Has the Office of Inspector General seen Dr. El Sanadi’s CEO Contract with Broward Health?

“Oh what a tangled web we weave when first we practice to deceive.” – Sir Walter Scott

According to the Broward Health’s contract with Dr. El Sanadi as CEO, Broward Health recognizes him administratively as CEO, as a physician who works in the Emergency Room (4 hours per week), and as a Medical Director for the Cities of Fort Lauderdale, Sunrise, Tamarac and the Broward Sheriff’s Office.

Also according to Dr. El Sanadi’s contract, he will receive a substantial bonus based on the financial performance of Broward Health.

As a physician who works in the Emergency Room, he has the opportunity and sometimes the responsibility to admit a patient to inpatient or outpatient status with the hospital.  This is a referral to a health system with which he has a financial arrangement.

As the Medical Director for the cities and Broward Sheriff’s Office (BSO) – he is the physician for their EMS activities that can deliver patients to a variety of hospitals for emergency, inpatient and outpatient services.  This can result in a referral to a health system with which he has a financial arrangement.

Not referenced in Dr. El Sanadi’s contract, are his on-going businesses:

  • South Florida Fire Rescue Medical Directors’ Association, LLC
  • N & L Services, Inc.
  • Total EMS, Inc.
  • El Sanadi Holdings, LLC
  • Green Harbor Company

nobody_tells_meDepending on the business activities of his on-going businesses, they might also refer patients to a health system with which Dr. El Sanadi has a financial arrangement.  The nature of the activities for Dr. El Sanadi’s businesses is unknown not only because of the Board’s seemingly abject failure to adequately negotiate Dr. El Sanadi’s contract and protect the public, but also because of Dr. El Sanadi’s apparent failure to be forthcoming with the information.  After a public records request was made for this information, Broward Health’s attorneys asserted that information about Dr. El Sanadi’s ongoing businesses is not public, and therefore related documents are not public records. See the public records request here.  See Dr. El Sanadi’s  (through Broward Health’s attorney) response to the public records request here.  See Dr. El Sanadi’s asserted exemption log  here.

As is generally known, the Office of the Inspector General (OIG) has been investigating Broward Health for some time, and is in the process of finalizing a settlement with the Hospital System all about STARK federal anti-kickback law violations.  The Stark Act is implicated when a hospital or health system has a financial arrangement, which can be either an ownership or compensation arrangement, with a referring physician.  Fines to Broward Health as a result of this investigation are rumored to be in the 10’s of millions of dollars that we Taxpayers will have to pay.  If so, this is money that will not be spent for Broward County’s Health care needs.  A copy of the draft OIG settlement agreement is here.

It is surprising then that the Broward Health Board would enter into a contract, which on its face seems to create STARK violations.  Certainly few could argue that the actual terms of Dr. El Sanadi’s contract with Broward Health, at the very least, create the opportunities for STARK violations.

What is even more egregious is section 6.3 of Dr. El Sanadi’s contract with Broward Health that essentially says that even if his outside financial arrangements are somehow not ethical, not lawful, and/or not permitted that “the parties agree to negotiate in good faith to secure a compliant alternative that provides for EL SANADI’S continued functioning in a medical director capacity during the term of the Agreement.”  See Dr. El Sanadi’s Broward Health full contract here. (A future Post will get into the public records request, and its responses.  Stay tuned.)

It is a public disservice when an important contract with wide ranging implications is negotiated by a politically appointed board member with little or no previous experience in negotiating contracts that affect the taxpayers, and a public institution – created, and paid for by public money –who hides behind words like “strategic planning” and “Trade secrets” to shield them from public oversight.  See my article “The Best Broward Health CEO contract politics can buy!”.

trust

Dr. El Sanadi needs to decide whether he will be a practicing physician and medical director or Broward Health’s CEO.  Ostensibly, to do both is to do both jobs poorly, and puts the public at risk for additional STARK violations.  The Broward Health Board Board of Commissioners, particularly it’s current chairman David Di Pietro and Governor Scott will be held responsible for the irresponsible actions of this politically appointed board.

 “Oh what a tangled web we weave when first we practice to deceive.” – Sir Walter Scott

Embattled Broward Health paid law firm $10.2 million; Tab included a lawyer’s M&Ms

Florida Bulldog has a great article published today; Embattled Broward Health paid law firm $10.2 million; Tab included a lawyer’s M&Ms  (click for the full story!!) written by Dan Christensen.  It’s a must read!

Here’s the first paragraph…

“Taxpayer-supported Broward Health has paid $10.2 million so far for legal advice about how to deal with an ongoing federal investigation into allegations that it colluded with doctors to submit tens of millions of dollars in bogus claims to Medicare and Medicaid.”

