Exclusive: UNMC's new chairman of PM&R has a dark, troubled history of Medicare fraud, patient endangerment, and medical board investigations

The September 2016 issue of Strictly Business featuring the new Madonna Rehab Hospital set to open in October 2016

Links and References have been updated!

Last February, we covered a story about the University of Nebraska Medical Center (UNMC) creating a new physical medicine & rehabilitation (PM&R) program at the Nebraska Medical Center.

UNMC's newly appointed founding chairman of their newly
created physical medicine & rehabilitation program, Samuel
Bierner, has a dark, shady, and very troubling history with
Medicare fraud, patient safety issues, and investigations
from the Texas Medical Board, according to the public
record, including Dallas' leading daily newspaper

PM&R, or physiatry as it is also known as, is a rather obscure and relatively unknown medical specialty that cares for patients with disabling conditions, including traumatic brain injuries, spinal cord injuries, strokes, neurological impairments, and musculoskeletal problems, who are medically stable, but otherwise have some therapeutic, equipment, or other prosthetic needs to take care of themselves after being discharged from the hospital.

In essence, it's a field of medicine that doesn't deal in urgent life or death matters like most other medical specialties, which may explain why it's relatively obscure and unknown to most people in the first place.

In that article, UNMC officials announced they had selected a Dallas-based physiatrist, Dr. Samuel Michael Bierner, as the new founding chairman of UNMC's new PM&R program in Omaha, Nebraska.

Bierner has more than 25 years experience in physiatry and had previously served as the residency director of the PM&R program at the University of Texas Southwestern Medical Center at Dallas (UTSW) since 2005 and medical director of Parkland Memorial Hospital's PM&R department with what appeared to be a immaculate record; however, we were given an anonymous news tip that there was more than meets the eye to Dr. Bierner's past than he had revealed to UNMC officials when he landed the prestigious job to head their fledgling PM&R program back in February.

Unbeknownst to UNMC officials, the new chairman of their PM&R department was charged in 2012 by the U.S. Department of Justice (DoJ) in a federal court in the Northern District of Texas of conspiring with four other fellow UT Southwestern PM&R faculty members of defrauding federal and state programs with "thousands" of false billings to Medicare and Medicaid that endangered the lives of patients, and later, he made false statements to the medical board saying he was "exonerated of all the charges of fraud" when in fact he wasn't.

U.S.A., ex rel John Doe v. Parkland, Samuel Bierner, Karen Kowalske, Vincent Gabriel, Anne Hudak, and Susan... by Michel Schwalbe

The proof of those bombshell charges comes in the form of a $1.4 million settlement with the U.S. Dept. of Justice with UT Southwestern's main teaching hospital, Parkland Memorial Hospital, which was finalized as recently as May 30, 2013 in a federal lawsuit successfully brought on behalf of the U.S. government by a whistleblower who was a former resident in Dr. Bierner's PM&R residency program at UT Southwestern in 2010. (See qui tam lawsuit and DoJ settlement press release above.)

Two whistleblower lawsuits against Parkland and UTSW, including one that
directly names Samuel Bierner as a direct co-defendant, are purported to have
sparked a 4-year investigative series by Dallas' leading newspaper, the Dallas
Morning News, against Parkland and UTSW for billing fraud and serious
patient safety deficiencies that placed many patients in harm's way

For the sake of protecting the innocent, we have redacted the whistleblower's name and his background in the suit above as there have been strong indications that Parkland and UT Southwestern have taken retaliatory actions in the past against whistleblowers who have come forward against the teaching hospital and university.

The suit charged that “thousands” of Medicare or Medicaid billing claims were falsely submitted for rehabilitation consultations from the five named UT Southwestern individual co-defendants—Karen Kowalske, Samuel Bierner, Vincent Gabriel, Anne Hudak, and Susan Knapton—that had not been ordered by the patients’ primary care physicians, as required by federal rules established by Medicare and Medicaid. In fact, it was found that no attending PM&R physicians had seen the patients at all despite the fact that consultation services were billed under the attending physicians' names to Medicare and Medicaid for reimbursement.

The suit accuses the residency director, Samuel Bierner, and the chairwoman of the UT Southwestern PM&R department, Karen Kowalske, of masterminding the scheme in ordering only resident doctors-in-training “to see all potential patients as early as possible during their Parkland inpatient stay, including in the ICU,” with many in critical condition and without the primary care doctors' knowledge, while billing the consultations and inpatient rehab transfers under the department attending physicians' names to Medicare.

