“They’re not?” I drained my coffee.
“Uh-uh. When I went through the files this morning, I saw that all of those patients—the ones Kelly coded as unqualified or unnecessary general inpatients—have been discharged.”
“Discharged?” I frowned. “You mean, they died?”
“No. That’s the interesting thing. They didn’t die—except for MacDonald, of course, who was definitely dead. They were simply marked ‘discharged,’ every single one of them. There’s no indication in the file whether or where they were transferred. They were just . . . discharged.”
“Easy enough to do,” I said, “if they’re fictitious.” Or the hijacked identities of real people with real social security numbers, fictitiously reported as “patients.”
She nodded. “But wait until you hear this.” She paused, making sure I was listening. “All of the discharges took place on the same day last week. On Saturday.”
“On Saturday,” I repeated. “When the office wasn’t open.” And Kelly had surreptitiously copied the files a few hours later, on Saturday night.
“Yes. If I had to guess, I’d say that somebody in the office found out that Kelly was suspicious and made a clumsy effort to get these names off the books.” She took a breath. “They probably figured on coming back later and purging all of them—and maybe they already have. But the thing is that the records have already been submitted to Medicare for payment. The reimbursements have been paid. So taking them off the books isn’t going to do the trick.”
“In fact,” I said, “taking them off the books is a crime, too. It’s a cover-up.” At a minimum, it can translate to obstruction of justice, with additional charges for falsification of records and making false statements. I had come across a half dozen examples of that in my early morning online research. And in the case of Medicare fraud, the penalties for attempted cover-ups are plenty stiff. In one case I’d read about, the manager of an Arkansas hospice got five years in prison and a twenty-five-thousand-dollar fine for each charge, and each falsified record counted as a single charge. In a scheme like that, there could also be charges of conspiracy and money laundering.
But right now, we were dealing with murder, not Medicare fraud—unless, as I now strongly suspected, the two were closely linked.
“Getting back to MacDonald,” I said. “According to the newspaper story, the man died last August, of a morphine overdose. At the inquest, it seems to have been assumed that morphine was being prescribed for pain and that he managed to hoard enough of the narcotic to serve as a lethal dose, either accidentally or deliberately.” I paused and said, slowly, out loud, what I knew we were both thinking. “It’s also possible that somebody brought the morphine and administered it.”
“Yes,” Lara replied slowly. “China, I’m willing to bet that MacDonald is the murder victim Kelly was thinking about.” Puzzled, she wrinkled her forehead. “The old man was certainly abusive, maybe even crazy. But I can’t come up with a good reason for killing him. Can you?”
“Perhaps,” I said, and then offered the explanation that had been banging around at the back of my mind since early that morning. “Perhaps he was killed to keep him from telling what he knew about the Medicare fraud.”
Lara’s mouth dropped open. “What he knew—”
I tapped a finger on the steering wheel. “Try this as a scenario, Lara. Let’s say that MacDonald didn’t have stomach cancer, or any other illness. As a hypothesis, let’s say that he was fraudulently recruited to become a hospice patient and then began to cause trouble for his recruiter. Say that he threatened to tell what he knew unless he was paid to keep his mouth shut. That he was asking for more and more money—until he became too unreliable, too much of a threat. At which point, somebody took him out. And somewhere along the way, instead of risking other similar threats, it was decided that it would be safer to create fictitious patients, rather than recruit potential troublemakers.”
“Wow,” she said, letting out a long breath. “Just . . . wow.”
“It’s possible?”
“It’s possible,” she said slowly, “all of it. I have to admit that I never saw any evidence of illness—of a terminal illness, I mean. MacDonald was so hard to deal with that it was impossible to tell what was really going on with him. Most of the time, he wouldn’t even let me check his vital signs.” She hesitated. “Of course, that could have been an act—part of the scam.”
