A former data analytics manager for OneCare Vermont who tried unsuccessfully to bring a whistleblower case against the health care reform organization is now suing for wrongful termination.
Robert Hoffman initially accused OneCare, a key player in the state’s all-payer reform effort, of violating the False Claims Act in a 2018 complaint to the U.S. Attorney’s Office. The federal law allows whistleblowers to sue companies on behalf of the government if they believe the government is being defrauded. Christina Nolan, the U.S. attorney for Vermont at the time, declined to intervene in the case, and Hoffman then withdrew it.
Hoffman’s chief contention in the whistleblower case was that OneCare was using bunk data to measure the reform effort’s success, and that he was fired for pressing the matter with his bosses. He reiterated these claims in a 13-page complaint filed in Chittenden County Superior Court in May, alleging wrongful termination and retaliation. He is seeking monetary damages, including back pay and benefits, punitive damages, attorney’s fees, court costs, and relocation expenses.
OneCare has denied all of Hoffman’s accusations in a June 2 filing with the court. In a statement, OneCare spokesperson Alida Duncan said Hoffman had worked for the organization less than two months, and the concerns he raised at the time “were thoroughly investigated and determined to have no merit.”
“Mr. Hoffman filed a lawsuit based on these very same allegations almost three years ago and then voluntarily dismissed it. It’s unfortunate to spend time and resources revisiting those allegations, but we intend to defend against this suit,” Duncan wrote.
In an attempt to rein in health care spending and improve the quality of care, Vermont is trying to transition the state from a fee-for-service model to a capitation system. The theory is that by paying providers a predictable lump sum based on the number of people served, capitation will remove the financial incentive for hospitals and doctors to provide unnecessary tests and services.
OneCare, which was created in 2016 and received a nonprofit designation from the IRS this April, is essentially a middleman. The accountable care organization, an entity established by the University of Vermont Medical Center, is responsible for divvying up payments made by private insurers, Medicare and Medicaid and doling them out to health care providers. (Both OneCare and UVMMC are named as defendants in Hoffman’s case.)
Nolan’s decision not to intervene in the whistleblower case left Hoffman with the option of pursuing a whistleblower suit on his own or filing an employment suit.
Norman Watts, Hoffman’s attorney, said Hoffman opted for the latter because Nolan had come to the conclusion that Hoffman’s claims did not meet the standard of “materiality.” For fraudulent conduct to be “material,” it needs to be significant enough to influence a government’s decision to pay for a particular good or service.
“Materiality is not the question in a retaliation case, nor in a wrongful dismissal case,” Watts said. “The question is whether they fired him for complaining about their misadventures and their analytical process.”
Hoffman’s suit comes at a pivotal time for OneCare. Its five-year contract is up in 2022, and state officials must decide within the next few months whether to renew it. Watts said there appeared to be interest from lawmakers and state auditor Doug Hoffer about investigating Hoffman’s accusations.
The auditor in 2019 called Hoffman’s claims a “big deal” and pledged to investigate them if Hoffman did not ultimately pursue them in court, and in 2020, Hoffman said he had turned his records over to the auditor’s office. Hoffer has repeatedly taken aim at OneCare, and earlier this week issued a new audit finding that the accountable care organization had so far cost more to run than it had saved the state in health care spending.
Hoffer said Wednesday that he was on Hoffman’s email distribution list and had “read his missives as time permits.” But asked to what extent an exploration of Hoffman’s allegations would feature in any forthcoming audits of OneCare, the auditor was noncommittal.
“Mr. Hoffman is knowledgeable and has a longstanding interest in these issues, but his views have not informed our audit work,” Hoffer wrote in an email to VTDigger. “As for upcoming health care audits, we just got this one out the door and have not yet made any decisions.”
