OneCare wrongful termination lawsuit settles out of court

By KRISTEN FOUNTAIN

VtDigger

Published: 12-12-2023 4:18 AM

A former employee and frequent public critic of OneCare Vermont has dropped his wrongful termination lawsuit after reaching a settlement agreement with the state’s largest accountable care organization outside of court. 

The case brought by Robert Hoffman was scheduled to be presented to a jury in early January, but the trial has been canceled and the case is in the process of being dismissed, said Hoffman’s lawyer, Norm Watts of Quechee, on Friday. 

“It’s over,” Watts said, adding the confidential agreement was reached roughly 10 days ago. “We’re pleased with the settlement and I think the other side is pleased with it,” he said.

OneCare spokesperson Amy Bodette was more circumspect. “On the topic of the Hoffman trial, the matter has been resolved,” she said Friday in an email. 

Hoffman brought his lawsuit in May 2021 against both OneCare and the University of Vermont Medical Center, described in the complaint as OneCare’s operational partner. Both organizations are part of the University of Vermont Health Network, the state’s largest health care provider. 

In the suit, Hoffman claimed that he was fired from his position as a manager in the OneCare data analysis department in May 2018 after he raised concerns related to software that he had been tasked with evaluating. He went on to lodge a federal whistleblower complaint that August, in which he said the company was making false claims about the capacity of the software to perform analyses of health care quality and outcomes for different health care providers.

OneCare disputed both Hoffman’s conclusions about its software’s capacity and his charge that he was fired for raising those concerns. The company offered various instances of what Hoffman’s supervisors considered his unprofessional style of communication with staff and contractors, arguing that those interactions were the cause of his termination.

This May, Chittenden County Superior Court Judge Helen Toor determined that the case should proceed to trial. 

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“If the evidence at trial bears out that Hoffman raised concerns of OneCare’s misuse of federal funds and violation of the False Claims Act before he was terminated, the court concludes that this would constitute a protected activity that could potentially support a claim of retaliatory discharge,” she wrote. The jury would need to listen to testimony because, she wrote, “ultimately, the decision on this issue will likely turn on credibility.”

Accountable care organizations, or ACOs, were created by the 2010 Affordable Care Act as a vehicle for allowing many different health care providers to contract as a group with private insurers and federal and state governments. 

Through an ACO, hospitals, provider groups or individuals agree to provide health care services for specific groups of patients at a set price per patient. A cost for all patients in the group is often also set, with the ACO or its affiliated providers sometimes earning a portion of the shared savings (if the total cost comes out lower than estimated) or taking a loss (if the cost comes back higher). 

Bonus payments can also be offered, tied to pre-specified health care quality metrics and health outcomes. 

OneCare, organized as a nonprofit, plays a unique role in Vermont’s current “all-payer” experiment, in that it is the only ACO active in the state that contracts with many different payers simultaneously — specifically, Medicare, Medicaid and certain kinds of private insurance. 

That allows the organization to bundle payments and incentives and pass those funds on to the state’s hospitals and hundreds of other health care providers in the form of regular monthly upfront payments and end-of-year bonuses. 

In theory, OneCare’s analytic software would assist its contracted health care providers in meeting specific targets by providing regular feedback on their performance and results.

In November 2019, the U.S. Attorney’s Office declined to pursue the case, concluding that, even if true, problems with the software would not have dissuaded the state or federal governments from contracting with the company to broker care services for Vermonters covered by the Medicaid and Medicare programs.