The public record shows that the whistleblower lawsuit was substantiated by the Department of Justice (DoJ) and joined by the U.S. Attorney's Office (USAO) in April of 2013 as plaintiffs to the suit, after they had conducted their own independent, 2-year investigation into the billing fraud charges and had confirmed the whistleblower's allegations were, in fact, true.

Assistant U.S. Attorney Sean McKenna led two
successful Medicare fraud lawsuits against
UTSW and Parkland in 2011 and 2013

That False Claims Act lawsuit was also the second successive Medicare fraud suit that rocked the academic partners of Parkland hospital and UT Southwestern in a short span of two years, charging the Dallas academic medical center and teaching hospital of Medicare and Medicaid fraud and patient endangerment that was joined by the U.S. Attorney's Office to either go to trial or go into talks for a settlement with Parkland and UT Southwestern.

Assistant U.S. Attorney Sean McKenna spearheaded both successful whistleblower Medicare fraud lawsuits brought against Parkland and UT Southwestern on behalf of the U.S. government, which were both settled by all parties involved before either case had a chance to go to trial.

Shortly after those lawsuits were initially filed under seal, Parkland hospital's deemed status for Medicare was revoked by the U.S. Centers for Medicare and Medicaid Services (CMS) while the teaching hospital itself, including the PM&R department, was put on a rare and wide-ranging federal safety oversight program by CMS and the Texas Department of State Health Services (DSHS), called a Systems Improvement Agreement (SIA).

The hospital had failed a slew of patient safety inspections, including a comprehensive and sweeping, last-ditch, 8-day "do-or-die" series of inspections in the July of 2011, which threatened to shutter the hospital for good.
    

The SIA was agreed upon by Parkland in September of 2011 at the eleventh hour as a compromise to avoid a complete cutoff of funding from Medicare and Medicaid which would have most assuredly been a death sentence for the hospital, closing its doors for good.

Only a handful of hospitals nationwide—especially the size of Parkland—had ever faced this kind of regulatory trouble to the point of being completely thrown out of the Medicare program. Parkland, in fact, is the largest hospital in U.S. history to ever have its Medicare deemed status formally revoked by CMS.

We were told that confidential news tips of the two successful whistleblower lawsuits filed in 2008 and 2010 were the impetus that sparked Dallas' leading daily newspaper, the Dallas Morning News (DMN), to initiate a four-year investigative series on patient safety issues and billing fraud at Parkland and UT Southwestern starting in March of 2010.

The award-winning investigative series aptly named, "First, do no harm," then subsequently sparked the avalanche of governmental regulatory inspections and disciplinary actions against Parkland and UT Southwestern shortly thereafter.

The investigative series eventually brought a lot of intense governmental regulatory scrutiny from several oversight agencies down on UT Southwestern's main teaching hospital Parkland Memorial Hospital, including from CMS, the Department of Justice, the Texas Medical Board, the Joint Commission (JCAHO), and Texas Department of State Health Services (DSHS).

Dr. Samuel Bierner has a dark and troubling past from UT
Southwestern and Parkland that he did not reveal to UNMC
officials before coming on board to the Nebraska Medical
Center which may damage UNMC's reputation with
patients, the community, and recruiting talent

As a result of the legal actions brought down by the U.S. Dept. of Justice, the five UT Southwestern named PM&R faculty members, including its residency director Dr. Bierner and chairwoman Karen Kowalske, were being investigated by the Texas Medical Board for their parts in causing the billing fraud and endangering the health and welfare of patients, who were unwittingly defrauded and taken out of their normal course of medical treatment at Parkland hospital in favor of undergoing a lower, substandard rehabilitation level of care in the hospitals' acute rehab facilities.

In the case of ICU patients, the majority of those patients were in critical condition suffering from acute traumatic injuries or medical conditions with clear contraindications for any physical activity. Yet, they were all seen by PM&R consultation services for some inexplicable reason without the patients' or the primary care teams' knowledge or consent.

Thus, these patients may have suffered potential harm after being transferred to rehab while being denied adequate medical care for their acute and often serious injuries in favor of undergoing rehab.

For her part in the scandal, UT Southwestern's PM&R chairwoman, Dr. Karen Kowalske, has since been forced to resign from her chairmanship positions from the PM&R department at UT Southwestern and from the American Board of Physical Medicine & Rehabilitation (ABPMR) in the wake of the highly publicized Medicare fraud scam and her ongoing problems with the medical board.

