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Her boss, the CMO, called it "pragmatic compliance." Carmen called it lying. But every time she "cleaned" an Angel, the hospital received a DSRIP check. That check paid for Mr. Vega’s actual heart medication. It paid for the volunteer nurse’s bus fare. It funded the shelter’s new air conditioner.

To make the Angel look clean, Carmen had to engage in "chart churning." She called Mr. Vega’s shelter manager, the mobile soup kitchen schedule, and a volunteer church nurse. She discovered that Mr. Vega was getting sick—he just wasn't going to the ER. He was going to a street medic who illegally gave him expired Lasix.

And the angels, for all their bureaucratic wings, could only fly because someone was willing to get them dirty.

The auditor grunted and moved on. The DSRIP payment went through. Mr. Vega got a housing voucher three weeks later (paid for by a different program).

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