Board of Commissioners Rubber Stamp Shady Deals at Meeting – Very Tacky.

Dateline:              February 25th, 2015 4:00pm
Broward Health North Conference Center

In Pompano Beach Florida, a windowless conference room decorated with chandeliers made out of tinsel, about 85 highly paid staffers, a few vendor representatives and as many as 3 people purportedly representing the public assembled for February’s public meeting of the Florida’s Broward Health Board of Commissioners.  On the dais the Board is flanked on one side by Sam Goren, its highly experienced and knowledgeable corporate counsel and on the other side by their recently appointed (see previous articles) CEO Dr. El Sanadi, CFO and Board Auditor.  And so the stage is set for a three hour meeting remarkable in its resemblance to Alice’s tea party (Disney– Alice in Wonderland (1951)) and more for what is not said than what was.

Meeting20150225After appropriately recognizing employee contributions with the obligatory distribution of plaques with pictures, the public was offered an opportunity to speak guaranteed by state statute.  (It is important to note that the public also has an opportunity to speak on each and every item on the Board agenda – guaranteed by state statute but that opportunity has only once been acknowledged by the Board in this writer’s more than three years attending meetings, and that was only by this writer’s insistence.)

The second of three speakers to address the Board came with carefully prepared notes to address the ENT physician contract approval that was appearing later on the agenda.  The speaker was a physician himself and he had serious questions wrapped in what the CEO and the Board asserted were misconceptions.  The contract was for on-call services for an Ear-Nose & Throat (ENT) specialist required under federal licensure for trauma hospitals.  The speaker asked how a new contract could be negotiated for 1 doctor (yes, one doctor) to replace a contract for 7 doctors (yes, seven doctors) for what was essentially $100.00 saving per day.  The speaker also raised issues relating to abnormalities in credentialing, e.g. rushed process, objection by the surgery staff, etc..  Notably, the Board Chair jumped in and said “no fair” (I’m paraphrasing), credentialing comments are confidential (he would know – he routinely represents physicians legally and “recuses” himself from votes regularly).  And the speaker raised even more concerns – that of the obvious coverage issue for one doctor to cover 4 hospitals that was covered by 7 doctors in the old contract.  The clear subtext of the speaker’s comments was the belief that the renewal of the old contract was not negotiated in good faith and the new contract was inadequate for the needs of the hospital system.  As a result of this speaker’s comments, the contract item was removed from the consent agenda to the discussion agenda which meant that there would be more conversation on the board for this item.

The final public speaker raised similar “process” concerns about a proposed million dollar sole-source lease for an orthopedic robotic surgery device for Broward Health North.  The speaker represented a competing company and asserted that the robotic device should not be a sole source and called into question the apparent one-sided process that precipitated the agenda item.  As this item was already on the discussion agenda, we were all assured a later conversation would ensue.

Because I want to delve a little deeper into the matters raised by the public speakers before I run out of space, I will skip some of the other agenda items that will be the subject of future articles.

The ENT Contract

To understand what happened with the ENT contract, there has to be an understanding of both the politics and personalities involved.  The previous ENT contract with Dr. Callari expired naturally on January 30th and was by any measure a bad contract that was grossly overpaid.  So why did Dr. El Sanadi fail to renew the agreement when after some tough negotiations, when the difference between renewing the contract with Dr. Callari who provided  7 physicians versus a new contract with Dr. DuMornay as a single physician was only somewhere around $100.00 per day?  For the answer, one needs to look to past presidential politics, petty jealousies, and abrasive personalities which serves as a micro-study for the management problems at Broward Health amplified by the ouster and replacement of the previous CEO.

There is a generally believed story that a dispute between Broward Health’s current chair and Sara Howley, the wife of Dr. Callari, started over a purported “lost” invitation to a Romney fundraiser in which Mrs. Romney was scheduled to appear.  The result was that the chair missed the event and Mrs. Romney.  It appears the Chair thought the “lost” invitation was intentional rather than an email foul-up, and a minor political dust-up ensued.  But here is where it gets interesting.   Sara Howley is the wife of the Dr. Callari and also the well-respected vice president of Corporate Communications at Broward Health.  At the same time that the ENT negotiations between Dr. El Sanadi and Dr. Callari were getting contentious, Sara Howley abruptly resigns her position (late January 2015).  It is generally believed that she was forced out with a resign or be fired mandate from Dr. El Sanadi on “instructions” from the Chair.  Very tacky.

