Sue Grafton - P is for Peril

Joel Glazer rose to greet me and the two of us shook hands. His looks surprised me. I was so enamored of Dana Jaffe's beauty that I'd imagined a mate for her equally good-looking. My reaction to Joel was much like mine when I first saw the photographs of Jackie Kennedy and Aristotle Onassis-the princess and the frog. Joel was in his sixties, with a high, balding forehead, his once fair hair turning a tawny shade of gray along his temples. Behind frameless glasses, his eyes were brown, with heavy creases near the outer corners. His mouth was bracketed with deep lines. When he stood up to greet me, I realized he was shorter than I, probably only five feet four. He was portly and his shoulders were hunched in a way that made me want to monitor my calcium intake. His smile revealed a gap between his two front teeth, which were discolored and slightly askew. He wore a fresh white dress shirt, with a pair of flashy cuff links, his suit jacket arranged neatly over the back of his chair. I picked up the faint citrus of his aftershave. "Nice to meet you, Miss Millhone. Have a seat. I understand you and my wife have a prior acquaintance."

I settled into a brown leather wing chair that blended perfectly with the cream, beige, rust, and brown of the carpeting. "Seems like a long time ago," I said. I wasn't sure how much Dana'd told him about her prior life and most of that story seemed too complicated to summarize in conversation.

He settled back in his chair, his right hand resting on the desk in front of him. He had a signet ring on the middle finger that glinted in the light. "No matter. You're actually here with regard to Dow. Fiona tells us she's hired you to track him down. I'll tell you what I can, but I'm not sure that's going to be much help."

"I understand," I said. "Could we start with Pacific Meadows? I gather there's been a problem with the Medicare billing."

"My fault entirely. I blame myself for that. I should have kept an unofficial eye on the day-to-day operations. Harvey Broadus and I- don't know if you've met him-my partner…"

I shook my head in the negative, allowing him to continue.

"We've had a host of projects in the works this past six months. We've been partners for years. My background's business and finance where his is real estate and construction-a match made in heaven. We met on the golf course fifteen years ago and decided to go into partnership building retirement communities, nursing homes, and board-and-care facilities. Both of us had parents who were deceased by then, but the need for attractive housing and skilled nursing care for the elderly was something we'd both struggled to find and not always with success. Anyway, long story short, we've now put together an impressive chain of residential health care and intermediate-care facilities. Pacific Meadows, we acquired in 1980. At the time, it was shabby and poorly run. We could see the potential, but the place was losing money hand over fist. We poured close to a million dollars into the renovation and improvements, which included the new annex. Soon after that, we made the lease arrangement with Genesis Financial Management Services. Somebody-I forget now who-suggested Dow's name to Genesis as a possible administrator. I'd known him socially and could certainly vouch for his reputation in the medical community. He'd just retired from private practice and was looking for a way to occupy his time. Seemed like a worthwhile arrangement for all the parties concerned."

"What happened?"

"I wish I knew. Harvey and I are often out of town, crisscrossing the state. We've probably taken on more than we should, but Harvey's like me-the two of us thrive on pressure." The phone on his desk began to ring. He glanced at it briefly.

"You need to get that?"

"Dana will pick up. I should go back and fill you in, at least superficially, on how this business works. What you have essentially are three separate entities. Harvey and I own the property through Century Comprehensive, which is a company we formed back in 1971. By property, I'm talking now about the land and the building occupied by Pacific Meadows. The nursing home is actually operated by Genesis, as I've mentioned before. They lease the physical plant from us. They also handle all the billing: accounts payable and receivable, Medicare and Medicaid billing, DME purchases-that's durable medical equipment, in case you're wondering. Genesis falls under the larger umbrella of a company called Millennium Health Care. Millennium is publicly held, and as such, they're required by law to submit financial information to Social Security, and by that, I mean lists of assets, liabilities, and the return on equity capital. A certified public accountant has to verify those figures. Ten, fifteen years ago, an owner and operator were often one in the same, but times have changed. By law, those functions now have to be separate and distinct. It's like a system of checks and balances, keeps everybody on the up and up."

"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-"