P is for PERIL

by Sue Grafton

  “Where did Dr. Purcell fit in?”

  “I’m just getting to him. Under the management company, you have Dow, or his equivalent. He’s the medical administrator of the facility, responsible for the day-in, day-out nuts-and-bolts decisions, which is where he may have gotten into trouble.”

  “The three of you are partners?”

  “Not really. That’s how Dow refers to us, but it’s not technically true. For the layperson, it’s the easiest explanation of our relationship. We couldn’t be in partnership with Dow or the management company that runs the business. Believe me, the government gets very testy about any agreement that isn’t the result of an arm’s-length negotiation: in other words, two unrelated parties not in collusion with one another. Dow could hardly make unbiased decisions about billing practices if he stood to profit. What you’re probably referring to is the fact he bought stock in Millennium Health Care, which is a chain we also own stock in. I guess that makes us partners of a sort. We’re all in the same business, which is service to the elderly in our community. Of course we had no real say in the matter, but Harvey and I both thought Pacific Meadows would be the perfect venue for a man with Dow’s experience and reputation. I see now he may not have had quite the head for business I’d been led to believe. The first we heard about this Medicare business was last May. I thought then, and I’m still convinced, any discrepancies would turn out to be simple clerical mistakes, a compilation of coding errors as opposed to actual inflation of the figures with any intent to defraud. Dow Purcell is just too fine a man to stoop to cheating in that way. My guess is, he either didn’t have a thorough understanding of how Medicare works or he got impatient with all the nit-picking nonsense the bureaucrats put you through. I can’t fault him for that. As a physician, his first thought is always going to be for the well-being of the patient. He might have bridled at seeing all the ridiculous amounts of paperwork get in the way of first-class care, or worse still, he may have felt the government had no right to dictate to him.”

  “So you think he might have bent the rules a bit?”

  “I prefer that explanation to the one the fraud control investigator seems to be taking. A better guess is he was careless, penciling approval on charges he should have examined more closely. The notion of Dowan actively debunking the government is incomprehensible.”

  “Suppose he did, though. I don’t understand how he benefits. If Medicare or Medicaid is overbilled, aren’t those monies paid to the operating company? Seems like it’s really their responsibility, isn’t it?”

  “Absolutely. But outside providers, such as ambulance companies and medical supply businesses, can collect thousands of dollars for services never rendered, or goods not delivered, or goods billed out at inflated prices. If someone in Dow’s position were in league with them, the contracts could mean thousands of dollars to the companies involved. For this, he’d receive remuneration – a kickback – perhaps under the heading of a professional discount or a referral fee. Now that HCFA – excuse all these acronyms, that’s the Health Care Financing Administration, which regulates Medicare and Medicaid programs –”

  “Gets complicated,” I remarked.

  “Very. At any rate, now that HCFA has stepped in, they’re insisting on documentation for every such transaction, including the lease agreement, which is where we come in.”

  “But you don’t think he’s really guilty.”

  “I don’t. At the same time, it isn’t looking good for him.”

  “You think he left to avoid disgrace?”

  “Possibly,” he said. “If he felt unable or unwilling to face the charges. I’m not sure how he’ll deal with the humiliation if they decide to prosecute. I’m not sure how any of us would deal with that. He’s a man in big trouble. I don’t like to think of him as a coward as well.”

  “When did you see him last? Do you remember the occasion?”

  “Of course. September 12, the day he disappeared. I took him out to lunch.”

  “I didn’t realize that. Was this at his request or yours?”

  “His. He called and asked to see me. Of course, I said yes. By then, I knew about his difficulties. I had some other business in that part of town so we met at a little place in walking distance of Pacific Meadows. Just a hole in the wall called Dickens, a mock English pub. It’s quiet and affords a measure of privacy, which I knew he’d appreciate.”

  “Did he talk about the problems with Medicare?”

