Topic: The Efficiency Expert

Ali al Amat

Date: 2009-02-19 17:07 EST
Ali was going through common patient billing practice when he first found the discrepancy. It was the kind of work usually handled by Robert Milken and his assistants: look at the clinic's billing structure, audit random patient charges to compare against the structure, repeat ad nauseam. Ali felt the need to familiarize himself with the hospital's pricing, though, so here he was. It was deadly dull, boring work—he might never have noticed if he hadn't been wired on Maranya's coffee.

But he was awake, and looking through the billing, and there it was: inpatient in-residence MD consultation, one hour, 235.01. He checked it against the structure book spread out on his computer's desktop. Specialized medicine, inpatient in-residence MD consultation...235.00/hr. He looked back and forth between the paper printout and the computer screen. Had the consultation had run over by some precisely defined fraction of a second"

No, said the structure when he queried it, though it took several minutes of digging. Anything up to sixty minutes of in-resident consultation was charged as a solid hour, at 235.00. However, there was a separate structure for patient indigency that muddied the waters, and it was difficult to tell whether any particular patient was noted as indigent or not, just by looking at the bill.

On a whim, he trolled through the remainder of the stack of bills, all fifty of them. Every single one was off in some charge, by a single copper. The extra penny was always in some less well-defined region of the bill—a prorated surcharge for cleaning the room after the patient was gone, or consultation time, or something called "research/filing fees."

Every single one. One copper penny. He could feel a headache starting behind his left eye. He rubbed at it, rubbed at his forehead, called Lorelei in.

Two minutes later she appeared, somehow managing to bounce in four-inch heels. "You rang, Boss?" she sang...then took in his expression, half-angry and half-bewildered. "What's up?" she asked him, with less cheer.

"I need...I don't even know what I need. Let's try—can you get me some paper copies of the deposit records of the hospital for the last..." he checked the billing records scattered all over his desk, "...six months?"

"Well, normally the accountants work with just the electronic files for everything, but I can probably get them from the bank. Anything else?" Lorelei asked him, lips pursed in thought, her elven ears twitching with it.

"Yes. If anyone asks you why I need it, here or over at the bank, tell them...tell them I'm checking the bank's efficiency in cycling our deposits. Make it sound like I'm angry with the bank for not processing them fast enough. And tell me who asks, if they do." Ali picked up a bill, saw the penny overcharge, and flipped it away across the desk. It sailed off the edge and onto the floor. His growl was enough to startle the elf.

"Okay, um, Boss...is everything all right?" Lorelei managed to make retrieving and replacing the bill look like performance art, but that was what elves did, even cheeky administrative assistant elves.

"I don't know yet. We'll see."

Ali al Amat

Date: 2009-02-19 18:37 EST
"Boss. Boss. Boss, Boss, Boss. BOSS!" Lorelei gave the back of Ali's head a slap on the last one.

"Ow! What?" He jerked his head back, crumpled up the sheet of paper in his hand and glared at her.

"Well, you weren't paying attention to me! It's seven o'clock and I want to go home!"

"So' Go home!" The glare relented once he realized how late he'd kept her with his demands for more records. His office looked like a bomb had gone off in a paper warehouse: it was a maze of boxes, with reports strewn on every level surface. After his computer started to complain about memory overload, he shut it off.

"No! You gotta tell me what?s going on first, Boss, or so help me I'll reschedule all your appointments for six tomorrow morning!"

Did he trust her enough to explain" Who was he kidding" He could hardly tie his shoes without her. And the chance to talk to someone—anyone—about it, and make sure he wasn't losing his mind...

"All right. Take my card and go get some Chinese takeout. Please. I can't leave this alone. I can't trust that someone won't come in and realize what I'm doing." He gestured at the boxes and piles of paper, well aware of how paranoid he sounded.

"Ooooookay. I'll just, you know, order one of everything on the menu. Back in a flash." Lorelei backed out, and Ali sank back into the sea of disbelief he'd spent the day floundering through.

—-

Once Ali barricaded the door with boxes, they sat on the floor in a small cleared space—his back against his desk, hers against the wall—and ate Kung Pao chicken together in the glow of the evening lamp.

When the first rush of hunger was satiated, Lorelei stirred her chopsticks around in the white carton for a minute. Then she took a deep breath and looked up. "Okay, spill it. You're scaring me, the way you look. You don't get enough sleep as it is, and now you look like someone kicked you in the head or something. What's going on?"

"I think," he said, searching her sweetly elegant face and choosing his words very carefully, "that someone has been stealing funds from the clinic for the last eighteen months. I don't know how much they've taken, but my conservative estimate is a quarter of a million gold."

Absolute silence reigned. Lorelei stared at him. He stared back.

Then Ali blinked, and sighed, and said, "Close your mouth, Lei, that's gross."

She squawked like an outraged songbird, "Oh, screw you! A quarter million?"

"I think so. They've been taking it a penny at a time—from the patients, from the lab charges back to the clinic, from the employee contributions to the pension funds, from the fund dividends, the pharmacy, the cafeteria, everywhere. They don't take it out of the clinic's payments to our suppliers, but it comes out of the funds we request from the bank to pay those bills. The more I look, the more I find."

"But...but how come nobody noticed this already? I mean, jeezum crow, how come Accounting didn't pick it up the first time it happened?"

His tie was trying to sneak back into the rice. He fished it out. "They do most of their auditing and tracking electronically, yes" Using our intranet, our links to the bank and suppliers."

"Right, so?"

"None of it shows up there. All the electronic records show the correct numbers. If I hadn't been stubborn in asking for the paper records, I would never have noticed it." With his nightmares losing him so much sleep, he'd found it easier to focus on a white piece of paper than on his computer's virtual desktop, but she didn't need to know that.

"So...none of it shows up on the computers." Lorelei looked over his head, at the back of the computer asleep on his desk. "So it's someone who knows our systems. But who' Why' Why would anyone do it?"

"Well, and that's the quarter-million question, isn't it?"