But the ENT contract story gets even better and more curiousDr. DuMornay, the new contractor Dr. El Sanadi “recruited” actually previously worked with Dr. Callari’s ENT group until they had a falling out and because Dr. Callari enforced a non-compete clause, Dr. DuMornay moved to Georgia to work. But wait, it gets better.  In 2012 after the Dr. Calari’s original ENT contract was extended to provide time to negotiate a smooth transition to in-house (Broward Health employed physicians), Broward Health recruited Dr. DuMornay from Georgia to come and work for Broward Health.  The plan was for Dr. Callari to be on call for two weeks, and Dr. DuMornay together with other ENT physicians Broward Health intended to hire to work for a few weeks as a transition to the complete elimination of the ENT contract that had been so troublesome.  Dr. DuMornay agreed to and signed a contract – but then, just didn’t show up.  No notice, he just didn’t show up.   Apparently he later gave the reason that he wasn’t going to be paid enough. Surfacing just in time for Dr. El Sanadi to “recruit” and give him a new ENT contract, but not in time to go through the normal burdensome credentialing process at Broward General.

Now you know the rest of the story.

It should be noted that all these ENT physicians are experienced and perhaps even exceptional clinicians, but the extraordinarily unprofessional manner in which this contract was negotiated and eventually approved at this meeting is a throwback to the dark days at Broward Health where politics ruled.

As taxpayers, we should all be worried – and the Inspector General’s Office should take note.

I’m out of space for this article so In Meeting – part 2, I will add some additional tidbits you might find interesting about this meeting.  Look for it in the next few days.

To be continued…

Broward Health – Deja Vu, all over again!

Historically, Florida’s Broward Health was used a cash register for the politically connected where everything from lucrative land deals, insider supply & service procurement’s, to outrageous physician contracts given to cliques of gate-keeping physicians were the rule and not the exception for our public hospital.   Typified by a revolving door of politically appointed CEO’s more interested in their next position than in the mission of Broward Health as one of Broward’s 2 public health care systems, Broward Health thrived as a financial political base for the political aspirations of Florida’s governor’s office.

Then a few years ago, almost by accident, a politically naive chief financial officer was suddenly elevated to the position of CEO (see my previous article).  Not knowing any better, this professional CEO began to put the district on a firm financial footing for the first time in the hospital system’s history.  But because this financial CEO never could master the politics of the system, he failed to correct the legacy of the past misconduct quickly enough, and did not address the dangerous politics of the well connected physician contracts.  This was, in part, due to pressure from the politically appointed Board of Commissioners and the historically absent public oversight.  Instead, this CEO focused on financially strengthening the system and investing in quality health care system initiatives, again largely ignored by absent public oversight.

MoneySuckThe result was a whistle-blower complained to Medicare (OIG – Office of the Inspector General) about the excessive physician contracts at the system, and a federal investigation ensued.  The financial CEO was named in the complaint because he did not confront the improper direction from his political board, and failed to address the problems quickly enough.  In fairness, he was between the proverbial rock and hard place.  Soon you will hear about this OIG investigation because it is widely believed that it is coming to an end with a significant financial penalty in the tens of millions of dollars, against our public hospital for the misdeeds of past politically appointed boards and CEO’s.  A fine, we as taxpayers, must and will pay.

Recall that Broward Health was established many years ago as a tax supported public hospital system to serve the health care needs of Broward residents living north of Griffin Road.  Over the years, with substantial tax support, the system has grown to 4 hospitals, over 50 facilities including urgent care neighborhood centers, close to 8,000 employees and annual billings of close to 4 billion dollars (with a budget of over 1 billion dollars). From every perspective, it has become a substantial economic engine in our county.  Simply put, the money that goes to Broward Health generally stays in Broward – and that’s good.

But because of the governance structure of the hospital system, it essentially operates without effective oversight from those it serves, or the public that owns the system.  Its Board of Commissioners are appointed by the Governor, and so it is no surprise that the Board of Commissioners are either political operatives or simply the unapologetic result of political patronage with little or no relevant experience.

For much of the past year, Broward Health’s 7 member Board of Commissioners operated with only 4 and 5 members because the Governor’s office failed to timely fill vacancies.  3 of these members effectively orchestrated the financial CEO’s ouster and replaced him with a well-connected politically active physician through a sham recruitment and interview process.  2 of the 3 are political operatives, only recent Broward residents, and have no business or public policy experience.  In contrast, the leader of the 3, has an extensive but recent political pedigree – but no previous business or health-care experience.  It is noteworthy that this new CEO – has given tens of thousands of dollars to political candidates, committees and PAC’s in recent years.  It is not a coincidence that the current chair of the Board of Commissioners and the purported architect of the ouster is known as a prolific political fund raiser who maintains a number of political committees and PACs, which have benefited from the largess of the newly appointed CEO. Why else would the Board hire a person with no administrative experience running a hospital system?  It is déjà vu all over again!

We should all be nervous.