  “Not directly. He did ramble on a bit about the ongoing investigation. He was clearly upset. He seemed to want reassurances that Harvey and I would come to his defense. I did what I could to put his mind at rest, but I told him I couldn’t condone anything underhanded. I don’t mean to sound pompous, but in truth, if the charges turn out to be provable, then Dow’s actions are not just unethical, they’re illegal. As much as I like and admire the man, there’s no way I’d be willing to cover for him, even if I could.”

  “But why would he risk it? Especially at his age and station in life. He couldn’t need the money.”

  “I’m not so sure about that. Dow always did well for himself financially, but Crystal is high maintenance. She costs him a bundle. He has two houses to maintain – you know he bought Crystal that beach house at her insistence. Nothing would do, but she had to have that place. Plus he has Fiona’s alimony, which is burdensome to say the least. Crystal likes to travel and she does it in style, including first-class airfare and accommodations for Griffith’s nanny along with everyone else. She’s the kind of gal who insists on being gifted – birthdays, anniversaries, Christmas, Valentine’s Day – she expects to receive jewelry and nothing cheap. She makes sure of that. Dana’s theory is she’s busy accruing personal assets in case the bottom drops out.”

  The phone rang again. This time his eyes didn’t even flicker, so I went right on. “You think she married him for his money?”

  He considered the question briefly and then shook his head. “I wouldn’t say that. I think she genuinely loves the guy, but she’s been poor all her life. She wants to make sure she’s safe just in case something happens to him.”

  “What about the rumors of an extramarital affair on her part?”

  “You’d have to ask Dana. She’s the one who spotted that piece of shenanigans. I prefer to steer clear.”

  “Did Dr. Purcell say anything to suggest he might flee?”

  Joel shook his head. “I don’t remember anything of the kind. Is that the direction the police are leaning in?”

  “Well, they can’t rule it out. Apparently, his passport and a substantial sum of money are missing.”

  Joel stared at me as though trying to take that in. “If he ran, he’d have to continue running for the rest of his life.”

  “Maybe that’s not as bad as the alternative. From what you say, he was feeling desperate.”

  “Exactly. He was horrified at the prospect effacing criminal penalties.”

  “I talked to an attorney who thinks it wouldn’t be that bad. He might have to pay restitution, but he wouldn’t go to jail.”

  “That wasn’t his perception. He was deeply depressed. The government’s getting tough. He knew they might well decide to make an example of him. More than anything we’re talking about the loss of face, something I’m not sure he could handle.” He paused, moving four pencils from one side of his table to the other.

  I saw his gaze shift. “What’s going through your mind?”

  He shook his head. “Something I haven’t dared say to anyone else. It crossed my mind – after seeing him that day – he might have been thinking of doing himself in. He was trying to cover his distress, but it might’ve been too much. He wasn’t sure Crystal would stick with him once the scandal came to light. You have to ask yourself just how despondent he was and how far he’d go to get relief. I should have asked how he felt. I should have done what I could to reassure him, but I didn’t.”

  “Joel?”

  We both turned to find Dana s
tanding in the doorway.

  “Harvey’s on line two. This is the second time he’s called.”

  “Sorry. I better get this.”

  “Sure, go ahead. I appreciate your time. It’s possible I’ll want to talk to you again at a later date.”

  “Any time,” he said. He stood up when I did and the two of us shook hands across his desk. By the time I reached the door, he’d picked up the phone.

  Dana walked me to the elevator with its two-person capacity, the interior about the size of the average telephone booth. I could have run down the stairs in the time it took. During its slow, whirring descent, I said, “What’s the story on Glint Augustine?”

  “Simple. For the six months Augustine rented from us, Dow would go off to work and the next thing you know, Crystal would come sneaking out her backdoor, through the trees, and into the cottage. She’d be there an hour or so and then slip back home. Meanwhile, Rand minded the baby, taking him for endless walks around Horton Ravine. It got to be the talk of the neighborhood.” We reached the first-floor foyer.

