by Maren Cooper
Chapter 32
Jess was enmeshed in paperwork at the office when she took a call from Diane, who, along with George, was babysitting for PJ until Claire got home. “George is having such fun with the baby that I’m on kitchen duty.”
Jess felt a wave of nostalgia as she pictured Diane and George preparing dinner and fussing over PJ. She had always loved that cozy feeling in her family’s house when dusk brought house lights on, furnaces kicking in, and everybody talking at once to share the day’s events. How she missed those moments!
Diane spoke quickly, baby noises in the background. “Jess, you sound a little down. Are you still at the office?”
“Slow down, girl. I’m fine and just finishing a few things here. Almost out the door.”
“Are you sure? Why don’t you join us?” “No, no, no, I’m totally fine. You guys enjoy. And, Diane, I appreciate the concern, but maybe it’s time for you to stop worrying about me.”
“But it’s such a habit now.” They laughed.
Jess was transported back to Diane’s porch swing, where the background notes of her mother’s organ wafted outside as she practiced for Sunday church in the next room. Safe, nurtured, loved. Jess had depended on Diane’s emotional support then and still did. But she wondered if it was fair to Diane now.
“You need to immerse yourself in your lovely romance right now—not worry about me.”
“Promise you won’t cross-country on me again?”
Silence, then a quick recovery, but only after Jess received the message. She knew Diane felt responsible for not having vetted Arthur when Jess had eloped after dating him for only a few months.
“Diane, I’m a big girl,” she said, a slight edge in her voice. “I release you from responsibility for me. I promise I won’t do anything foolish.”
For a long minute, she reconsidered her plan to stay in the office for another hour or two and thought she might instead just go home, turn on the fireplace, cook a real meal, and listen to jazz while sipping a glass of wine. It struck her that maybe that sense of leisure was why she was enjoying her dinners with Jim—three now in the past three weeks. Of course, the companionship is a good thing, she thought. Then she wondered, would Diane approve of Jim? Diane knew her better than anyone, and when Diane had met Arthur for the first time, after he and Jess were already married, Diane had clearly not approved of him.
She stayed in the office for another hour, trying to decipher the information from the Goodmoor business office review. Floyd Ramsey, the group’s practice manager, had tragically been killed in a car accident several months earlier. He had been at the helm for the past fifteen years. The interviews she’d conducted thus far indicated that he’d had a tight grip on the business side of things, and the group was confident that all was in order. But they were having a difficult time tracking the receivables, and even more trouble with insurance billing.
Floyd may have been a taskmaster, but he didn’t seem to have been able to keep staff very long. She saw a handwritten note from him, chewing someone out—presumably, one of his office employees. Who signed nasty notes with such a flourish? It did seem to explain one of the reasons the group wanted to join Midwest Health. Because Floyd had been the go-to guy, the practice leaders had no clue how to do things without him. There was no real attempt to replace him, so they were relying on temporary help. She needed to sit down with Dr. Personne and try to get a better understanding of their current situation, if he knew it.
But first she needed to follow up on that internal Medicare audit. Joyce should have preliminary results this week, and that would help decipher the weaknesses they were seeing with their own friendly eyes, rather than having Medicare come in. Something didn’t feel right, but she wasn’t sure what it was.
She left the office to drive home and realized it was still quite warm. Spring in St. Louis was hard to beat. It could be a bit brisk, but it was always a wonderful surprise to see the start of green in the yard and the crocuses peeking out.
As she unlocked the door and dropped her briefcase, the phone rang. “Hello.”
“Hi, Jess. How are you?” Jim asked.
At the sound of his voice, her heart rate quickened, yet she also felt relaxed as she responded warmly, “Oh, hi, Jim. How are you?”
“Good, good. I’m good. Actually, I just wanted to touch base. It’s nice to hear your voice.”
“It’s nice to hear yours too. How was your day?”
Early the next afternoon, Jess took a call from Sam Hirsch about Midwest Health’s prep. “That sounds like good progress, Sam. If they could have that diagram and sensitivity analysis ready by our meeting Wednesday, that would be great. Tell Matt and Roy I’m excited to see what they’ve got.”
She was about to hang up, when she remembered: “Oh, Sam, is Gloria there? Great. Can you transfer me to her for a minute? Thanks. See you Wednesday.”
“Hi, Gloria. Jess Lawson here. I hope this isn’t too much to ask, but I’m wondering if you keep records from the medical staff’s golf outings over the years.”
“Oh, yes. We have to keep all the records for the family history, you know.” Gloria laughed lightly. “What were you interested in, Ms. Lawson?”
“Well, this is a little awkward, but you might know that Dr. Steele, my ex-husband and I, offered a weekend at our lake place for the silent auction a couple of years back. I never really knew who won and enjoyed the time there. Do you have that information in your history?”
“Should have, yes. Let me take a peek and call you back. Is that OK?”
“Of course. I appreciate your looking it up for me.”
Jess walked down to Cindy’s office to relay the good news and settle her nerves. She had almost forgotten that damn picture, and now that she had found an easy way to determine who had been at the same house where the picture might have gone missing, it made her jumpy.
