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Is the Bill Cassidy LSU billing row over or rigged ?
Written by  // Thursday, 26 February 2015 12:26 //

landrieu-cassidyIs the Bill Cassidy LSU double-billing controversy jigged or rigged?

 

Is the "jigged-up" Bill Cassidy LSU double-pay controversy over, dead and gone, as at least one conservative commentator claims?  Or, has a just-released LSU audit of the "scandal" that arose during the last moments of the very hotly contested election  between former US  Senator Mary Landrieu and then US Rreepsentative Cassidy, been rigged due to powerful influences?   Apparently, according to the public sentiments of the two bloggers who broke the story, Lamar White Jr. and Jason Berry, the audit is worthless.

Conservatives and those backing Cassidy during the 2014 election felt the charges leveled against Cassidy were trumped-up and bogus and cite the LSU audit as vindicating Cassidy.   

 To understand whether the controversy is now history, let's look at the LSU Audit which was released on Wednesday details the facts of the controversy:

Initiation of the Review During the 2014 campaign for the United States Senate, Senator Landrieu’s campaign raised concerns of improprieties related to Dr. William Cassidy’s part-time employment with LSU Health Sciences Center. Specifically, it was alleged that Dr. Cassidy did not “earn” his salary from the Health Sciences Center. This allegation is predicated primarily upon timesheets produced in response to a public records request which reflected less than asserted required effort and which purportedly indicated that his Congressional and Health Sciences Center schedules conflicted. On December 1, 2014, in response to these allegations, we initiated a review of Dr. Cassidy’s employment arrangement with the Health Sciences Center. The focus of our review was to gather facts to facilitate a determination as to whether the services provided by Dr. Cassidy were commensurate with his pay independent of any asserted records deficiencies.

Finding Although Dr. Cassidy’s effort was not adequately documented by the Health Sciences Center, sufficient facts and information exist to conclude that Dr. Cassidy provided services equal to at least that of his compensation for his part-time educational work.1

According to the audit report:

Dr. Cassidy estimated he spent during the month of January 2009 on Health Sciences Center business, including clinical activity at Angola, LSU Healthcare Network private practice, discussing research issues and patient care issues with his research coordinator and Nurse Practitioner, speaking to residents and taking internet courses in research ethics required by the IRB.

The audit describes in some detail the monitoring of services allegedly performed:

