Embattled Orlando guardian didn't report $4 million billed to AdventHealth, report finds

Invoices connected to 682 patients, records show

ORANGE COUNTY, Fla. – Former Orange County guardian Rebecca Fierle failed to submit nearly $4 million in invoices sent to AdventHealth to the court that appointed her to watch over hundreds of patients, according to an investigation by the Orange County Comptroller's Office.

Fierle, a state guardian, was removed from nearly 100 guardianship cases in July after she was accused of filing "do not resuscitate" orders on behalf of clients without their permission.

Under Florida law, a judge appoints guardians for minors and adults with mental or physical disabilities, allowing them to make financial and medical decisions.

Key takeaways from the investigation:

  • AdventHealth paid Fierle's business $3.7 million since 2014.
  • Fierle failed to submit more thousands of invoices to the court.
  • AdventHealth paid Fierle twice the court-approved hourly rate.
  • Fierle double-billed wards in her care for services already paid for by AdventHealth.
  • More than 470 patients not protected under Florida law could still have "do not resuscitate" orders.

AdventHealth representatives told an Orange County judge in July that the company had paid Fierle for guardianship services. The judge learned that some of those payments had not been reported and it would have been improper for Fierle to receive those payments for her guardian services without reporting them to the court.

During the hearing the judge ordered AdventHealth to produce a record of "all contracts and documents" related to Fierle's services rendered to AdventHealth.

The Orange County Comptroller's Office conducted a review of nearly 7,000 invoices that totaled almost $4 million in a 10-year period. A review of their findings was released Thursday.

682 patients, only 210 were court-appointed

The investigation found each invoice was submitted by Fierle's business, Geriatric Management, and included the name of a patient and their guardianship case number.

According to the invoices, AdventHealth had made payments to Fierle's business totaling $3.7 million since 2014. The payments were made on behalf of Fierle's services for 682 patients, however, only 210 of those services were for guardianship cases. The rest were for non-court-appointed guardianship-related services.

For services related to 177 Orange County patients alone, Fierle was paid more than $2.5 million, and none of those payments were reported to the court overseeing the guardianship cases.

While guardianship can be established under Florida law, the report said it's not clear how Fierle obtained the authority to act on behalf of 472 patients who were not court-appointed wards in her care. The investigation refers to this group of patients as Group 2.

"Fierle is likely not related or a close friend of (those) patients. It does not appear that she would qualify as a proxy, especially since she was not appointed as a guardian in any of the 472 cases. Therefore, it is unclear how Ms. Fierle could have become a health care proxy with the authority to make life-and-death decisions for Group 2 patients," the report said.

Patients with DNRs still out there

The investigation into Fierle began after a family reported she had filed "do not resuscitate" orders on behalf of clients without obtaining permission from their families and also when a ward clearly expressed objection to being placed under a "do not resuscitate" order.

The Comptroller's Office said the investigation found numerous entries among Fierle's invoices referencing "do not resuscitate" orders and other life-or-death health care decisions. Investigators wrote that they believe Fierle likely obtained "do not resuscitate" orders for 472 patients who were not court-appointed wards.

Although in July an Orange County judge revoked any "do not resuscitate" orders that Fierle had executed on behalf of her guardianship wards this would not provide any protection for the other patients because they are not under the protection of the Florida guardianship system.

"The Court, law enforcement, and patient families should be aware that Ms. Fierle has made similar critical decisions for the Group 2 patients without the Court's knowledge or approval," the report said. "Those decisions should be reviewed to confirm that they are appropriate for the Group 2 patients."

Twice the court-ordered rate, double billing

The investigation also found that AdventHealth was paying Fierle twice the amount Orange County guardians are normally paid per hour. 

"The maximum amount that will be paid for Orange County guardian fees is currently $65/hour," the report said. "The invoices indicated that AdventHealth is currently paying $130 per hour. Therefore, in bypassing the court approval process, Ms. Fierle's fees were not consistent with the fees determined to be reasonable by the Court."

The Comptroller's Office investigation found that a number of the invoices submitted to AdventHealth, which were not submitted to the court, matched invoices sent to the court for services performed. The only difference was the billing was at the approved $65 per hour rate and those funds were coming from her ward's assets.

(Image: Orange County Comptroller)

"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 said. "AdventHealth was billed $120/hour and the same services were also approved for payment by the Court from the ward's assets at $64 for 7 hours for a total of $1,192.24."

The Comptroller's Office found that Fierle's wards paid multiple payments that included attorney fees, home care services and rent. The investigation found at least 20 invoices for these services that were paid twice.

AdventHealth released a statement Thursday about the findings:

"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. 

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."

The Office of Attorney General Ashley Moody issued a comment stating:

"Our office is aware of the report. As our investigations are ongoing, we cannot comment further at this time."

News 6 continues to review the investigative findings. Check back for updates on this developing story.