“At our Midwest Health meeting Wednesday, we should have all the data we need to start prioritizing target clinics for them,” she said when she arrived.
“Wow, that’s quicker than I expected. Those outreach guys moved pretty fast.” Cindy smiled.
“Yes, they did. It’ll be interesting to see where Goodmoor comes in on the list.”
Cindy nodded. “You’re right. Come to think of it, Good-moor came to us. We didn’t have to put that practice through a screen at all. Should be a good test of our matrix.” Cindy got up and put on her coat. “Gotta go. Meeting in Brentwood. See you tomorrow.”
Jess fought back her anxiety and returned to her office. There was a voice mail. She tensed up before she accessed it.
“Ms. Lawson, this is Gloria from Dr. Hirsch’s office. I found the information you asked about. The silent-auction winner of your lake place that year was Floyd Ramsey. He’s not a physician. Looks like he signed in as the office manager for Goodmoor Family Medicine. Community physician groups often fill in with office people. Hope this is what you wanted. It’s really all I have in the records. Bye, now.”
Jess gasped. How could that be? What were the chances that the winner of the weekend was the office manager she was learning so much about? She stood up and took a turn around her office. Suddenly, the other shoe dropped. My God, he’s dead. The winner is dead. The winner of the weekend at the lake place, who could have found my picture, is dead. Her heart beat faster as a combination of relief, followed quickly by guilt, confounded her. How can I feel relieved about someone’s death? She needed to get some air.
Jess checked her calendar to see whether she could leave the office. She decided to take a drop-in yoga class in her neighborhood, starting in thirty minutes—just the thing to calm her. She drove to the class, still trying to process this revelation. There was something just beyond reach in her mind, something still unsettled.
She got to the yoga studio, changed, and laid out her mat in the classroom by four p.m. The class started with some easy poses. Jess concentrated on her breathing and tried to clear her mind. Her muscles started to
respond to the gentle stretches, but her brain was still working overtime. Forty-five minutes in, she finally started to relax.
Just as the instructor called for corpse pose, Jess’s subconscious mind locked onto its target. It was the signature! Now she remembered why it had caught her eye. She had been going through Goodmoor office files, looking for anything that might help clarify their situation, when she had come across the scribble of a signature. It had seemed so odd that Floyd Ramsey, the Goodmoor manager, had signed the nasty note to an employee with such a flourish. And she had a similar-looking signature in her guest book from the lake house. If they matched, she would know for sure that Floyd had been there.
She fought the impulse to run from the studio as the other students near her continued lying as if dead. But the minute class ended, she would take the steps she needed to check the signatures and get the closure she needed so desperately.
She forced herself to walk calmly from the class and got into her car. She reached Joyce by phone at 4:55 and asked her to put the box of Goodmoor files in her office before she left for the day.
Jess’s heart raced as she drove the five blocks to her house, dashed in, and made a beeline to the guest book. One minute later, she quickly found the page, glanced at it, and hurried back out to the car.
She made it to her office by five thirty. Almost nobody around. The box of files sat on her table. She closed the door, stood over the box, and rifled through its contents. She found it. The nasty note. Floyd’s scrawl at the bottom. She took the guest book out of her coat pocket, pulled the note out of the box, and placed it next to the entry in the guest book on her conference table. She compared the writing. Could it be?
Her body trembled. She exhaled loudly. A match. Thank God! The man had a terrible signature, but it was terrible in both places. She sat down and concentrated on breathing normally and talked herself down. “The man who may have found the picture died in a car accident months ago—end of story. You were scared, but it’s over now.”
With that, she closed the box and felt her body go limp with relief that this ridiculous situation had finally been resolved.
Chapter 33
“Is there a piece missing? Something that we might not be seeing that could explain this?” Jess asked Joyce. The billing-audit specialist had just briefed her on possible overbilling at the Goodmoor practice. Joyce and Cindy had been poring over the audit results and were not happy; their empty coffee cups and papers were strewn across the conference table after several hours of frustrating effort.
“Well, nothing in life is certain,” Joyce responded. “But this is the data from their own office and covers the past seven years. Between the business manager’s death and the lack of long-term employees to decipher this, it’s hard to know for sure.”
“Cindy, what do you think?” Jess asked, frowning. “Does it look like it could be the result of sloppy work by poorly trained staff, or does it look deliberate?”
“We need to spend more time on this, right?” Cindy glanced at Joyce, who stood up to stretch and nodded in agreement. “Maybe the next step is to see if we can tie individual staff to the incidents of overbilling. Of course, that could still be just larger-scale negligence. It’s too early to point to a cause.”
“OK, and in the meantime, let’s keep this information among us. I’d hate to get a rumor going that could foil a deal or stop people from cooperating with this process.” As medicine became more of a business, Jess knew, MDs who had spent countless years learning the science and art of practicing medicine were tempted to allow those interested in, and supposedly expert at, managing the business to do so.