Monitoring of Dr. Cassidy’s Performance
In January 2009, the Health Sciences Center Vice Chancellor of Administration and Finance provided
guidance in the form of an email to the EKL Medical Director and Dr. Cassidy that Dr. Cassidy’s “effort
should be documented and monitored and appropriate adjustments to percent of effort made, if
needed, in a timely manner.” He also directed that actual hours worked be documented and that work
performed be certified by the Medical Director monthly. However, based on the documents provided
by the Health Sciences Center, this appears to only have partially been done as no records have been
provided that indicate the presence of a formal, comprehensive system to track Dr. Cassidy’s effort in
accordance with that guidance.
Because a formal documented tracking system was not in place and available for review, to gain
reasonable objective assurance that Dr. Cassidy did, in fact, perform the services for which he was paid,
we gathered available documentation and conducted interviews of those with knowledge of the
provision of those services. Documentation included, to the degree that they were available, the
following: 1) Health Sciences Center contracts with Our Lady of the Lake Regional Medical Center
(OLOL) and the Louisiana Department of Corrections, 2) timesheets, 3) emails and other
correspondence, 4) payroll file records, 5) personnel file records, and 6) patient billing data and billing
sheets. We also conducted interviews with members of Health Sciences Center management and
finance staff, Health Sciences Center School of Medicine employees located in Baton Rouge including
the Associate Dean, the Internal Medicine Department Head, Business Manager, and Nurse Practitioner,
and well as the OLOL Clinic Manager and the Louisiana Department of Corrections Medical Director. We
did not interview Dr. Cassidy although we did provide him that opportunity through his staff.
From January 2009 through March 2013, Dr. Cassidy primarily worked in EKL clinics providing patient
care, resident supervision and provided physician oversight on Health Sciences Center contracts with the
Louisiana Department of Corrections by serving as a “collaborating physician” for the Nurse Practitioner
who had primary responsibility for seeing hepatitis patients in the prisons. In April 2013, the EKL clinic
closed and was moved to OLOL. Dr. Cassidy continued to provide patient care and resident supervision
as he had previously at EKL with the exception of liver biopsies, which are now performed by another
department of OLOL.
Earl K. Long/OLOL Clinics
The Health Sciences Center used timesheets completed by clinical faculty as a means to support billing
on physician services agreements. For those faculty receiving no salary supplement such as Dr. Cassidy,
timesheets are not used for payroll purposes. Therefore, Dr. Cassidy’s timesheets were not used to
support or justify any payments made to him by the Health Sciences Center for his part-time work.
However, in accordance with the requirements of an agreement between the Health Sciences Center
and the LSU Health Care Services Division (HCSD) initially and later OLOL, timesheets should have been
prepared for EKL from July 2012 to March 2013 and at OLOL from April 2013 to March 2014. No
timesheets were completed for Dr. Cassidy’s work on the Department of Corrections contracts as it
appears that none were required by the contract. In all, six timesheets were provided for Dr. Cassidy’s
work at EKL, one for each month from July 2012 through December 2012. Each timesheet reflects Dr.
Cassidy’s signed name and an average of five hours of specified and designated work per week. No 5
timesheets were provided for the period January 2009 through June 2012 as it appears that this was not
a requirement of prior agreements with HCSD.
As detailed below, for the time period between January 2013 and March 2014, timesheets were either
missing or lacked certification by Dr. Cassidy and his supervisor. Timesheets were missing for the period
of January 2013 through March 2013, November 2013, and December 2013. When the EKL clinics
moved to OLOL in April 2013, the hepatitis clinic was staffed on Tuesday mornings. Dr. Cassidy was one
of three physicians, along with residents, to staff the clinic. Scheduling was worked out among the
physicians such that Dr. Cassidy would be scheduled for clinic two to three times a month. We were
provided 10 timesheets for Dr. Cassidy related to his work in the OLOL clinic. These timesheets were
only intended to capture work on the OLOL contract and, again, would not have included any efforts
related to supervision of the nurse practitioner and the Department of Corrections contracts. However,
even for only the OLOL clinic work, the timesheets appear to be of limited materiality or value for
documenting Dr. Cassidy’s actual time worked. Three of the timesheets were signed by the Business
Manager for Dr. Cassidy with all others being unsigned. None of the timesheets for the OLOL clinic were
signed by Dr. Cassidy himself. The Business Manager acknowledged that he prepared the timesheets for
Dr. Cassidy and stated that he did so after verifying with clinic staff the physician schedule and inquiring
as to whether Dr. Cassidy was in clinic for a particular month. He stated that he recorded those hours
based on the best recollection of the staff, and if the staff did not recall or Dr. Cassidy was not
scheduled, he did not prepare a timesheet for that month. Differing understandings were
communicated to us from the School of Medicine – Baton Rouge management and staff as to whether
hours recorded on the timesheets represents time Dr. Cassidy was physically in the clinic. Some
explained that a portion of the hours recorded could have been worked outside of the clinic for the
benefit of the LSU OLOL contract. Others thought that the hours recorded would represent time
physically in the clinic.
As noted above, given the lack of a reliable documentary tracking system, we gathered additional
available information through interviews and records requests. We interviewed Health Sciences Center
employees located in Baton Rouge including the Associate Dean, the Internal Medicine Department
Head (Dr. Cassidy’s immediate supervisor), Business Manager, and Nurse Practitioner. All interviewed
expressed satisfaction with Dr. Cassidy’s work and stated that it was their belief that his pay was fully
justified and supported by the services provided.
We also verified with the OLOL Clinic Manager that Dr. Cassidy does regularly attend clinic. She stated
that, although she does not manage the physicians’ schedules, she is aware that Dr. Cassidy is physically
present for clinic at least twice per month. She also confirmed that his responsibilities for that clinic are
primarily related to teaching and serving as the collaborating physician for the Nurse Practitioner. She
stated that Dr. Cassidy loves to teach and is very good at it; she also indicated that she always knows
when he has been in clinic because the white board is filled with his notes from instruction given to
residents. She also recounts having observed the Nurse Practitioner contact Dr. Cassidy by phone at
times when he was not scheduled for clinic to discuss patient care. We obtained resident schedules
from July 2012 through December 2014 and confirmed that residents (usually three or four) were
actually scheduled in the hepatitis clinic on Tuesday mornings. It was also noted that, although Dr.
Cassidy has not received compensation from the Health Sciences Center since March 2014, he has 6
continued to provide patient care and resident supervision in the OLOL clinic and to serve as a
collaborating physician for the Nurse Practitioner.
Although Dr. Cassidy received no additional income from patient billings, the Health Sciences Center did
bill for patient care provided by Dr. Cassidy. We therefore reviewed information related to patient
encounters at the EKL/OLOL clinics. We obtained a list of charges billed under Dr. Cassidy’s provider
number from January 2009 through March 2014. We also selected a sample of the supporting billing
sheets to confirm Dr. Cassidy’s presence. The following was noted regarding the frequency and volume
of patient contacts at the clinic independent of other educational duties not involving patient contact
and his collaboration with the Nurse Practitioner:
 There were 214 distinct dates where charges were generated for Dr. Cassidy’s clinical services,
resulting in an average of 3.4 days per month for which patient billing occurred indicating that he
was either in clinic or performing liver biopsies (until EKL closed).
 There were 1,286 encounters involving 833 individual patients, averaging 6 encounters per day
worked.
 Dr. Cassidy’s presence in the clinic and performing liver biopsies (until EKL closed) generated an
average of $35,000 in annual charges and $9,000 in collections for the Health Sciences Center.
 At least 60% of the patient contacts for sampled billing sheets had documented evidence of the
involvement of a resident, along with Dr. Cassidy.
Louisiana Department of Corrections
The Louisiana Department of Corrections has for many years contracted with Health Sciences Center for
health care services for prison inmates. Three such contracts with deliverables related to the provision
of care to hepatitis patients are represented to have been, at least in part, satisfied with physician
oversight and physician/Nurse Practitioner collaboration provided by Dr. Cassidy. These contracts
require the Nurse Practitioner, for whom Dr. Cassidy serves as a collaborating physician, to provide
services on-site for a minimum number of days per month, plus teleconferencing for one of the
contracts. Nurse practitioners providing these services are required to collaborate with a medical
doctor. Two of these contracts provided funds specifically for physician oversight. Annual contract
amounts for only the physician oversight portion of the contracts was $25,000 for one and $15,000 for
the other.
We contacted the Medical Director for the Louisiana Department of Corrections who confirmed that
services are provided by the Nurse Practitioner and Dr. Cassidy in accordance with the contract
requirements. He indicated that he is aware that Dr. Cassidy’s involvement with direct patient care was
significantly reduced after his election to Congress and that his role since has been to serve remotely as
the collaborating physician for the Nurse Practitioner who conducts hepatitis clinics in the prisons. The
Department of Corrections Medical Director also stated that he observed a number of emails regarding
prisoner care that reflect collaboration between Dr. Cassidy and the Nurse Practitioner. Maintenance of
documentary timekeeping records for the physician collaborations does not appear to be a usual
practice.7
The Nurse Practitioner, who estimated that approximately 75% of her responsibilities related to
satisfaction of deliverables on the Department of Corrections contracts, described to us frequent
contact with Dr. Cassidy regarding this work. She indicated that this contact was mostly by telephone or
email, although she stated that she does meet with him in person regularly but less frequently than
when he was full-time. To gain reasonable assurance that Dr. Cassidy was, in fact, in regular
communication with the Nurse Practitioner and consequently performing the oversight function, we
documented that approximately 160 email communications occurred between Dr. Cassidy and the
Nurse Practitioner related to patient care during the period from January 2012 through March 2014.
We did not attempt to verify telephone calls or contact by any other means which may have revealed
additional contact.

