*****See Below*****

Please Note: Our Model Letters are just that: models. The facts, events and circumstances that are depicted in these model letters have been created solely to illustrate what you can do for yourself. Your own letters must use actual facts, events and circumstances, and should use your own words, phrasing, and writing style.

If you ever file a report of wrongdoing by your colleagues, your superiors and/or your company, you will likely be asked to sit for an interview as part of your company’s investigation of the matter. Very commonly, the “investigation” is not an investigation, but only an assessment of what you know, and how the employer’s legal counsel can protect the employer from what you know. Never expect your employer’s legal counsel to seek the truth, for that is not their job, as they see it. They see their job as “risk elimination,” and so will commonly “bury” the truth if they can. This model letter is intended to frustrate that purpose, and to instead set a clear, permanent record of what you said and did in your meeting with legal counsel, so that the truth can not be “buried.”

[Sent by Email and Federal Express]

To: Robert Jimenez, Esq., (Hartling & Honig Law Firm)
Marcia Schookman, Human Resources Director
Cc: Evelyn Corrado, Esq. (Hospital General Counsel)
Fr: Marilyn Gibraltar, Chief Bariatric Nurse
Re: Internal Investigation: My Reporting of Insurance Fraud re: Bariatric Surgeries
Dt: July 26, 2007

Dear Mr. Jimenez and Ms. Schookman:

Thank you for meeting with me yesterday following my reporting to CEO James Morales the fraud I have witnessed in our hospital regarding Bariatric Surgeries.

I know that you took notes in our meeting, and that your paralegal took notes, too. I am aware that no one can ever see those notes, since you have told me that are 100% confidential because they are something called “Attorney Work Product.” It is for this reason that I have decided that it is best that I MAKE A CLEAR, PERMANENT RECORD OF WHAT HAPPENED IN OUR MEETING. If you disagree with any fact, event or circumstance that I write in this memo, please me know – in an email – immediately, and we can resolve our different memories. I know we both want the truth to come out, whatever that truth is.

A. Overall/General: I sat with you and Ms. Schookman for six hours (with a short lunch break) and answered every question without exception, without pause, without hesitation. You and Paralegal Bruce Cohen took voluminous notes. Your notes were handwritten, while Bruce’s notes were on a laptop computer. My request to have my attorney present was denied. When I started taking notes, you ordered me to stop. I was told that there was no tape recording of the meeting.

B. Law Enforcement Authorities: You started off the meeting by asking me if I had told anyone other than CEO James Morales, my attorney and those in the room of my “allegations.” I told you that I had not. You asked me if I had been in contact with law enforcement authorities. I told you I had not, that I thought that was your job. When I asked you if you were going to do that, you told me I had no right to ask you questions.

C. Facts of Fraud Reported: I reported to you that Dr. Budinsky had ordered me and my assistant, Akeem, to “make sure more patients qualify for insurance reimbursement, because when they aren’t they don’t come back.” When Akeem and I asked Dr. Budinsky how we should do that, he told us “Change their BMI [that means Body Mass Index] by making them shorter than they are, or add 20 pounds to their weight. I don’t care how . . . just do it.” I have not done that, and I won’t. However, I know that Akeem has done that several times. Akeem told me Dr. Budinsky has paid Akeem money from his own practice, which violates hospital policy; I’ve even seen the checks.

D. Attached are Copies of Document I Gave You: At the meeting, I gave you (1) seven Insurance Qualification Forms that list people as three or four inches shorter than they are; (2) a copy of one check Dr. Budinsky gave Akeem; and (3) four Insurance Qualification Forms on which my signature is obviously forged.

E. Names of Witnesses to the Fraud that I Gave You: I told you that hospital employees (1) Robert Denny, (2) Margaret Cadler, (3) Noelle Winters, and (4) Sara Helmley, all witnessed what took place.

F. I requested that the Board of Trustees All Be Notified: I requested that all members of the Hospital’s Board of Trustees be notified of that fact that I have reported this fraud, and that you are investigating it. You declined to respond to that request.

G. I requested that the Hospital Not Retaliate Against Me. You assured me there would be no retaliation, “provided [I] continue to cooperate.” I felt then, and I feel now, that statement was a threat.

Let me know if there is anything else I can do to help in your investigation. I hope you won’t delay in your efforts, because surgeries not warranted by medical need can result in unnecessary patient deaths.

Respectfully, [Documents Attached: 18 pages]

Marilyn Gibraltar, RN
Bariatric Supervisor

***This letter is not, and is not intended to be, legal advice, which must be provided only by an attorney licensed to practice law in your locale. Nor is it intended as a substitute for legal advice. Instead, it is suggested as a model to be considered in conjunction with legal advice.

© 2008 Alan L. Sklover. All Rights Reserved; Commercial Use Prohibited

? Return to Model Letters