CUMBERLAND COUNTY, N.C. — Recent questions of hospital overbilling have now surfaced in two area counties. First Health in Moore County faces a federal audit because of irregularities in ambulance billing. The county's Emergency Management Services director later resigned. Now, a paramedic in Cumberland County has taken fraud allegations to state and federal investigators.
Cape Fear Valley Medical Center's Life Link trucks are like hospitals on wheels. They transport people who need high-level life support from hospital to hospital.
For more than a decade, critical care paramedic Melissa Wen Petren worked in emergency services for the hospital. She claims the hospital regularly manipulated transfers to overcharge Medicare, Medicaid and private insurers.
"It's all about the money," Wen Petren said. "They care more about money."
To back her allegations, Wen Petren produced two boxes of medical records and billing she copied while working as a Life Link supervisor. She said it was Cape Fear's policy to place a respiratory therapist, or RT, on almost every pediatric run, regardless of need.
By doing that, Wen Petren said Cape Fear could bill $1,700 plus mileage. And she said it did not stop there. She claims cardiac monitors were unnecessarily placed on dialysis patients so they could be billed for Advanced Life Support. Yet, all they needed was Basic Life Support, which costs at least $100 less or no ambulance at all.
"A lot of these patients don't need to go by ambulance," Wen Petren said.
Clinton Weaver, spokesman for Cape Fear Valley Medical Center, said the hospital started investigating Monday, although Wen Petren refuses to turn over her records to them.
"We take any allegation such as this very seriously," he said. "So far, we haven't found anything to substantiate her claims, nor do we believe them to be true."
Under the law, Cape Fear Valley Medical Center cannot comment on Wen Petren's personnel history. Wen Petren filed an EEOC gender discrimination complaint against the hospital last year. She is also fighting a demotion.
"The proof will be in the pudding as to whether there's any legitimacy to those complaints or not," Weaver said.
Wen Petren believes the state and federal agents with whom she's met will find the truth about Cape Fear's billing.
"All the money they collected, that they overbilled -- where has it all gone?" Wen Petren said.
As is standard practice, state and federal Medicaid/Medicare agents will neither confirm nor deny an investigation. Wen Petren points out her allegations relate only to billing, not quality of care at Cape Fear. She said she is unsure how much could have been overbilled.