I nodded. “Yes, part of the act. But we are very far out on a very thin limb, Lara. We have a theory of a crime, but we don’t have a shred of evidence. We’re identifying a murder victim that the authorities have already written off as a suicide or an accidental OD. We’re conjecturing that there was a large-scale fraud and that MacDonald was involved in it. We’re guessing that—”
“Yes, we’re guessing,” she said impatiently. “But we’re not making it up, China. It’s all part of a bigger picture, and the records Kelly copied prove it. She knew that somebody at the hospice was defrauding Medicare and she knew how it was being done. More than that, I’ll bet she knew who was doing it. That’s why she was killed.”
“I suppose you have a candidate,” I said quietly.
“Yes.” She took a deep, ragged breath. “It had to have been Chris. Dr. Christopher Burgess. He signed off on every single one of the patients that Kelly coded as unqualified. They were in hospice because he gave his approval.”
“And murder?” I studied her. “Do you think Dr. Burgess would have killed somebody who threatened to reveal what he was doing?”
She tried to say something, cleared her throat, and tried again. “Yes,” she said, very low. “Yes, I think . . .” She blinked fast, trying not to cry. “I think he’d do that. There was a kind of . . . ruthlessness about him. I saw it once or twice when we were together, and it scared me. It was one of the reasons I decided to break up with him.”
“I’d like to hear more,” I said gently, and put my hand on her arm. “But we don’t have to go into that now. Let’s back up. You’ve met MacDonald’s neighbor—what can you tell me about the woman?”
Making a visible effort to pull herself together, Lara squeezed my hand. “I saw her for the first time on my second visit to MacDonald’s house. She had stopped in to bring him some groceries. We left at the same time, so we had a chance to talk. She’s a woman in her late sixties, I’d say. As I remember, she’s retired from the library—children’s librarian, I think she said. Some people might think she’s a bit of a busybody, I suppose, and she seems a little nosy. But she probably does a lot of good, checking on older people in the neighborhood and keeping an eye out for kids. She seemed quite reasonable and nice, unlike MacDonald, who kept telling her to go away and never come back.” A smile ghosted across her face. “Cantankerous doesn’t begin to describe the man, China. He was a first-class jerk.”
“Did you see her often?”
“Two or three times. We didn’t talk much, but I had the feeling that she was . . . well, puzzled about MacDonald. She seemed curious about him.”
I nodded. “Well, let’s go see if she’s at home, shall we?”
With its yellow walls, white shutters, and blue front door, the Mueller house was the prettiest on the street. The front steps featured pots of purple and red petunias and there was a blue-painted swing at one end of the shaded porch.
Lara had to knock several times before the door opened on a chain and an older lady peered out at us over plastic-rimmed bifocals. Her long white hair was braided and neatly coiled around her head and there was a hearing aid in one ear. Slightly stooped, she wore pink felt house slippers and a cotton housecoat that zipped up the front. The housecoat was printed with huge pink and chartreuse cabbage roses bright enough to make me blink.
“Hello, Mrs. Mueller,” Lara said, smiling. “It’s been quite a while, but I wonder if you remember me. I’m one of Mr. MacDonald’s hospice nurses. We met when you brought hi
m groceries one afternoon.”
“Oh, yes, of course I remember.” The woman spoke rapidly and in the high, shrill voice of the hard of hearing. “That poor man. He was such an old rascal, wasn’t he?”
“Well, that’s certainly one way to describe him,” Lara replied with a chuckle. She gestured at me. “This is my friend China Bayles. If you’re not busy just now, we’d like to chat with you for a few minutes.”
“China Bayles? Why, of course! From Friends of the Library! You gave a talk in our herb garden just after it was opened. Do you remember?”
“Of course,” I said. I remembered helping to plant the garden and giving the talk. I even vaguely remembered her, although I hadn’t known her name. “It’s good to see you again.”
The chain came off the door and she stepped back. “Well, isn’t this nice?” she said cheerfully. “I was just ironing tea towels, so you’ll give me a little break. Come on in, girls. It’s a warm morning, even if it is just April. How would you feel about a glass of lemonade?”
“Lemonade would be lovely,” I said. “Thank you for your hospitality.”
