Authorized questions, inquiries intensify round Noble Well being’s rural Missouri hospital closures

A yr after personal equity-backed Noble Well being shuttered two rural Missouri hospitals, sufferers and former workers grapple with a damaged native well being system or lacking out on thousands and thousands in unpaid wages and advantages.

The hospitals in Audrain and Callaway counties stay closed as a slew of lawsuits and state and federal investigations grind ahead.

In March, Missouri Lawyer Common Andrew Bailey confirmed a civil investigation. He had beforehand advised native speak radio that there was an “ongoing” investigation into “the hospital difficulty.”

Bailey’s remark got here weeks after the U.S. Division of Labor’s Worker Advantages Safety Administration notified executives tied to Noble Well being, a startup, that that they had violated federal legal guidelines and requested them to pay $5.4 million to cowl unpaid worker medical health insurance claims, in line with a 13-page letter detailing “interim findings” that was obtained by KHN.

The January letter confirms KHN’s earlier reporting, which was knowledgeable by workers and sufferers who described lacking paychecks; receiving sudden, high-dollar medical payments; and going with out care, together with most cancers therapy. In response to the letter from federal investigators, the Noble hospitals and their company homeowners collected worker contributions for medical, dental, and imaginative and prescient insurance coverage in 2021 and 2022 however then didn’t fund the insurance coverage.

The homeowners and executives had been “conscious of the hurt to individuals and, in some instances, had been making an attempt to resolve particular person participant complaints,” the letter states, including that “regardless of the quantity and gravity of complaints and payments acquired,” they failed to reply.

‘Tomfoolery’ and doing ‘everyone soiled’

Marissa Hagedorn, who labored as a hospital laboratory technician, has spent a lot of the previous yr beginning a brand new job, caring for her 2-year-old son who was born with spina bifida, and haggling over unpaid medical payments. She advised KHN the household owes at the least $8,000 for son Ryder’s specialty care in St. Louis, with $6,000 of that in collections. As a Noble worker, Hagedorn mentioned, she was advised repeatedly that her worker medical health insurance would cowl Ryder’s care. It did not.

Noble has “accomplished everyone soiled,” she mentioned. “We simply would really like for some duty to be taken by this firm that did not really feel the necessity to get their act collectively.” Hagedorn’s story of unpaid payments, which was first reported by the native newspaper, the Mexico Ledger, is widespread amongst former Noble workers a yr after the hospitals closed.

A former worker of the Fulton hospital has filed a class-action lawsuit meant to symbolize lots of of workers from each hospitals.

The Jan. 13 letter from federal officers known as for responses by Jan. 27 from Noble company and hospital executives in addition to Platinum Neighbors, which final April purchased the hospitals and assumed all liabilities. The letter instructs executives to contact the company “to debate how you plan to right these violations, fund participant claims, and obtain compliance.”

Former workers say their claims haven’t but been paid. A Labor Division spokesperson, Grant Vaught, mentioned the company couldn’t touch upon an ongoing investigation.

Individually, the Kansas Division of Labor is reviewing Noble and Platinum’s failure to pay wages and severance to company workers. Company spokesperson Becky Shaffer confirmed that hearings happened in early February on a half-dozen instances totaling greater than $1 million in claims for unpaid wages and severance.

Dave Kitchens was amongst those that filed claims towards Noble Well being. Kitchens labored briefly as a contract worker after which was employed in October 2021 as a company controller, an accounting function through which he was liable for monetary reporting and knowledge analytics. Kitchens supplied an audio recording of his listening to to KHN and hopes to ultimately receives a commission greater than $90,000 in misplaced wages, advantages, and severance pay. Through the listening to, Kitchens advised the executive decide: “I’d similar to to be paid what I am owed.”

Kitchens, who can be named as a fiduciary on the federal investigation, mentioned he was not on Noble’s govt staff. When requested by Kansas Administrative Regulation Choose James Ward whether or not he anticipated Noble or the secondary purchaser Platinum to pay his wages, Kitchens responded he had “no thought who was in cost.”

“I imagine there was some tomfoolery,” Kitchens mentioned.

A ‘rabbit gap’ of duty

Noble launched in December 2019 with executives who had by no means run a hospital, together with Donald R. Peterson, a co-founder who previous to becoming a member of Noble had been accused of Medicare fraud. Peterson settled that case with out admitting wrongdoing and in August 2019 agreed to be excluded for 5 years from Medicare, Medicaid, and all different taxpayer-funded federal well being applications, in line with the Well being and Human Providers Workplace of Inspector Common.

By March 2022, the hospitals had closed and Noble supplied explanations on social media, together with “a expertise difficulty” and a have to “restructure their operations” to maintain the hospitals financially viable. In April, Texas-based Platinum Neighbors paid $2 for the properties and all liabilities, in line with the inventory buy settlement.

Regardless of receiving approval for practically $20 million in federal covid-19 reduction cash earlier than it closed the hospitals — funds whose use remains to be not totally accounted for — Noble had stopped paying its payments, in line with court docket data. Contractors, together with nursing businesses, a lab that ran covid exams and landscapers, have filed lawsuits looking for thousands and thousands.

