ORLANDO, Fla. — A new county investigation reveals former professional guardian Rebecca Fierle was paid nearly $4 million by AdventHealth over a number of years and did not report those payments to the court.
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This includes more than $1 million for patients who were never guardianship wards.
The findings are part of an Orange County Comptroller investigation released Thursday.
OCC investigators reviewed 6,936 documents Advent Health provided as part of a court order.
“She wasn’t reporting what she was doing to the courts, and there were a lot of instances that we found where she didn’t tell the court that she had a previous relationship with the patient,” Orange County Comptroller Phil Diamond said.
Orange County Comptroller Phil Diamond also says Fierle did not disclose the fees she was receiving from other sources, and there were even instances where she may have collected payment more than one time.
The report outlines identical fee requests were submitted to both AdventHealth and the court and ultimately paid to Fierle by both.
“We were very troubled to see that there were duplicated bills sent to the hospital and to the court, and I think that is wrong,” Diamond said.
Bryan Malenius, spokesman for AdventHealth responded to the Comptroller report in a statement saying, “We are both surprised and dismayed with the Orange County Comptroller’s findings that a professional guardian withheld information from the court and improperly billed the hospital and the court for resources to care for the most vulnerable in our community.”
He continued, “The report from the Orange County Comptroller’s Office clearly highlights the importance of the state taking action. We are committed to lending our voice to reforming the guardianship system because it is core to our mission to ensure those who need this kind of help are cared for and protected.”
It’s also a sentiment echoed by Phil Diamond.
“These are things that need to be brought to the attention of decision makers — that is part of the reason why we exists. We are an independent auditor. We call it as we see it, and we found real problems here with what Ms. Fierle did.”
"We determined that Rebecca Fierle, through her companies (Ms. Fierle), submitted charges of at least $3,956,325 to AdventHealth for payments between January 2009 and June 2019," the investigative report states. "Each invoice was submitted by either Geriatric Management, Inc. or Geriatric Management LLC and included the name of the patient being served and the guardianship case number assigned by the court, if applicable."
Investigators say payments were made on behalf of 682 patients, and the total amount paid to Fierle from AdventHealth "… was slightly less than $4 million."
Total Invoices Submitted to Advent Health:
- 2014: $287,301
- 2015: $636,933
- 2016: $831,785
- 2017: $901,346
- 2018: $800,519
- 2019: $248,725
"We also identified some Orange County guardianship cases that were assigned to another guardian, but AdventHealth was making payments to Ms. Fierle," the report states.
One conflict, according to comptroller investigators, is that it says it found only 210 of the 682 patients were ever under the protection of a Court supervised guardianship case.
The agency says it also found while reviewing documents that it identified 539 invoices that were paid, but not included in payment files.
The report also says in those payment files were 900 invoices totaling $502,112 that were not provided to the court.
Investigators say while rules limit guardians to charge a rate of $65 per hour, AdventHealth paid Fierle an average of $130 per hour for unspecified guardianship services.
"In bypassing the court approval process, Ms. Fierle's fees were not consistent with the fees determined to be reasonable by the Court," the report states.
The report also appears to paint a picture of instances where Fierle may have been double-dipping, billing AdventHealth and a ward's account for the same services.
"For example, Ms. Fierle submitted an invoice to AdventHealth for guardian fees for May 2016 services totaling $2,222.64. The description and charge for each item on the AdventHealth invoice were identical to those items on an invoice later submitted to the Court – except for the hourly rate," the report states. "Advent Health was billed $120/hour and the same services were also approved for payment by the Court from the ward's assets at $64/hour for a total of $1,192.24."
Investigators also say they found in more than half of the cases, Fierle filed invoices to Advent Health for services at least one month prior to guardianship cases being open, well before she had any legal authority over a ward.
"One case included 28 invoices totaling $7,640 over the three-year period to the guardianship case. In this case, the first invoice submitted to AdventHealth in December 2011. However, the guardianship case was not initiated until October 27, 2014. The petition submitted by Ms. Fierle stated, 'The relationship and previous association of the proposed guardian to the ward is none.' However, Ms. Fierle had a continuing relationship with the ward for three years prior to the guardianship," the report states.
AdventHealth petitioned Orange County Judge Janet Thorpe in September 2018 to appoint Fierle as guardian of Steven Stryker. This is one of multiple cases where AdventHealth has requests Fierle be appointed guardian over an AdventHealth patient, often with families later saying they were never told of any filing or court hearing.
Stryker died in May 2019 while in the care of Fierle, after state investigators say Fierle ordered Stryker's feeding tube capped, against the advice of doctors, and filed a Do Not Resuscitate order against Stryker's wishes.
Stryker's family have long questioned why AdventHealth petitioned for a guardian in the first place.
During an emergency hearing on July 11, 2019, the judge chastised AdventHealth's attorney when he disclosed in court that the hospital had been providing unreported payments to Fierle.
AdventHealth declined to talk about any case specifically, but did say it may file a guardianship application when a patient does not have family available to care for the patient and all efforts have been exhausted.
"In the Florida Hospital petition for guardianship, they state the Ward's daughter whereabouts were unknown," the Office of Public & Professional Guardians investigative report states. "However, her contact information was listed on the Advance Directive on file with the hospital, and our office found her contact information with a quick Google search."
It is unclear what relationship Fierle had with AdventHealth, if any, beyond being a member of a professional guardian's registry.
In each of the cases seeking Fierle appointments, AdventHealth relied on attorney Phillip Wallace as outside counsel.
Wallace also represents Fierle individually in a series of other guardianship cases.
Spectrum News asked Wallace about the dual representation as he was leaving a Fierle-related hearing in July at the Volusia County Courthouse. Wallace would not comment, nor has he responded to multiple emails asking.
AdventHealth did tell Spectrum News from what it knew, it was not an uncommon arrangement and saw no conflict of interest.
The findings, released Thursday, are part of the Orange County Comptroller's second such investigation into Fierle, who is also the focus of multiple criminal investigations being conducted by Florida Department of Law Enforcement and the Office of Florida Attorney General, which includes a focus on Medicaid Fraud.
A search warrant executed at Fierle's Orlando office in August turned up the cremated remains of nine people and one dog, reportedly found in boxes and on shelves throughout the office.
The Florida Department of Law Enforcement is attempting to identify who the remains belong to.
A Spectrum News investigation found at one time judges in 13 counties had appointed to Fierle to oversee the care, affairs, and finances of at least 450 seniors or so called "wards," with Fierle given full legal authority to make decisions on their behalf.
In July, Thorpe removed Fierle from 98 cases after finding Fierle acted inappropriately. Those accusations including filing "Do Not Resuscitate" orders against the wishes of her wards, as well as having conflicts of interest.
Fierle eventually resigned from all of her cases statewide, as local and state leaders vow to examine the faults of the state's guardianship system.
Private Investigator Angela Woodhull told Spectrum News that she tried to alert state and federal investigators years ago to Fierle's alleged fraud and wrongdoing, to no avail.
Groups like Americans Against Abusive Probate Guardianship say Florida's guardianship program has been fractured for years, like other states. They say much of the blame should be on judges who appoint guardianship with little actual oversight.
AAPG is hosting a community Town Hall on the issue of guardianships. That town hall has been rescheduled for November 4 from 3 p.m. to 7:30 p.m. at Marriott Orlando Airport Lakeside, located at 7499 Augusta National Drive in Orlando. The town hall will begin with a screening of the documentary "The Guardians" followed by a Q&A sessions.