The kitchen was a pleasant, sunshiny room with wide, multipaned windows that gave a view of a small vegetable garden. It was planted in neat rows, the ferny tops of carrots marching in careful alignment between beets and rainbow chard. Several fuchsias in full pink and purple bloom hung from the eaves of a frame garage. Beyond the garden, I could see a low privet hedge along the alley and, on the other side of the alley, the empty lot where the MacDonald house had once stood. An ironing board was set up in front of the window, where Mrs. Mueller could watch the birds visiting the feeder on the small brick patio just outside. On one end of the board, a stack of neatly ironed tea towels sat next to an electric iron, and a slightly damp tea towel with a crocheted edge was spread on the working end, waiting its turn.
“You girls sit down right there at the table.” Mrs. Mueller went to the board and turned off the iron. “Make yourselves at home.”
“Thank you,” Lara said, as we took chairs. The table was covered with a cheery white cloth printed with little red and blue and green birds. “This is very kind of you.”
“I’m always glad to have company,” the old woman said. “I used to love to go to work—I was a librarian, you know—because I love seeing people. I miss that.” She went to the refrigerator and took out a frosty pitcher of lemonade. “So you’ve come to talk about Mr. MacDonald? Well, as I told that other nurse last week, I would certainly like to see something done about the poor man’s case, if it isn’t too late. It just doesn’t sit right with me, knowing—”
“Excuse me,” I said. “The other nurse?”
“Yes. Kelly Kaufman.” As Lara and I traded glances, Mrs. Mueller took three glasses out of the cupboard and began to fill them. “The girl who was in that car wreck night before last. I read about it in the Enterprise yesterday.” She put a hand over her heart and patted herself several times. “Such a shock that was! I had to read it three times before I could get my mind around it. Would you happen to know how she is?”
“I’m sorry to tell you,” Lara said soberly, “that Kelly died last night.”
“Oh, dear!” Mrs. Mueller’s eyes widened behind her glasses. “Oh, mercy me! What a horrible thing!” She put the pitcher down with a thump. “I am so sorry to hear it. Kelly was a lovely girl. She seemed to understand the problem and want to see what could be done to fix it.” Sighing heavily, she put two filled glasses in front of us. “But it’s really too late, I’m afraid. Once the bureaucracy decides a thing, it’s done. St. Peter himself couldn’t change it.”
I made a quick stab. “You’re talking about the ruling in Mr. MacDonald’s death?”
“Yes, that’s right. I blame myself, you know. If I’d been here, it wouldn’t have happened. Not the awful way it did, anyway. I am just so sorry about that. Which is what I told Kelly.” She opened an old-fashioned tin breadbox printed with yellow daffodils. “You wouldn’t say no to a peanut butter cookie, would you? I make them for the little boy across the street. Gerald, his name is. He comes over every day after school for a glass of milk and a cookie, and sometimes I read him a story. He’s a latchkey child, you know. We have several in this neighborhood.”
“We’d love a cookie,” I said warmly, although the memory of Lila Jennings’ sugary jelly doughnut was still with me. “And peanut butter is my favorite, hands down.” I paused. “When did you talk to Kelly, Mrs. Mueller?”
“Last week,” she said, putting the cookies on a plate in the middle of the table. She sat down in a chair opposite me. “It was Thursday, I think. Yes, Thursday. I’d just got back from driving old Mrs. Grumper to the beauty parlor for her regular Thursday shampoo and set. Kelly came over on her lunch hour and we had tuna salad sandwiches.” She brightened and started to get up again. “Is it too early for a bite of lunch? I have bread and plenty of—”
“Oh, thank you, no, Mrs. Mueller,” Lara said hastily. She picked up a cookie. “This is really perfect. Just this, and the lemonade.”
“So Kelly came to discuss Mr. MacDonald’s death,” I said, prodding Mrs. Mueller back to the subject. “I’m sure you told her your concerns about it.”