“How about if I order some lunch for you two?” Jess offered, and got hearty thanks from both women. When she left the room, she called Dr. Personne to let him know she would be dropping by to see him at the end of the day. She needed to get a read from him about whether he knew of any irregularities. She would give Dan an update based on Dr. Personne’s response. Dan didn’t like surprises any more than she did.
Later that day, as Jess drove onto the Goodmoor lot, Larry Personne crossed in front of her on his way to his Lexus. She stopped and called to him from her car. His fingers released their grip on the door handle. He responded like a schoolkid sneaking out early. “I wasn’t sure you were going to make it.”
“Sorry. I didn’t expect you to be finished yet. I got held up at the office.” She gave him a moment to recover. She had clearly told him she wouldn’t be there until five forty-five, and it was barely five thirty. “Are you available to chat for a few minutes now?”
Jess could see the conflict on his face. He responded with a weak smile, “Of course.” He looked up and down the street for a moment, then said, “Let’s walk down the block to Gabe’s. I’ll buy you a drink.”
He walked slowly and without a word, but by the time they reached the bar, he seemed to recover his composure and became quite chatty.
They talked about the weather and the state of road construction nearby. He was still nursing his vodka tonic after twenty minutes, when he started in on the forthcoming St. Louis Cardinals season. At this rate, he might go on forever.
Jess looked at his ringless left hand—probably no wife at home, making his dinner. Larry didn’t seem to be friendly enough to socialize with his staff, so Jess knew he was stalling. She held up her hand to refuse a second glass of wine from the attentive waiter. Time to move this along.
“We need to talk about some confusing findings on your audit. My team has spent considerable time on it now, and there are some inconsistencies in the Medicare billing that we need to understand.”
He downed the last of his drink and eyed everyone in the quiet bar. Finally, he shrugged and spoke in a pronounced whisper, as if sharing a secret. “You know, Jess, I don’t really know anything about any of that.”
“Larry, Floyd was an experienced manager, at the peak of his career. I can see why you delegated so many of the practice’s business dealings to him. But as head of the group, you were ultimately responsible for what he did. How did you two interact?” Jess wasn’t about to let him off the hook easily.
Larry jiggled his keys in his coat pocket. “Floyd handled everything. His death was such a blow to all of us, although of course I realize now that we should have been . . .” He hesitated and looked away. “I should have been more involved in the business aspects of things.”
Jess kept at him. “So, did the two of you have regular meetings and review the financials?”
Larry looked away.
“Often, a head physician pulls the manager and the lead billing person together to review the past month. Were you doing that or anything like that on a routine basis?” She wasn’t sure how much further she could push him.
“All right, all right. I wasn’t involved. I wasn’t interested, OK?”
Continuing to look him in the eye, Jess waited for the payoff. “So, what do you want me to say? That it was my responsibility and I let everyone down?” His voice rose. A guy at a nearby table looked their way. Larry fought to regain control. He slumped. It took him some time to gather his words.
“You know, when I was a kid, I realized I wanted to help people stay well and make them better if they were sick. I never once wanted to run a business. Managing people, keeping everyone happy in the group, keeping track of the business side of medicine—none of that is my interest or my forte. I can’t believe I’ve been doing it this long, and now that Floyd is gone . . . well, I realize how little I’ve actually done. And how much I’ve let my group down.” His face drooped.
“Is that why you initiated a potential arrangement with Midwest Health?” Jess asked softly.
“Yes. Once Floyd was dead, I was clueless. I could see I had no understanding of our finances, much less of how to move forward to replace him. I panicked.”
“It’s very difficult to lead a group in this day and age,” Jess said. “Many have succession plans in order to avoid burnout for any one gro
up president, or they rotate roles so that everyone understands the business and is basically forced to evaluate decisions that affect their livelihood.” She slowed down to let that idea sink in before asking, “Did you ever think about stepping down and allowing new leadership to emerge?”
“Yes, yes, I did.” Larry made eye contact again. “But nobody wanted the position. I failed to groom a successor, and I failed to learn and perform my job as president. And now the group has pinned its hopes on Midwest Health.”
He paused and took a deep breath, exhaling slowly. “I’m so grateful that Jim Nathan mentioned a purchase by Midwest Health as a possibility. We’ve got to make this work.” His voice stronger again, he slapped the table with the heel of his hand. “It has to work.”
“Oh, so Jim Nathan suggested this to you?” Jess asked carefully, covering her surprise at this new information, a shiver tickling her spine.
“Yes. Jim’s been our senior surgical consultant for years and knew how we had depended on Floyd. He gave me the idea and set up the first meeting with the outreach guy at Midwest Health. And now here you are to do the assessment. There’s been no forward movement by the practice in the several months since Floyd was killed in that car accident. I’m really just treading water until this deal gets done.” He looked spent.
Jess responded with a lukewarm smile. “Larry, I appreciate your sharing this with me. I can understand what a great burden this is for you. But knowing this will help us sort things out.”
She noticed he was following her every word, and she needed more. “It would help if you could tell me if there’s anyone on the billing side who you think has a better handle on the history of the group’s financial practices.”