Orlando Health targeted in lawsuit

Former orthopedic surgeon accuses system of retaliation, violation of anti-kickback laws

A former Orlando Health orthopedic surgeon who filed a federal whistle-blower lawsuit against the the health system last year and voluntarily dropped the suit later, is suing the health system again for unlawful retaliation and violation of anti-kickback laws.

Dr. Ayman Daouk alleges that Orlando Health mandated that he and other doctors to refer patient to Orlando Health facilities only and barred him from performing procedures at other health systems. When he refused to comply, Orlando Health fired him, he says.

Daouk filed the lawsuit Aug. 28 in Orange County circuit court, demanding $800,000 from Orlando Health and two of its subsidiaries — Orlando Health Physician Associates and Orlando Health Physician Group.

An Orlando Health spokeswoman said the health system doesn’t comment on pending litigation.

Daouk was employed by Orlando Health Physician Associates from 2009 to 2018.

In his new lawsuit and previous federal lawsuit, Daouk alleges that Orlando Health “routinely emphasized to their physician employees that all referrals needed to be made within the ‘integrated network’ of Orlando Health,” and that emphasis grew from a mere suggestion to a mandate, “with threats made against those who failed to comply.”

For instance, in 2018, when Daouk continued to use non-Orlando Health imaging centers, he says he received an email from one of the Orlando Health executives, warning him to stop doing so. The email said his “lack of support for” an Orlando Health imaging center was “being discussed throughout the system.”

“You’re going to want a favor at some point, and your lack of support is going to hurt you someday,” wrote Dennis Buhring, Physician Associates president, according to the lawsuit. “I’m sorry to be so bold, but you have to know this.”

By mid-2018, Daouk was removed from the board of Physicians Associates and, by that August, he was told that he could no longer work for the organization unless he agreed to certain conditions, the suit says.

Part of the agreement required him to refer patients to the Orlando Health Imaging Center and perform all his surgeries at Orlando Health Dr. Phillips Hospital, even though his preferred facility was at an AdventHealth hospital, which was closer to one of this offices, according to the lawsuit.

He alleges that this closed-loop referral pattern violates the federal Stark Law, which bars doctors from referring patients for certain health services to care providers with which they have a financial relationship.

“Because Orlando Health owns [Orlando Health Imaging Center]

and Dr. Phillips Hospital, as well as Orlando Health Physician Group and Physician Associates, and these entities have compensation arrangements with their physicians, there exists an unbroken chain of financial relationships that render these referrals as violations of the Stark Law,” according to the lawsuit.

On Aug. 31, 2018, Daouk was told that his employment with Orlando Health would end on Dec. 30, 2018.

The lawsuit alleges that, even though Daouk remained part of Orlando Health’s Clinically Integrated Network after he was fired, the health system didn’t refer any patients to him.

Daouk initially brought the charges against the health system in a federal whistle-blower lawsuit in June 2019 on behalf of himself, the United States and the State of Florida.

Both federal and state attorneys declined to be involved in the case, which happens in about 80% of such cases, but Daouk pressed on until June, when he dropped the suit, while reserving the right to bring another lawsuit against Orlando Health on the same grounds.

His attorney didn’t respond to a request for comment.