The findings of the Dept. of Justice lawsuit substantiated that the PM&R department was a "rogue" medical department inside the hospital where the faculty doctors involved “had a financial incentive” to commit fraud because “their UT Southwestern compensation contracts state their base compensation rate may rise and fall from year to year in recognition of their ‘productivity.’”

According to the Dallas Morning News, all five UT Southwestern PM&R co-defendants named in the whistleblower lawsuit were either demoted or were forced to leave UT Southwestern as numerous investigations went forward against the hospital and the individual defendants—with some of the investigations still pending to this day—and the entire Parkland senior executive management and board of managers were replaced after all the dust had settled from the series of scandals that had come down on the teaching hospital and medical center.

The case against Parkland's PM&R department—of which Dr. Bierner was the lead physician and medical director of—resulted in the entire hospital entering into an onerous five-year Quality of Care Corporate Integrity Agreement of which only five other hospitals and nine total health care entities across the nation had been forced to undergo by the U.S. Health & Human Services Inspector General (HHS OIG) since 2010.

UTSW's former chair of PM&R Karen Kowalske was
forced to resign her chairmanships at both UTSW and
the ABPRM in the aftermath of the Medicare fraud
scandals and ongoing investigation with the Texas
Medical Board

Parkland is still under the terms of that stringent federal probationary agreement with on-site patient safety and billing monitors until 2018.

What may be most disturbing of all is that the Texas Medical Board had independently initiated their own probe into the five UT Southwestern PM&R faculty members, including Dr. Bierner, for professional misconduct starting in 2013 after the settlement was finalized.

We were told that Dr. Bierner may have deliberately misrepresented to the medical board that he was "exonerated of all the charges" of fraud while he was being investigated by the board, so that he could buy some time while he looked for a way to leave the state.

His actions suggest that he may have fled the state of Texas to move to Nebraska to avoid facing charges against the Texas Medical Board, so that he could continue his ability to practice while avoiding a hearing to face more serious charges against the revocation of his medical licensure back in the State of Texas.

In any case, the latest bombshells suggest that UNMC officials may not have known about these disturbing facts when they unwittingly selected Bierner to head their new PM&R program at UNMC and its affiliated hospitals at the Nebraska Medical Center, Children's Hospital & Medical Center, Madonna Rehab, and the V.A. Medical Center.  

Texas Medical Board investigation about Kowalske, Bierner, Gabriel, Hudak, and Knapton by Michel Schwalbe

 
Thus, UNMC may not have properly done its due diligence, and Dr. Bierner may not have been properly vetted by UNMC officials when he was selected for the prized position to lead UNMC's new PM&R department, which appears to be due to a willful lack of disclosure and transparency on his part.

Dr. Bierner has said of his appointment as the founding chairman of UNMC's PM&R department, "It's a great opportunity for me to have an impact that would put a capstone on my career."

Samuel Bierner's involvement in defrauding and endangering patients on Medicare
and Medicaid at Parkland hospital nearly shut the entire hospital down for good
in 2012 after CMS began investigating claims by inside whistleblowers

However, now it appears that Dr. Bierner may have been trying to rehabilitate his own medical career and professional reputation by making a new start in Omaha after he was run out of the State of Texas by the feds, the press, and the medical board.

The optics of this case just does not look good as this may damage the reputation of UNMC with patients, with the community, in recruiting talent from across the nation, and may even bring the same kind of unwanted government scrutiny down on UNMC and their affiliated hospitals that Dr. Bierner had previously brought down on Parkland and UT Southwestern in Dallas.

It may be in UNMC's best interests to address this issue as soon as possible as no medical center can ill afford the kind of media and governmental regulatory scrutiny and bad publicity that his case has already brought down on Parkland and UT Southwestern.

At this point, we are eagerly waiting UNMC's response to the controversy, but have not heard back from them.

All we can say is that this kind of shocking news is not getting UNMC's newly created PM&R program off to a promising start with such an embarrassing scandal and devastating revelation about the department's founding chairman and his very troubling past.

