“Suppose he did, though. I don't understand how he benefits. If Medicare or Medicaid is overbilled, aren't those monies paid to the operating company? Seems like it's really their responsibility, isn't it?”
“Absolutely. But outside providers, such as ambulance companies and medical supply businesses, can collect thousands of dollars for services never rendered, or goods not delivered, or goods billed out at inflated prices. If someone in Dow's position were in league with them, the contracts could mean thousands of dollars to the companies involved. For this, he'd receive remunerationâa kickbackâperhaps under the heading of a professional discount or a referral fee. Now that HCFAâexcuse all these acronyms, that's the Health Care Financing Administration, which regulates Medicare and Medicaid programsâ”
“Gets complicated,” I remarked.
“Very. At any rate, now that HCFA has stepped in, they're insisting on documentation for every such transaction, including the lease agreement, which is where we come in.”
“But you don't think he's really guilty.”
“I don't. At the same time, it isn't looking good for him.”
“You think he left to avoid disgrace?”
“Possibly,” he said. “If he felt unable or unwilling to face the charges. I'm not sure how he'll deal with the humiliation if they decide to prosecute. I'm not sure how any of us would deal with that. He's a man in big trouble. I don't like to think of him as a coward as well.”
“When did you see him last? Do you remember the occasion?”
“Of course. September 12, the day he disappeared. I took him out to lunch.”
“I didn't realize that. Was this at his request or yours?”
“His. He called and asked to see me. Of course, I said yes. By then, I knew about his difficulties. I had some other business in that part of town so we met at a little place in walking distance of Pacific Meadows. Just a hole in the wall called Dickens, a mock English pub. It's quiet and affords a measure of privacy, which I knew he'd appreciate.”
“Did he talk about the problems with Medicare?”
“Not directly. He did ramble on a bit about the ongoing investigation. He was clearly upset. He seemed to want reassurances that Harvey and I would come to his defense. I did what I could to put his mind at rest, but I told him I couldn't condone anything underhanded. I don't mean to sound pompous, but in truth, if the charges turn out to be provable, then Dow's actions are not just unethical, they're illegal. As much as I like and admire the man, there's no way I'd be willing to cover for him, even if I could.”
“But why would he risk it? Especially at his age and station in life. He couldn't need the money.”
“I'm not so sure about that. Dow always did well for himself financially, but Crystal is high maintenance. She costs him a bundle. He has two houses to maintainâyou know he bought Crystal that beach house at her insistence. Nothing would do, but she had to have that place. Plus he has Fiona's alimony, which is burdensome to say the least. Crystal likes to travel and she does it in style, including first-class airfare and accommodations for Griffith's nanny along with everyone else. She's the kind of gal who insists on being giftedâbirthdays, anniversaries, Christmas, Valentine's Dayâshe expects to receive jewelry and nothing cheap. She makes sure of that. Dana's theory is she's busy accruing personal assets in case the bottom drops out.”
The phone rang again. This time his eyes didn't even flicker, so I went right on. “You think she married him for his money?”
He considered the question briefly and then shook his head. “I wouldn't say that. I think she genuinely loves the guy, but she's been poor all her life. She wants to make sure she's safe just in case something happens to him.”
“What about the rumors of an extramarital affair on her part?”
“You'd have to ask Dana. She's the one who spotted that piece of shenanigans. I prefer to steer clear.”
“Did Dr. Purcell say anything to suggest he might flee?”
Joel shook his head. “I don't remember anything of the kind. Is that the direction the police are leaning in?”
“Well, they can't rule it out. Apparently, his passport and a substantial sum of money are missing.”
Joel stared at me as though trying to take that in. “If he ran, he'd have to continue running for the rest of his life.”
“Maybe that's not as bad as the alternative. From what you say, he was feeling desperate.”
“Exactly. He was horrified at the prospect of facing criminal penalties.”
“I talked to an attorney who thinks it wouldn't be that bad. He might have to pay restitution, but he wouldn't go to jail.”
“That wasn't his perception. He was deeply depressed. The government's getting tough. He knew they might well decide to make an example of him. More than anything we're talking about the loss of face, something I'm not sure he could handle.” He paused, moving four pencils from one side of his table to the other.
I saw his gaze shift. “What's going through your mind?”
He shook his head. “Something I haven't dared say to anyone else. It crossed my mindâafter seeing him that dayâhe might have been thinking of doing himself in. He was trying to cover his distress, but it might've been too much. He wasn't sure Crystal would stick with him once the scandal came to light. You have to ask yourself just how despondent he was and how far he'd go to get relief. I should have asked how he felt. I should have done what I could to reassure him, but I didn't.”
“Joel?”
We both turned to find Dana standing in the doorway.
“Harvey's on line two. This is the second time he's called.”
“Sorry. I better get this.”
“Sure, go ahead. I appreciate your time. It's possible I'll want to talk to you again at a later date.”
“Any time,” he said. He stood up when I did and the two of us shook hands across his desk. By the time I reached the door, he'd picked up the phone.
Dana walked me to the elevator with its two-person capacity, the interior about the size of the average telephone booth. I could have run down the stairs in the time it took. During its slow, whirring descent, I said, “What's the story on Clint Augustine?”
“Simple. For the six months Augustine rented from us, Dow would go off to work and the next thing you know, Crystal would come sneaking out her backdoor, through the trees, and into the cottage. She'd be there an hour or so and then slip back home. Meanwhile, Rand minded the baby, taking him for endless walks around Horton Ravine. It got to be the talk of the neighborhood.” We reached the first-floor foyer.
“Couldn't there be another explanation?”
Dana's smile was jaded. “Maybe they were having tea.”