  “Couldn’t there be another explanation?”

  Dana’s smile was jaded. “Maybe they were having tea.”

  Santa Teresa Hospital – St. Terry’s – is located on the upper west side, a neighborhood once devoted to open farmland, working vineyards, dairies, and stables, all with sweeping views to the mountains on the northern edge of town. Early black-and-white photographs of the area show wide, dusty roads, shanties flanked by groves of citrus and walnut trees, all leveled long ago. It’s a world that appears curiously bald and flat: rural expanses planted with pampas grass and star pines that look like mere sprigs. A few unpretentious structures from that era remain, tucked like vintage treasures among modern-day buildings. The rest – churches, the original county courthouse, the wooden boarding houses, the dry goods establishment, the early mission, the trolley car barn, and numerous snazzy three-story hotels – were razed by intermittent earthquakes and fires, Nature’s demolition crews.

  It was not quite two o’clock when I parked on a side street and walked a block and a half to St. Terry’s front entrance. The wind had picked up and the trees seemed restless, stirring uneasily. Occasionally a miniature rain shower would shake loose from the upper branches. The very air seemed gray and I was happy to pass into the hospital lobby through the sliding glass doors that parted at my approach. On my left, the coffee shop was sparsely occupied by hospital employees and visitors. I inquired at the information desk and was given directions to the office of the Director of Nursing Services. I passed a ladies’ restroom and made a brief detour before I continued my quest.

  I found Penelope Delacorte in a small private office with a window looking out onto the street. Overhead fluorescent lights contrasted sharply with the gloom outside. She was seated at her desk, using her pencil point to trace the lines of print on a photocopied memorandum.

  When I knocked on the doorframe, she peered at me above a pair of half-glasses with tortoise-shell frames. She was in her early fifties, at that stage where she hadn’t quite decided whether to dye her graying hair. I pictured her in arguments with her hairdresser, unsure of herself when it came to permanent versus temporary rinses. They likely also argued about the cut; Penelope clinging to the shoulder-length page boy she’d probably been wearing for years. Her bangs were too short and I wondered if she chopped them off herself between appointments. She removed her glasses and set them aside. “Yes?”

  “You’re Ms. Delacorte?”

  “Yes.” Her attitude was cautious, as though I might be on the verge of serving her with papers.

  “Kinsey Millhone,” I said. “I’m a private investigator here in town and I’ve been hired to look into Dr. Purcell’s disappearance. May I have a few minutes?”

  Without much in the way of encouragement, I’d entered her office, slipped off my rain garb, and eased myself into the chair near her desk. My shoulder bag and the slicker I left in a pile at my feet.

  Penelope Delacorte got up and closed her office door. She didn’t seem happy with my presence. She was close to six feet tall, slim, conservatively dressed – a navy blue coat dress with small brass buttons up the front. Her low-heeled navy blue pumps were plain and looked vaguely orthotic, as though prescribed for fallen arches or excessive pronation.

  She sat down and put her hands in her lap. “I’m not sure what I can tell you. I was gone by the time he… went missing.”

  “How long did you work for Pacific Meadows?”

  “I was the administrator there for the past eight years, until August 23. I worked with Dr. Purcell for the last forty-seven months of that.” Her voice, like her manner, was carefully modulated, as though she’d set her internal dial to “Pleasant.”

  “I thought he was the administrator.”

  “His title was Medical Director slash Administrator. I was the Associate Administrator, so I suppose you’re correct.”

  “Can you tell me why you left?”

  “Genesis, the management company that oversees the operation of Pacific Meadows, received notification that Medicare was conducting a rigorous audit of our records.”

  I raised my hand. “What prompted them to do that? Do you have any idea?”

  “Probably a complaint.”

  “From?”