References:

• Medicine of Omaha—Dark secrets in Dallas, part I: Nebraska Medicine's PM&R chairman and his hidden past of Medicare fraud in Texas (2/26/17) 
• Medicine of Omaha—As Madonna Rehab Hospitals holds grand opening of its new Omaha campus, controversy still swirls around new UNMC PM&R chairman's troubled past in Texas (10/1/16) 
• Strictly Business—Madonna Rehabilitation Hospital - committed to serving Omaha (9/1/16) 
• Strictly Business—Samuel Bierner to Head New Physical Medicine & Rehabilitation Program (5/1/16) 
• ABPMR Diplomate News—Farewell to ABPMR Chair Karen Kowalske MD (Spring 2016) 
• KETV—Madonna Rehabilitation Hospital scheduled to open in October (3/4/16) with video 
• WOWT—Inside look at Madonna Rehabilitation Hospital's new Omaha campus (3/3/16) with video 
• Omaha World-Herald—At Omaha's new Madonna Rehabilitation Hospital: a mock grocery store, an indoor SUV and three therapy gyms (3/3/16) 
• Omaha World-Herald—Opening curtains for primo Madonna (3/3/16) 
• Medicine of Omaha—Samuel Bierner named to head new physical medicine & rehabilitation program at UNMC (2/27/16) 
• Madonna Rehab Hospitals—Samuel Bierner, M.D., to Head New PM&R Program (2/26/16) 
• UNMC Newsroom—Samuel Bierner, M.D., to head new PM&R program (2/26/16) 
• WOWT—Nebraska Medicine, UNMC Partner With Madonna Rehabilitation Hospital (11/13/14)

News from Dallas:

• Dallas Morning News series on Parkland and UTSW, "First, do no harm:" 
• Parkland hospital
• Miles Moffeit
• Brooks Egerton
• Reese Dunklin
• Sue Ambrose
• Dallas Morning News—Federal scrutiny to follow Parkland hospital to new location (8/17/15) 
• Vimeo Video—Investigative Reporting panel discussion - Headliners Foundation, with Miles Moffeit starting at 23:00 (9/13/14) 
• KXAS NBC 5—Parkland Hospital’s patient care drew scrutiny (8/28/14) interview with Miles Moffeit with video 
• Dallas Observer—The feds are pretty sure Parkland Hospital won't kill you now (8/7/13) 
• Dallas Morning News—Remedying quality-of-care problems could cost Dallas' Parkland hospital $9 million (8/6/13) 
• Dallas Morning News—Texas Medical Board investigating 5 UT Southwestern physicians linked to hospital's Justice Department settlement (6/5/13, No longer in circulation) 
• DMN Watchdog blog—Texas Medical Board now investigating UTSW physicians linked to U.S. Justice Department settlement with hospital (6/5/13) 
• Dallas Morning News—Parkland Memorial Hospital's $1.4 million settlement of whistleblower lawsuit is final (5/31/13) 
• DMN Watchdog blog—U.S. attorney in Dallas finalizes $1.4 million deal to settle allegations against Parkland Memorial Hospital (5/31/13) 
• Culture Map Dallas—Parkland Hospital pays U.S. government $1.4 million to settle Medicaid fraud claims (5/23/13) 
• DMN Watchdog blog—Parkland Memorial Hospital faces another form of federal oversight—and Dallas County judge calls it a 'serious matter' (5/23/13) 
• DMN Watchdog blog—Federal safety report shows patient backlog still plaguing Parkland hospital rehab unit (12/5/12) 
• DMN Watchdog blog—Patient-case backlog continues to plague Parkland rehab unit; read full report the hospital is keeping from the public here (12/5/12) 
• DMN Watchdog blog—UT Southwestern doctor is lead individual defendent in Medicare fraud lawsuit, despite her bosses' public denials (11/1/12) 
• Dallas Morning News—Doctor in whistleblower lawsuit is stepping down from UTSW supervisory post (10/25/12) 
• DMN Watchdog blog—UTSW official at center of fraud investigation stepping down (10/25/12) 
• Culture Map Dallas—Parkland hospital whistleblower finally reveals all: A dangerous emergency room's politics (10/1/12) 
• Culture Map Dallas—The untold story of the Parkland whistleblower: Parts I-IV (10/1/12) 
• Part I: Dr. Larry Gentilello's meteoric rise
• Part II: Dr. Larry Gentilello's formative years
• Part III: Peeking behind the hospital's curtain
• Part IV: Dr. Larry Gentilello's crash and burn
• Dallas Morning News—Parkland hit with largest fine in Texas history for patient safety violations (8/31/12) 
• KXAS NBC 5—Parkland outlines fixes for CMS violations (8/19/12) with videos 
• Dallas Morning News—Parkland hit with new Medicare-Medicaid fraud allegations (5/8/12) 
• DMN Watchdog blog—Medicare fraud lawsuit targets Parkland Hospital, UT Southwestern doctors (5/8/12) 
• KVTV CBS 11— Parkland Hospital agrees to safety reform measures (9/28/11) with video 
• Dallas Morning News—Parkland agrees to federal oversight to avert funding cutoff (9/28/11) 
• Dallas Morning News—Rare agreement puts independent monitors inside Parkland (9/24/11) 
• KXAS NBC 5—Parkland to negotiate to keep Medicare (9/9/11) with videos 
• KVTV CBS 11—Parkland prevents loss of Medicare funding (9/9/11) with video 
• Dallas Morning News—Parkland faces funding cutoff, but government offers compromise (9/9/11) 
• Dallas Observer—Doc's Whistleblowing Results in Parkland, UT Southwestern Paying $1.4 Million to Feds (9/1/11) 
• Dallas Morning News—UTSW must pay $1.4 million in settlement with federal, state officials (9/1/11) 
• KXAS NBC 5 Video—Parkland to outline fixes for CMS violations (8/19/11) 
• KVTV CBS 11—Parkland says it can and will fix problems (8/19/11) with video 
• KXAS NBC 5 Video—Will Parkland lose Medicare, Medicaid funding? (8/11/11) 
• KXAS NBC 5 Video—Parkland review: 'Serious threat to patient health' (8/11/11) 
• KVTV CBS 11—Feds say Parkland Hospital poses 'threat' to patients (8/10/11) with video 
• Dallas Morning News—Feds find conditions pose 'serious threat' to Parkland patients (8/10/11) 
• Nieman Watchdog—The Morning News takes a long, hard look at hospital care in Dallas (1/7/11) 
• Dallas Morning News—Parkland kept information from its auditors, feared federal subpoena (8/29/10) 
• Dallas Morning News—Feds probe alleged fraud at UT Southwestern, Parkland (5/30/10)

