Whistleblower alleges Hopkins favors out-of-state patients for profit

(Story updated at 3:35 p.m. on Dec. 18, 2017, to reflect comments from Johns Hopkins Medicine.)

The Johns Hopkins Hospital System has been violating its revenue agreement with the state of Maryland by favoring out-of-state patients over in-state residents in an effort to raise profits, according to an amended whistleblower lawsuit Wednesday.

Anthony C. Campos, who worked as director of patient access operations for more than six years ending in January, claims Hopkins has given out-of-state patients priority access to health care services over Maryland residents since December 2014.

A spokeswoman for Johns Hopkins Medicine said it would not comment on ongoing litigation, but said the complaint is “without merit.”

“Safe and high quality care for all patients, regardless of where they live, is our number one priority.  Our census shows that the majority of our patients are from Maryland and that the number has steadily increased over the past several years,” Hopkins said in a statement.

Under the agreement between Hopkins and the state’s Health Service Cost Review Commission, revenue for health care services Hopkins provides is capped at an annual amount. The exception to the cap is money that comes from treating out-of-state patients, according to the lawsuit, filed in U.S. District Court in Baltimore.

“I think Maryland residents will find it highly offensive that Johns Hopkins is pushing out-of-state patients to the front of the line while Maryland residents are forced to the back of the line, all in the interest of profits,” said Lindsey Ann Thomas, a lawyer for Campos.

Campos oversaw a 25-person team that included operations analysts, operations and call center managers, and each of the patient access managers of approximately more than a dozen medical departments within Hopkins, according to the lawsuit. He was also in charge of a patient access call center used to schedule appointment for the entire Hopkins health system, according to the lawsuit.

Among the practices used by Hopkins is “filling the plane,” where Hopkins would allegedly populate its schedule with as many out-of-state patients as possible, much like airlines limit empty seats on flights. This practice was “vigorously enforced” by senior management, including Hopkins President Ronald Peterson and CFO Ronald Werthman, lawsuit states.

“If you live in Maryland, you’re not profitable for Hopkins, you are a low priority,” said Thomas, of Conti, Fenn & Lawrence LLC in Baltimore. “If you live in Pennsylvania, Hopkins has instructed its employees to roll out the red carpet, get you in front of the line and in the door first.”

The “filling the plane” initiative began after Peterson emailed Campos’ supervisor in January 2012, according to the complaint. Hopkins’ in-patient admission was driven by specialty appointments for out-of-state residents, including specialty consultations that would lead to surgeries or other treatments, according to the complaint. Campos’ supervisor told him and someone else in the department to make changes to scheduling to increase the number of out-of-state patients for those in-patient services, according to the complaint. On that call, Campos was told that directive was coming from “senior management,” according to the complaint.

Campos’ lawsuit seeks damages under the federal False Claims Act for allegedly presenting false and fraudulent claims when filing forms for Medicare and Medicaid payments with the federal government; misrepresenting contract violations and providing medically unnecessary services that favored out-of-state patients.

The case is Campos v. The Johns Hopkins Health System Corporation, 1:17-cv-02156-CCB.