Santa Teresa HospitalâSt. Terry'sâis located on the upper west side, a neighborhood once devoted to open farmland, working vineyards, dairies, and stables, all with sweeping views to the mountains on the northern edge of town. Early black-and-white photographs of the area show wide, dusty roads, shanties flanked by groves of citrus and walnut trees, all leveled long ago. It's a world that appears curiously bald and flat: rural expanses planted with pampas grass and star pines that look like mere sprigs. A few unpretentious structures from that era remain, tucked like vintage treasures among modern-day buildings. The restâchurches, the original county courthouse, the wooden boarding houses, the dry goods establishment, the early mission, the trolley car barn, and numerous snazzy three-story hotelsâwere razed by intermittent earthquakes and fires, Nature's demolition crews.
It was not quite two o'clock when I parked on a side street and walked a block and a half to St. Terry's front entrance. The wind had picked up and the trees seemed restless, stirring uneasily. Occasionally a miniature rain shower would shake loose from the upper branches. The very air seemed gray and I was happy to pass into the hospital lobby through the sliding glass doors that parted at my approach. On my left, the coffee shop was sparsely occupied by hospital employees and visitors. I inquired at the information desk and was given directions to the office of the Director of Nursing Services. I passed a ladies' restroom and made a brief detour before I continued my quest.
I found Penelope Delacorte in a small private office with a window looking out onto the street. Overhead fluorescent lights contrasted sharply with the gloom outside. She was seated at her desk, using her pencil point to trace the lines of print on a photocopied memorandum. When I knocked on the doorframe, she peered at me above a pair of half-glasses with tortoise-shell frames. She was in her early fifties, at that stage where she hadn't quite decided whether to dye her graying hair. I pictured her in arguments with her hairdresser, unsure of herself when it came to permanent versus temporary rinses. They likely also argued about the cut; Penelope clinging to the shoulder-length page boy she'd probably been wearing for years. Her bangs were too short and I wondered if she chopped them off herself between appointments. She removed her glasses and set them aside. “Yes?”
“You're Ms. Delacorte?”
“Yes.” Her attitude was cautious, as though I might be on the verge of serving her with papers.
“Kinsey Millhone,” I said. “I'm a private investigator here in town and I've been hired to look into Dr. Purcell's disappearance. May I have a few minutes?”
Without much in the way of encouragement, I'd entered her office, slipped off my rain garb, and eased myself into the chair near her desk. My shoulder bag and the slicker I left in a pile at my feet.
Penelope Delacorte got up and closed her office door. She didn't seem happy with my presence. She was close to six feet tall, slim, conservatively dressedâa navy blue coat dress with small brass buttons up the front. Her low-heeled navy blue pumps were plain and looked vaguely orthotic, as though prescribed for fallen arches or excessive pronation.
She sat down and put her hands in her lap. “I'm not sure what I can tell you. I was gone by the time he . . . went missing.”
“How long did you work for Pacific Meadows?”
“I was the administrator there for the past eight years, until August 23. I worked with Dr. Purcell for the last forty-seven months of that.” Her voice, like her manner, was carefully modulated, as though she'd set her internal dial to “Pleasant.”
“I thought he was the administrator.”
“His title was Medical Director slash Administrator. I was the Associate Administrator, so I suppose you're correct.”
“Can you tell me why you left?”
“Genesis, the management company that oversees the operation of Pacific Meadows, received notification that Medicare was conducting a rigorous audit of our records.”
I raised my hand. “What prompted them to do that? Do you have any idea?”
“Probably a complaint.”
“From?”
“One of the patients, a guardian, a disgruntled employee. I'm not sure what it was, but they seemed to know what they were doing. Apparently, the clinic was suspected of any number of violations, from overpaying our suppliers to submitting false or inflated claims for services. Dr. Purcell was in a panic and blamed the bookkeeper, Tina Bart, which was absurd and unfair. Ms. Bart was working for Pacific Meadows before I arrived and she was faultless in her performance. I went to bat for her. I wasn't going to let them push it all off on her. She didn't make the decisions. She didn't even pay the bills; Genesis did that. She processed purchase orders and prepared the room-and-board bills for each resident, including central supply, therapy, anything other than medication. This was Medicare, Medicaid, HMOs, private insurance, and private pay. The same information crossed my desk as well. She didn't
generate
the paperwork. She forwarded what she was given.”
“Why isn't Genesis considered responsible for the problem if they pay the bills?”
“We supply them the information. As a rule, they don't stop to verify the data, nor did Ms. Bart.”
“But she was fired, anyway.”
“Yes, she was, and I turned in my notice the very same day. I was determined to file a complaint with the Labor Relations Board.”
“What was their response?”
“I never got that far. I had second thoughts and decided not to go through with it. Tina Bart didn't want to make a fuss. She was as reluctant as I was to call attention to Dr. Purcell's situation.”
“His situation?”
“Well, yes. We're all fond of him. He's a darling human being and a wonderful doctor. If he didn't have a head for business, that wasn't an actionable offense as far as we were concerned. I'm being candid in this. He just had no clue when it came to the Medicare rules and regulationsâwhich items were billable and which would automatically be disallowed, co-payments, deductibles, claims for fee-based services. I grant you, it's enormously complicated. Make one mistakeâ god forbid you put a code in the wrong place or leave even one window blankâand the form comes right back at you, usually without a hint about where you've erred.”
“But Dr. Purcell didn't do the billing.”
“Of course not, but it was his job to review the TARsâ”
“The TARs?”
“The Treatment Authorization Requests. He was also responsible for reviewing CPT codes and approving the cost of any ancillary services or DME's. I have to emphasize, he was always genuinely concerned and very innovative when it came to patient care and well-beingâ”
“You don't have to work so hard to defend the man,” I said. “I'll take your word for it. What I hear you saying is when it came to the day-to-day management, he was incompetent.”