Hospital’s Emergency Room Chief Leaves Under Financial Cloud : Scripps Memorial Cites Medicare Billing Irregularities

Dr. Robert J. Eggold, for 10 years the physician in charge of emergency room doctors at Scripps Memorial Hospital here, has left the hospital amid allegations that he overcharged the federal government for services to Medicare patients, Scripps officials confirmed Wednesday.

The hospital’s contract with Emergency Care Medical Group Inc. to manage and bill for doctor services in the emergency room was cancelled Aug. 21, the day Scripps administrators learned of possible billing irregularities, Michael Bardin, the hospital’s director of communications, told The Times. Eggold, as president of Emergency Care Medical Group Inc., billed Scripps Memorial for the emergency room services of eight doctors in his group.

On the day the contract was cancelled, Bardin said, Eggold requested and received a leave of absence from his hospital duties for an “indefinite” period. Two days later, Scripps’ chief administrator Martin Buser sent a letter describing the alleged irregularities to the Health Care Financing Administration, the federal agency that oversees the Medicare program, and an investigation was begun, Bardin said.

A spokesman for the agency was unable to confirm Wednesday that it had initiated an investigation.

Bardin said the allegations center on emergency room billing during the past year, but he would not estimate the amount of money or the number of patients who may have been involved. He said neither he nor other hospital officials could discuss details of the allegations or how they came to light.

If the allegations are true, then Scripps would have been an unwitting participant in the cheating, because the hospital passed along bills submitted by Eggold to the Medicare program, then reimbursed him with money received from the federal government, Bardin said.

“That’s why we want to get to the bottom of this as soon as possible,” he said. “We’ve got to discover every single instance where there has been improper billing.”

The hospital is continuing its own internal investigation of the allegations, which Bardin said centers on Eggold’s role, and will turn over its findings to the Health Care Financing Administration’s regional office in San Francisco. The health care agency is part of the U.S. Department of Health and Human Services.

It was clear this week that officials at Scripps, a private, nonprofit 351-bed hospital east of Interstate 5 near the UC San Diego campus, were fearful that media coverage of allegations against Eggold might harm the hospital’s reputation. All calls to hospital administrators were routed to the hospital’s public relations office, and Bardin, in Chicago this week for a convention of hospital public relations officers, had left behind a four-paragraph statement to be released in response to any inquiries about the alleged irregularities.

“We have had 60-plus years of excellent provision of medical services to the community, and anything which calls that into question is of concern to us,” Bardin said. “We certainly want to learn everything about it and we want to guard against anything like this happening again.”

Eggold, 38, is listed in state records as president of Emergency Care Medical Group, a corporation that also provides doctors for the emergency rooms at Mission Bay and El Centro Community hospitals. An El Centro Community Hospital official said Wednesday he did not know the extent of Eggold’s relationship with that facility, while Mission Bay officials said they have worked with other doctors in the group but have had no contact with Eggold.

“We’ve been told that whatever problem exists is between Dr. Eggold and the Scripps administration,” said Ken Dillard, chief operating officer at Mission Bay Hospital. “We have no relationship whatsoever with Dr. Eggold.”

Bardin said Scripps Memorial had contracted with Eggold since 1975, with Eggold responsible for arranging subcontracts with other doctors to work in the hospital’s emergency room. Eight such doctors now work regularly in the emergency room, treating an average of about 1,300 patients a month, roughly 200 of whom qualify for Medicare. No other doctors were not affected by the cancellation of the contract.

Since Eggold began his leave of absence, his duties have been transferred to Dr. Edwin Iliff, who worked in the emergency room under contract with Eggold, but is not suspected of wrongdoing, Bardin said.

Sources at Scripps said Eggold has been unreachable since he left his job at the hospital. In the recent past he has had a high profile as he worked to help establish Scripps’ trauma care center and joined the fight to persuade county officials not to add new hospitals to the system.

Dr. Brent Eastman, director of the hospital’s trauma center and described by others as a close associate of Eggold, shed no light on his colleague’s predicament.

“I’m not going to be able to provide any information for you,” Eastman said in a brief telephone interview. “All I know is he’s on a leave of absence.”

Eggold did not return a message left Wednesday on his telephone answering machine, and was not at his Rancho Santa Fe home, one of eight pieces of real estate valued at about $1.5 million listed in his name in county records.

A neighbor said she had last seen Eggold there Monday.

Eggold’s attorney, Cheryl Ruffier, scoffed at reports that Eggold had vanished. Ruffier said she could, and would, relay a message to Eggold, but he had not reached The Times by Wednesday evening.

Ruffier is defending Eggold in a lawsuit filed earlier this year by Dr. Stephen Gormican, who contends in the suit that Eggold cheated him out of money he was due as a partner in Emergency Care Medical Group Inc.

In that suit, filed March 8 in Superior Court, Gormican said he had worked with Eggold since 1979, with the understanding that he would be paid $25 an hour for his services, plus bonuses determined in part by the number of patients the corporation served. The suit alleges that Eggold deprived Gormican of a portion of those bonuses, even after the two signed a second agreement in April, 1984, aimed at resolving their differences.

Gormican declined to comment when reached by The Times.