The whistleblower who accused OneCare Vermont of fraud will not pursue his case in court.
Robert Hoffman, who worked as a data manager for OneCare for two months in 2018, had said the accountable care organization was using inaccurate data and then lied about it to regulators and to the state. Hoffman also accused OneCare of firing him in retaliation for raising those concerns.
In November, U.S. Attorney Christina Nolan declined to move forward with the case against OneCare. Hoffman had the option of hiring a personal lawyer to prosecute the case, in which he has alleged fraud and unlawful termination.
“At this time, I’m moving on with my life,” he said in an email Thursday.
Hoffman says he stands by the allegations of wrongdoing.
The investigation “was not exculpatory for OneCare nor a commentary on the merits of my allegations,” he said. “If the case were baseless and lacking in merit – it would have been dismissed.”
OneCare spokesperson Amy Bodette declined to comment on the case.
The accountable care organization is charged with implementing the state’s all-payer health care system, which was launched in 2016. OneCare collects money from Medicaid, Medicare, and private insurers and then distributes the funds to doctors and hospitals. The company aims to save money by encouraging preventive care, and ultimately, by keeping Vermonters healthy.
That requires data: knowing what care patients are getting, being able to track the issues that are putting Vermonters in the hospital, and the measures that will keep them healthy. Those numbers can determine the funding that OneCare gets from the state and the feds, as well as how much they pay to doctors or hospitals.
Hoffman filed the case with the U.S. Attorney’s Office in August 2018 accusing OneCare of violating the False Claims Act, which allows a whistleblower to come forward if he believes a company committed fraud that cost the government money. He also asserted that staff at UVM Medical Center, which partly owns OneCare, also knew about the issues with the data.
In an interview in November, Nolan declined to say why she didn’t prosecute the case. The U.S. Department of Justice intervenes in less than a quarter of total of False Claims cases.
As part of his decision to drop the case, Hoffman turned over his documents and records to State Auditor Doug Hoffer. The auditor is in the midst of a months-long audit of OneCare and had previously said he’d look into the whistleblower complaint.
On Thursday, Hoffer said that while he’s interested in the allegations, it would be at least eight months before his office had time to investigate them thoroughly.
The whistleblower allegations “are just a slice of a bigger investigation,” the auditor said.
Hoffman also urged legislators to pass H.181, a bill introduced last year that would have granted the auditor’s office increased access to OneCare’s records. He also said he supported the prospect of the accountable care organization becoming a nonprofit, which Agency of Human Services Secretary Mike Smith requested in exchange for granting OneCare additional taxpayer dollars.
“I have never viewed these claims as my own, but instead, Vermonters’ — who deserve a remedy to THEIR claims,” Hoffman said in a statement.
Hoffman said he wouldn’t comment further on the allegations. His statement in full:
At this time, I’m moving on with my life.
DOJ’s investigation was not exculpatory for OneCare nor a commentary on the merits of my allegations. If the case were baseless and lacking in merit – it would have been dismissed. Instead, DOJ maintained fidelity to SCOTUS precedent – Escobar, in its decision to decline intervention against a backdrop of well documented sponsorship rather than regulation by GMCB and DVHA.
I have communicated to the SAO (State Auditor of Accounts) my intent to foreclose litigation at this time and turned over to his office all discovery in my possession previously provided to DOJ.
I have also enjoined Anne Donahue and her committee to finally move her bill — H.181 out of committee for a vote on extending SAO broadened investigative powers. Alternatively, Mike Smith’s recent conditional offer could be predicated upon OneCare voluntarily extending SAO the transparency H.181 portends.
Further, I now enjoin the House Healthcare Committee, the Senate Health and Welfare Committee, and the Health Reform Oversight Committee to closely monitor SAO’s investigation as they contemplate extending OneCare additional taxpayer funds as they’ve been lobbied to do by OneCare and its lobbyist.
I have never viewed these claims as my own, but instead, Vermonters — who deserve a remedy to THEIR claims.