  “One of the patients, a guardian, a disgruntled employee. I’m not sure what it was, but they seemed to know what they were doing. Apparently, the clinic was suspected of any number of violations, from overpaying our suppliers to submitting false or inflated claims for services. Dr. Purcell was in a panic and blamed the bookkeeper, Tina Bart, which was absurd and unfair. Ms. Bart was working for Pacific Meadows before I arrived and she was faultless in her performance. I went to bat for her. I wasn’t going to let them push it all off on her. She didn’t make the decisions. She didn’t even pay the bills; Genesis did that. She processed purchase orders and prepared the room-and-board bills for each resident, including central supply, therapy, anything other than medication. This was Medicare, Medicaid, HMOs, private insurance, and private pay. The same information crossed my desk as well. She didn’t generate the paperwork. She forwarded what she was given.”

  “Why isn’t Genesis considered responsible for the problem if they pay the bills?”

  “We supply them the information. As a rule, they don’t stop to verify the data, nor did Ms. Bart.”

  “But she was fired, anyway.”

  “Yes, she was, and I turned in my notice the very same day. I was determined to file a complaint with the Labor Relations Board.”

  “What was their response?”

  “I never got that far. I had second thoughts and decided not to go through with it. Tina Bart didn’t want to make a fuss. She was as reluctant as I was to call attention to Dr. Purcell’s situation.”

  “His situation?”

  “Well, yes. We’re all fond of him. He’s a darling human being and a wonderful doctor. If he didn’t have a head for business, that wasn’t an actionable offense as far as we were concerned. I’m being candid in this. He just had no clue when it came to the Medicare rules and regulations – which items were billable and which would automatically be disallowed, co-payments, deductibles, claims for fee-based services. I grant you, it’s enormously complicated. Make one mistake – god forbid you put a code in the wrong place or leave even one window blank – and the form comes right back at you, usually without a hint about where you’ve erred.”

  “But Dr. Purcell didn’t do the billing.”

  “Of course not, but it was his job to review the TARs –”

  “The TARs?”

  “The Treatment Authorization Requests. He was also responsible for reviewing CPT codes and approving the cost of any ancillary services or DME’s. I have to emphasize, he was always genuinely concerned and very innovative when it came to patient care and well-being –”

  “You don’t have to work so hard to defend the man,” I said. “I’ll take your word for it. Wh
at I hear you saying is when it came to the day-to-day management, he was incompetent.”

  “I suppose, though it seems too strong a word.”

  “Didn’t Glazer and Broadus realize what was going on?”

  “It wasn’t their place. They purchased the property from the previous owner, did extensive improvements, financed and built the annex. The rest was up to Genesis and Dr. Purcell. Please understand, this is just my personal opinion, but I’ve worked with a number of doctors over the course of my career. It almost seems that the better a man is at the practice of medicine, the worse he is at business. Most of the doctors I know have a hard time admitting this about themselves. They’re used to being gods. Their judgment is seldom questioned. They have no awareness of the limits they face, so they’re easily duped. They may have medical knowledge, but often not an ounce of common sense when it comes to money management. At any rate, I didn’t mean to digress. I’m just trying to explain how Dr. Purcell could have gotten himself into such a mess.”

  “Didn’t you explain it to him?”

  “On numerous occasions. He seemed to listen and agree, but the errors continued to accrue.”

  “But if you suspected he was screwing up, couldn’t you have gone to the operating company yourself?”

  “Over his head? Not if I wanted to keep my job.”

  “Which you lost, anyway.”

  Mrs. Delacorte pressed her lips together, color warming her cheeks. “I felt compelled to resign when Ms. Bart was fired.”

  I said, “Do you think Dr. Purcell was intentionally cheating the government?”

  “I doubt it. I can’t see how he’d benefit unless he had some covert arrangement with Genesis or the various providers. The point is, Dr. Purcell was on the premises. Genesis wasn’t, and neither were Mr. Glazer or Mr. Broadus. It was his responsibility and ultimately, he’s the one who’ll be held to answer.”