“I certainly did.” Mrs. Mueller helped herself to a cookie. “And if I hadn’t been out of town when the poor man died, I would have told the police about it—then, I mean. But it all happened while I was staying in Chicago, taking care of my sister. She was dying of cancer, and of course I wanted to stay with her until the end.” She shook her head. “Well, what with one thing and another, I was gone from the middle of August to the end of September. By the time I got back, everything was all over and done with and settled. At least, that’s what the police told me when I tried to talk to them about it.” She sniffed. “They told me to go back home and mind my own business. They were nice about it, but I could tell there wasn’t any use in trying to get them to listen. They just kept saying that the JP had ruled and the case was closed and that was it.”
“So you were out of town when Mr. MacDonald died,” I said thoughtfully. “And you didn’t get back until—”
“Until after Maude Porterfield had held the inquest.” She shook her head. “My older sister went to school with Maude, you know, and she used to come over to our house every Saturday. Maude is as smart as a whip but she has always been very opinionated. Once she’s made up her mind, nothing’s going to budge her. Which is what I told Kelly.” She sighed heavily. “Oh, I am so sorry to hear about that lovely girl’s death! Such a tragedy. Does anybody know how the wreck happened?”
“I think it’s still under investigation,” Lara said.
“Well, I hope the police do a better job than they did with poor Mr. MacDonald,” Mrs. Mueller said tartly.
I cleared my throat, wanting to get the conversation back on track. “Why made you want to go to the police about Mr. MacDonald? What did you want them to do?”
“Well, I just never did understand why the man was in hospice,” Mrs. Mueller said. “Especially when things dragged on and on. Mrs. Patterson, two blocks down on the other side of the street, was in hospice for three months at the end of her life, the dear old thing. But she was really, truly sick, not like Mr. MacDonald. He was just playing sick. And he didn’t even do that very well.” She gave a sarcastic harrumph. “Stomach cancer, of all things. That’s what my sister died of, you know. She wasn’t playing sick, believe you me.”
“How did you know he was playing sick?” Lara asked. She reached for another cookie. “Would you mind if I—”
“Oh, my dear child, no!” the old woman exclaimed. “I just love to see people eat my cookies. Well, about playing sick.” She nodded toward the window. “I like to iron. It’s my hobby, you might say, so I’m there at the window a lot, ironing and watching the birds and enjoying my garden. I could see that man, out in his backyard almost every day, pushing his lawn mower,
one of those old reel things. And painting the back porch, and lifting weights. And he had one of those bicycles, you know, that doesn’t go anywhere. It just sits and you pedal it. It was on his back porch and he pedaled it every day for an hour, with a book propped up in front of him. My sister had a real case of stomach cancer, and I could tell the difference. That man was no sicker than I was. In fact, he wasn’t even taking painkillers. He’d thrown them all out.”
“He did?” I asked encouragingly. “How do you know?”
“Because one day last summer Mrs. Van Kirsten’s German shepherd got out of the yard and got into all the garbage cans along the alley. I went out to pick mine up, and Mr. MacDonald was out there picking his up and cursing the dog. I saw what he was throwing away and it was all his medicines. Bottles and boxes of pills and things like that.”
“Maybe he was just tired of taking them,” Lara objected. “He was such a difficult patient. He might have been doing it just to be contrary.”
“No, he said he was cleaning house,” Mrs. Mueller said. “And he was getting rid of stuff because he was going to move, and anyway, he’d never needed any of it to begin with, which was why there was so much. Then the next week, when he was out mowing the backyard, I took him a nice big slice of cake. He’d had a little too much to drink, I think, and it made him want to brag. He told me right straight out that he was pulling the wool over everybody’s eyes. About being sick, I mean. He said, ‘I’m as fit as you or anybody else on this block, Mrs. M.’ That’s what he called me. Mrs. M.”
“Oh, really?” I asked, thinking what a marvelous witness this woman would make, if you could keep her focused on the questions. “When was that? When you took him the cake, I mean.”
“I can tell you exactly,” she said, “since it was the day after my birthday, which is August tenth. Mrs. Gregory from across the street made me the most beautiful coconut cake with a gorgeous strawberry rose right in the middle. I took him a piece and some of the strawberries, because I knew he’d love it. He did love to eat, and he could eat anything, which is another reason I know he wasn’t dying of stomach cancer.”
Blood Orange: A China Bayles Mystery Page 22