In Audrain County, the place neighborhood members nonetheless hope to reopen the hospital or construct a brand new one, county leaders filed go well with for the reimbursement of a $1.8 million mortgage they made to Noble. Former Missouri state senator Jay Wasson additionally filed go well with in September, asking for reimbursement of a $500,000 mortgage.

Two Noble Well being actual property entities filed chapter petitions this yr. One Chapter 11 chapter submitting names the Fulton hospital property in Callaway County as an asset and lists practically $4.9 million in liabilities. A 3rd chapter submitting by FMC Clinic contains Noble Well being as a codebtor.

Within the U.S. District Courtroom of Kansas, Central Financial institution of the Midwest is suing Nueterra Capital over a $9.6 million mortgage Noble used to purchase the Audrain hospital. The financial institution alleges Nueterra, a personal fairness and enterprise capital agency that in 2022 included Noble as a part of its portfolio, signed off because the guarantor of the mortgage.

Federal investigators listed practically a dozen folks or entities linked to Noble Well being as fiduciaries who they are saying are personally liable for paying again thousands and thousands in unpaid medical claims. The letter additionally detailed Noble Well being’s possession for the primary time. The homeowners included William A. Solomon with a 16.82% share, Thomas W. Carter with a 16.82% share, The Peterson Belief with a 19.63%, and NC Holdings Inc. with 46.72%.

NC Holdings can be listed on the inventory sale settlement with Platinum together with a number of signatures together with Jeremy Tasset, chief govt of Nueterra Capital.

Tasset didn’t reply to a request for remark for this text. In an e mail to KHN in March 2022, the Nueterra Capital CEO wrote, “We’re a minority investor in the true property and don’t have anything to do with the operations of the hospitals.” In Could 2022, Tasset wrote in an e mail to KHN that “all the things was offered (actual property included) to Platinum Neighbors, a subsidiary of Platinum Crew Administration.”

It’s unclear who owns and controls The Peterson Belief, which federal investigators recognized. Peterson, who’s listed on Noble’s state registration papers as a director and in different roles, did not reply to requests for remark for this text. He beforehand advised KHN that his involvement in Noble did not violate his exclusion, in his studying of the regulation.

He mentioned he owned 3% of the corporate, citing steerage from the Workplace of Inspector Common for the U.S. Division of Well being and Human Providers. Federal regulators might exclude firms if somebody who’s banned has possession of 5% or extra.

In March 2022, Peterson created Noble Well being Providers, which federal investigators be aware of their letter was “established to restructure the possession of a number of Noble entities.” Peterson dissolved that firm in July 2022, in line with a Missouri enterprise submitting.

In September, Peterson posted on LinkedIn that he was “sitting within the Emirates Air lounge in Dubai” to complete up due diligence on “launching a brand new enterprise.”

A 2013 OIG advisory states that “an excluded particular person might not serve in an govt or management function” and “might not present different kinds of administrative and administration companies … until wholly unrelated to federal well being care applications.”

KHN examined the federal system meant to cease well being care enterprise homeowners and executives from repeatedly bilking authorities well being applications and located that it failed to take action.

The OIG retains a public record of individuals and companies it has banned from all federal well being care applications, equivalent to Medicare and Medicaid. KHN’s evaluation discovered a system devoid of oversight and rife with authorized grey areas.

Within the wake of KHN’s reporting, Oregon Sen. Ron Wyden, a Democrat who’s the chair of the highly effective Senate Finance Committee, mentioned “it is crucial that federal watchdogs can guarantee unhealthy actors are saved out of Medicare.” Sen. Chuck Grassley (R-Iowa) mentioned the federal government must do extra and “it is also as much as private-sector entities to do a greater job checking towards the exclusions record.”

“We won’t simply depend upon one or the opposite to do all the things,” Grassley mentioned.

In current months, the Missouri hospitals seem to have been offered twice extra, in line with public data. Oregon-based Saint Pio of Pietrelcina notified state officers of a change of possession in December and requested an extension of the hospital licenses, which was denied. In January, Audrain County officers, in its lawsuit, revealed one other proprietor named Pasture Medical, which registered as a Wyoming firm on Dec. 27, 2022.

“We’ve not come out of the rabbit gap on this one,” mentioned Steve Bollin, director of the division of regulation and licensure for the Missouri Division of Well being and Senior Providers. Bollin’s company, which conducts inspections and approves hospital adjustments in possession, mentioned he would help his company doing monetary opinions.

“It is in all probability not a foul thought that somebody takes a little bit bit deeper dive. We do not have that many adjustments of possession, however we would wish acceptable staffing to try this, together with some actually good CPAs [certified public accountants].”

This text was reprinted from khn.org with permission from the Henry J. Kaiser Household Basis. Kaiser Well being Information, an editorially unbiased information service, is a program of the Kaiser Household Basis, a nonpartisan well being care coverage analysis group unaffiliated with Kaiser Permanente.