According to the conservative publication The Hayride, the  scandal was politically manufactured and politically desperate.

 http://thehayride.com/2015/02/dont-fall-over-but-lsu-concludes-their-bill-cassidy-investigation-and-clears-him/

Its publisher, Scott  McKay wrote:

The complaint against Cassidy was that he wasn’t punching in and out in a sufficient manner to prove he was working eight hours every week. And that somehow he was therefore stealing money from LSU and the taxpayers in Louisiana. This, despite the fact nobody at LSU ever complained they weren’t getting $20,000 worth of value from the U.S. congressman sitting on their payroll who was also supplying them with their only gastroenterologist on staff.

It was always a pathetically ludicrous claim, and yet when White and the Reeds and the rest of the Louisiana Democrats’Mystery Incorporatedcrew released it into the ether Landrieu’s camp jumped on it like they had Watergate on their hands. Of course, Landrieu’s camp was likely the instigator of all this; when Lamar White gets “research” to “break a story” it’s usually because somebody in the Democrat Party is feeding it to him.

And so, a great hope for a scandal dies a quiet death. Turns out the meddling kids and their stupid dog can’t stop the bad guys from getting away with it – because there’s nothing to get away with in this case.

 Blogger White, however, will not apologize.

In a blog post today, he feels Cassidy has not been vindicated and that serious questions still remain:

Editorial addendum: Considering Jason Brad Berry and I broke this story in November and in light of conservative commentators demanding that I issue some sort of statement of apology, I wanted to make this unequivocally clear: I absolutely do not regret and will not apologize for calling attention to this important story. As I said on Jim Engster’s show shortly after the audit was released, this audit was nothing more than a blatant attempt at damage control. It was farcical and propagandistic, and it wholly avoided the most critical and most troubling aspects of the story, once again underscoring the need for a truly independent investigation and audit. As Jeffrey Bostick succinctly observed, “LSU finds LSU acted appropriately.” It serves as yet another example of the ways in the Louisiana tolerates the fox guarding the hen house and is of very little value to those seeking the truth. While some suggest that Dr. Cassidy was somehow vindicated, the truth is that the audit actually proved what Sen. Landrieu had been saying all along: Dr. Cassidy systemically neglected documenting his work, and while other “similarly situated physicians” were not obligated to account for their work through time sheets, Dr. Cassidy was. The absence of records is truly alarming, because it means that a public university frequently compensated a member of Congress for work that had never been documented. LSU’s reliance on the conflicting testimony of Cassidy’s peers should be considered problematic. It failed to produce anything more than hearsay.

Louisiana deserves an open and transparent government. Taxpayers deserve to know whether they are paying a prominent physician for medical care or a powerful politician for influence. We should demand to know how and why the Congressman could have been in two places at once. LSU has done a great disservice to the people of Louisiana by focusing more on praising a United States Senator and made a completely bogus justification of work effort and responsibility.

Not surprisingly, Jason cuts right to the chase. “If you had any doubt that some very powerful people are above the law in the state of Louisiana,” he writes, “this should put those doubts to rest. I still maintain that state Inspector General and/or the Legislative Auditor should have conducted their own investigation but that won’t happen because the game is rigged.”

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