Chapter 6: What the Audit Had Already Found
Diane Marsh was not what I expected.
She was small, somewhere in her early fifties, with short gray hair and reading glasses she kept pushing up her nose.
She arrived at my apartment at eight sharp carrying a leather folder and a coffee she had bought herself.
She sat down at my kitchen table, opened the folder, and said: "Tell me everything.
Start before Christopher.
Start with your father."
I talked for forty minutes.
She took notes and did not interrupt.
When I finished, she looked at her notes for a moment.
"You said you had already begun the inspection of St.
Jude before you heard the nurse's comment in the hallway."
"Yes.
I'd completed two of the four departments."
"And the cardiology department — you've been avoiding it for four years because of your marriage."
"I recused myself from anything connected to Christopher.
I thought I was protecting my integrity."
"You were.
But the recusal also meant no one was watching that department closely." She looked up.
"Who assigned the cardiology inspection to you this cycle?"
I stopped.
I had not thought about that.
"My supervisor," I said slowly.
"He rotated the assignments three months ago.
He said it had been long enough since my marriage that the conflict of interest concern was reduced."
"Does your supervisor know about the billing company?"
"I don't know."
"Does he know about your father?"
"I don't know that either."
Diane wrote something down.
"I want you to pull the preliminary data your team has already collected on the cardiology department.
Not the final report.
Just the raw data that's been gathered so far."
"I can access that from here."
"Do it now, please."
I opened my laptop and logged into the state inspection system.
The cardiology preliminary file had been started by a junior colleague, Marcus, who had done the initial document request three weeks earlier.
I hadn't looked at it yet.
I had been waiting until I was formally assigned to lead that section.
I turned the laptop toward Diane.
She read in silence for two minutes.
Then she took her glasses off.
"Isabel," she said.
"Your colleague Marcus flagged four billing anomalies in his preliminary notes.
He marked them as possible data entry errors and noted them for follow-up."
"That's standard procedure."
"They're not data entry errors." She turned the laptop back toward me and pointed to a line in Marcus's notes.
"This billing code here — it's been applied to a category of procedures that don't qualify for that reimbursement tier.
It's been applied consistently.
Across four years.
Across hundreds of claims."
I looked at the number beside the code.
The total reimbursement figure was $2.3 million.
"That's the hospital's money," I said.
"No.
That's the insurance companies' money.
Which means it's also a federal matter." She put her glasses back on.
"Christopher didn't just need you to delay the inspection.
He needed you to bury this.
Because Marcus already found the edge of it.
The moment a senior inspector looks at those four flagged items properly, the whole structure comes apart."
My phone buzzed on the table.
A text from Christopher.
*I hope you're thinking clearly, Isabel.
A lot depends on the next few days.*
I showed it to Diane without a word.
She photographed it with her own phone.
"He just made my job easier," she said quietly.
She closed her folder and stood up.
"I'm filing the whistleblower disclosure this afternoon on your behalf.
You continue the inspection on schedule.
You do not delay, you do not adjust, you do not communicate with Christopher, Gerald Shepherd, or your father about the content of the report." She picked up her coffee.
"And Isabel — when Marcus asks you about those four flagged items, tell him to look again.
Carefully."
She left.
I sat at the table and looked at Christopher's text for a long moment.
Then I opened a new message to Marcus.
*Can you come in early tomorrow?
I want to go over your preliminary cardiology notes together.*
His reply came in under a minute.
*Sure.
There were a few things in there I wasn't sure about anyway.*
I closed the laptop.
Outside, the first snow of the season had started to fall on Saint Paul.
May you like
Christopher had spent four years believing my ethics were an inconvenience he had successfully managed.
He was about to find out what they actually looked like in motion.