Documents & Other Sources:

• U.S. DoJ—Parkland Memorial Hospital Pays Nearly $1.4 Million To Resolve Allegations It Submitted Improper Physical Medicine And Rehabilitation Claims (5/31/13) 
• Texas Medical Board—Letter of investigation against Kowalske, Bierner, Gabriel, Hudak, and Knapton (5/30/13) 
• U.S. HHS OIG—Quality of Care Corporate Integrity Agreement for Parkland Memorial Hospital (5/30/13) 
• U.S. DoJ—Settlement Agreement for U.S.A. v. Parkland hospital, Karen Kowalske, Samuel Bierner, Vincent Gabriel, Anne Hudak, and Susan Knapton (5/30/13) 
• Cirriculum Vitae—Samuel M. Bierner, M.D. (2/02/12) 
• U.S. CMS—Systems Improvement Agreement with Parkland (9/28/11) 
• U.S. CMS—Final termination letter from CMS to Parkland (9/9/11) 
• U.S. DoJ—UTSW and Parkland resolve allegations of improper physician supervision of surgical residents (9/1/11) 
• U.S. DoJ—Settlement Agreement for U.S.A. v. UT Southwestern Medical Center at Dallas (8/31/11) 
• U.S. CMS—Statement of Deficiencies v. Parkland Hospital (8/31/11) 
• 1st Amended Qui Tam Complaint in the U.S. District Court for the Northern District of Texas—U.S.A. v. Dallas County, Texas, Dallas County Hospital District d/b/a Parkland Health & Hospital Systems, Karen Kowalske, M.D., Samuel Bierner, M.D., Vincent Gabriel, M.D. Anne Hudak, M.D., and Susan Knapton, M.D. (9/1/10) 
• 1st Amended Complaint in the U.S. District Court for the Northern District of Texas—Naiel Nassar, M.D. v. University of Texas Southwestern Medical Center, Parkland Health & Hospital System, Beth Levine, M.D., and J. Gregory Fitz, M.D. (8/19/08) 
• 1st Amended Qui Tam Complaint in the U.S. District Court for the Northern District of Texas—U.S.A. v. University of Texas Southwestern Medical Center at Dallas and Dallas County Hospital District d/b/a Parkland Health & Hospital System (7/31/08) 
• U.S. HHS—Sample of Dr. Samuel Bierner's Medicaid and Medicare false billing from FOIA requests (2007-2011) 
• 1st Amended Qui Tam Complaint in the U.S. District Court for the Northern District of Texas—U.S.A. v. University of Texas Southwestern Medical Center at Dallas (4/1/98) 
• Aldous Walker, LLP—Gentilello v. UTSW and Parkland: One doctors fight for proper patient care
• U.S. Health & Human Services Office of the Inspector General—Quality of Care Corporate Integrity Agreements