter million dollars is way too wealthy.’

  ‘Yes,’ Connor said, ‘but in the cases we’ve started to drill down through what appears to happen is at the point someone enters Nillewaug they begin a financial reconfiguring. Essentially, they are stripped of any recordable asset, through a combination of divestment and trusts. And five years after their balance sheet dips below the critical mark, an application is filed with Medicaid. So not only does Nillewaug rake in on the front end, by selling expensive units that aren’t really owned by the tenant, they receive their monthly fees through very clever end-of-life estate planning. On paper the resident has nothing, but their families are still paying the monthly fees. And after five years Nillewaug then begins double-billing the government for those same fees.’

  ‘But,’ Mattie said, recalling a long-ago conversation with Preston, ‘Nillewaug is an assisted-care facility, only a small portion is a nursing home.’

  ‘Yes and no, and that’s part of the beauty of this scam,’ Connor had said. ‘When licenses were filed with the state, the entire facility was given nursing home designation. So while in fact maybe one hundred beds are truly nursing home, all seven hundred residents could theoretically be counted – and billed – as extended care. Now, nationwide the average nursing home will have between seventy-five and ninety percent of their patients on Medicaid. It’s by far the number-one payment source for that level of care. Nillewaug, as a licensed nursing home with seven hundred beds is staying way below those percentages.’

  ‘And never triggered an audit,’ Mattie had said, following the logic.

  ‘Clever, huh?’ Connor had said, just as Jim Warren was being led into the interrogation room.

  Now, watching through the glass, pieces of heretofore random information clicked for Mattie. And with it her anxiety ratcheted up. Connor and Fitzhugh had pretty much admitted their hand was too weak to hold Warren on the fraud charges; they needed more time to trace the money. Warren’s attorney knew this, and had his client on a tight leash. And now her gaze was riveted on the scene unfolding before her. Agent Connor was holding up a black leather gym bag wrapped in a see-through evidence bag. He raised it and then placed it on the table in front of Warren. He proceeded to put on a pair of disposable gloves. ‘Do you recognize this bag, Mr Warren?’ he said as he unzipped it, revealing a change of clothing, each piece in its own evidence bag.

  Jim Warren seemed frozen in his metal chair. His eyes fixed on the items as they emerged.

  ‘Mr Warren?’

  ‘We observed and filmed you depositing it and its contents early yesterday morning into a donations bin, before proceeding to the airport.’

  ‘So?’ Warren said, his eyes darting to his attorney and then back to the agent. ‘So what, I’m giving clothes to charity?’

  ‘Yes,’ Connor said, ‘the very clothes we filmed you in on Saturday night when you “probably” visited Nillewaug Village at eight oh-two p.m. . . . What were you doing there, Mr Warren?’

  Jim looked to his attorney, and shook his head.

  ‘My client has answered all he intends to. I suggest we leave things in the judge’s hands at his arraignment this afternoon. But, gentlemen, based on what’s been presented so far, unless you pull a rabbit, Mr Warren will not be with you much longer.’

  Mattie pulled out her cell and punched in the number Fitzhugh had given her. She sensed the two agents’ frustration as they glared across at Warren and his slick attorney. Through the speakers she heard the phone ring and Fitzhugh pulled out his cell. ‘Yes?’

  ‘The M.E. said Preston had had sex within hours of her murder. Maybe that’s why he was there.’ And then, thinking it through further: ‘And that’s why he wanted to ditch the clothes. He knew she was dead. He’s scared of what physical evidence we’ll find on his clothes.’

  Fitzhugh nodded slightly and put his phone away. ‘Earlier,’ he said to Warren, ‘you said that your only knowledge of Delia Preston was as an employee of Nillewaug. Is that accurate?’

  ‘Yes,’ Warren answered, his eyes narrowed.

  ‘And you hired her when the facility first opened?’

  ‘Yes.’

  ‘So she’d be your employee.’

  ‘Yes.’

  Attorney Windham interjected, ‘I don’t see the point of this. We’ve already discussed Mr Warren’s employer/employee relationship with Ms Preston.’

  Keeping his gaze fixed on Jim Warren, Fitzhugh didn’t even acknowledge the attorney. ‘Do you sleep with all your subordinates, Mr Warren, or just Ms Preston?’

  ‘Oh my God,’ Jamie blurted, her eyes riveted on Warren’s face.

  Mattie held her breath.

  ‘Don’t answer,’ Attorney Windham quickly warned.

  ‘Why not?’ Fitzhugh’s expression blank. ‘Here, let me make it simpler. Were you having a sexual relationship with Delia Preston?’

  Silence filled the room.

  Fitzhugh persisted: ‘A yes or no, Mr Warren.’

  Jim Warren turned to his attorney.

  ‘Don’t answer, Jim.’

  ‘I see,’ Fitzhugh said, looking at his partner, and then at Warren. ‘Will you answer the question, Mr Warren?’

  ‘No.’

  ‘For the record,’ Fitzhugh said, with a slightly theatric flare, ‘Mr Warren has refused to answer the question as to whether or not he was having a sexual relationship with Delia Preston, the administrative director of Nillewaug Village and one of the two signers on Betty Grasso’s treatment plan.’

  From behind the mirror Jamie turned to Mattie. ‘He was sleeping with her?’

  ‘Appears that way,’ she said.

  ‘Betty Grasso is the woman who died up on the roof,’ Jamie added. ‘Don’t you think it’s strange that it’s her treatment plan? Was that deliberate?’

  ‘I don’t know. But it’s an excellent pick up. What I do know –’ watching and listening as Fitzhugh and C
onnor continued to question the tight-lipped Warren – ‘they don’t have enough to hold him.’ She empathized with the two agents’ frustration, a major case being carefully built and now possibly destroyed by prematurely bringing in their major suspect. All hopes of catching Jim Warren with a smoking gun evaporated as the man lawyered up and clammed up.

  ‘They’re going to let him walk?’ Jamie was incredulous.

  ‘Yes,’ Mattie said, realizing several things. ‘At least for now. They’ll keep a close eye on him. He’s obviously guilty of something. But is it just millions of dollars of fraud, or a few homicides as well?’

  ‘And because of the federal fraud piece, this whole thing will be a federal case?’

  ‘Yes, if in fact the murders have any connection to the fraud,’ Mattie said. And realizing Fitzhugh and Connor would get nothing further from Warren and that it would be only a matter of hours before Warren was released, she added: ‘We need to get back, and we have to work fast.’

  ‘What are you thinking?’ Jamie asked.

  ‘I’m thinking maybe we can find something that will make a charge stick. We’ve got possible motive for murder – Preston implicating him in fraud, maybe blackmailing him. We have him at the scene of the murder, and know he was trying to leave the country. What we don’t have is a witness or physical evidence.’

  ‘The clothes in the bag?’

  ‘Possibly, obviously he’s worried about them.’

  ‘You think he killed her and set the fire to try and cover up the fraud?’

  ‘I don’t know. But if he didn’t, I bet he knows who did.’

  NINE

  Kyle Sullivan stared out the window of the charge nurse’s office on the euphemistically named Safe Harbor Pavilion, the fifty-bed Alzheimer’s unit where he’d been working when the fire began. His view was of deep woods and a brook swollen with snow melt and spring rains. He sighed and turned back to the computer screen where he’d been flipping between spreadsheets of the facility’s residents as he tried to account for everyone.