Tangled Web

About the Book

An incredulous and, at times, hilarious, account of what really goes on in the healthcare system.

Based on a true story, Tangled Web, begins with Clarisse, a hospital review nurse, accepting a new position in a small community hospital. She inherits a Utilization Review Office severely backlogged and previously mismanaged. The hospital initially has at least $50,000 backlogged insurance reviews. She reports to a Director of Case Management, who has been at the hospital six months, blames the condition of the department on her predecessor and is desperate to hide it from upper level management.

After a tension filled period of several weeks during which Clarisse, cleans up the Department, recoups thousands of dollars in insurance denials, and deals with Thelma´s disorganization, she is fired for refusing to cover-up what has been going on.

Clarisse is subjected to the humiliation of collecting unemployment, and despite her credentials, is unable to find another job. Her personal and professional life is in ashes. She begins to suspect she is being blackballed, and decides to fight back.

She initially gathers information and reports her employer to state and national healthcare officals. In each case, except the state, she receives no reply. She initially receives the documents back from the State Health Department with a comment it has nothing to do with them. Undaunted and increasingly desperate to do something about her situation, she contacts a U.S. Senator. When the Senator gets interested, so does everyone else.

As the investigation begins to proceed, she finds a position with an independent review company. She learns that the employees are all somehow personally connected to each other, and people are only hired if they "know someone".

At one hospital she is reviewing, she learns that the former Director of Utilization Review is married to her predecessor at the hospital she was terminated from. The department manager is also a personal friend of her company´s president. She begins to learn that there is a network of people in multiple hospital middle and upper level management that are all connected to each other. In fact, one person in upper level management is on the Board of the independent review company. In a backdoor fashion, the hospital is overseeing itself.

Among other incidents, she receives a visit from the Chief Investigator for the State Medicaid Office, who not only appears to not understand the review process, he is so obnoxious, she refuses to cooperate with him any further.

The story describes the coverup of a wrongful death up to and including a quality review company telling her they can not obtain a copy of the death certificate and do not notify any local law enforcement authorities of possible wrong doing. At one point, when she has been the one providing them with all of the information, they tell her they can´t discuss it with her because it´s confidential.

When she reports the wrongful death cover-up to the Joint Commission of Accrediation of Healthcare Organizations, they take no action. However, when they receive a copy of a letter she has sent to the Senator, they forward the copy of the letter to the hospital she reported. She only learns of this when the Senator forwards a copy of a letter he receives from the hospital attempting damage control.

She then learns that anyone who reports wrongdoing to JACHO, a national hospital accrediting organization, has no protection from retaliation by the hospital. Here again is a question of how independent or objective are these reviews?

The story describes actual behind the scenes conversations with insurance companies. It depicts improperly handled and delayed insurance authorizations. Management personnel hired based on personal relationships or unqualified for their positions who then hire qualified personnel and rather than supervising th

About the Author

Tangled Web is Ms. Mason's first novel. She was born and raised in Northern New Jersey. With over 20 years in nursing, her experience includes coronary care, operating room, home care and utilization review. She received her R.N. from Bergen County Community College and completed her B.S.N. at the College of St. Elizabeth. She has met and cared for a wide range of people from poverty level to celebrities in acting, sports, publishing, teaching, healthcare, photography and the retail food industry. Ms. Mason has traveled extensively including Great Britain, France, Mexico, the Caribbean, and the United States. She was listed in Who's Who in the East 1999 Edition.