Or­tho­pe­dic sur­geon sues over self-re­fer­rals

Claims Or­lando Health, 3 sub­sidiaries skirted fed­eral law with prac­tice

Orlando Sentinel - - FRONT PAGE - By Naseem S. Miller

An or­tho­pe­dic sur­geon has filed a whistle­blower law­suit against Or­lando Health and three of its sub­sidiaries, al­leg­ing that his su­pe­ri­ors vi­o­lated fed­eral laws by re­quir­ing him to per­form surg­eries and make re­fer­rals within the Or­lando Health net­work only and then fired him when he re­fused to com­ply.

Dr. Ay­man Daouk is su­ing Or­lando Health, Physi­cian As­so­ci­ates, Or­lando Health Physi­cian Group and Or­lando Health Imag­ing Cen­ters, al­leg­ing that he was fired by Or­lando Health and Physi­cian As­so­ci­ates “be­cause he per­formed surg­eries at a non-Or­lando Health fa­cil­ity and re­ferred pa­tients for imag­ing at a non-Or­lando Health fa­cil­ity.”

The law­suit al­leges that be­cause Or­lando Health owns Or­lando Health Imag­ing Cen­ter, Or­lando Health Physi­cian Group and Physi­cian As­so­ci­ates, there is an un­bro­ken chain of fi­nan­cial re­la­tion­ships that con­sti­tute self-re­fer­ral, which is pro­hib­ited by the fed­eral Stark Laws.

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

Marni Jame­son Carey, ex­ec­u­tive di­rec­tor of the Associatio­n of In­de­pen­dent Doc­tors, said Daouk’s law­suit doesn’t sur­prise her.

“If a doc­tor knows that an­other site is less ex­pen­sive, has bet­ter qual­ity and is more con­ven

“If a doc­tor knows that an­other site is less ex­pen­sive, has bet­ter qual­ity and is more con­ve­nient [for the pa­tient] they’re still chas­tised and heav­ily rep­ri­manded for re­fer­ring out­side the sys­tem.” Marni Jame­son Carey, ex­ec­u­tive di­rec­tor of the Associatio­n of In­de­pen­dent Doc­tors

ient [for the pa­tient] they’re still chas­tised and heav­ily rep­ri­manded for re­fer­ring out­side the sys­tem,” she said. “It’s called leak­age and it’s strongly frowned upon, and I know many doc­tors who have been called into the ad­min­is­tra­tors’ of­fices and rep­ri­manded and even fired for this be­hav­ior.”

Daouk had been work­ing for Physi­cian As­so­ci­ates since 2009 when the 95-physi­cian prac­tice was bought by Or­lando Health in late 2012. In the law­suit, he al­leges that what started as a nudge to re­fer within the sys­tem even­tu­ally turned into a man­date.

At first the Physi­cian As­so­ci­ates doc­tors were told that “they should en­deavor to re­fer more pa­tients to Or­lando Health en­ti­ties,” ac­cord­ing to the law­suit. “Pretty soon, how­ever, such re­fer­rals be­came a man­date, with threats made against those who failed to com­ply.”

The law­suit cites an in­stance in 2014, when the Physi­cian As­so­ci­ates chief op­er­at­ing of­fi­cer emailed a po­di­a­trist who was per­form­ing surg­eries at Florida Hospi­tal, now Ad­vent-Health, in ad­di­tion to Or­lando Health.

“[Physi­cian As­so­ci­ates] board has asked me to re­mind you that you are an em­ployee of an Or­lando Health owned com­pany and, there­fore, should show some loyalty to the sys­tem. They have asked me to find out why you are still us­ing Florida Hospi­tal North for surg­eries,” read the COO’s email cited in the law­suit.

Daouk was also tar­geted for the same is­sue even though noth­ing in his em­ploy­ment agree­ment pre­vented him from per­form­ing surg­eries at Florida Hospi­tal, ac­cord­ing to the law­suit. The law­suit al­leges that sev­eral months later, Physi­cian As­so­ci­ates ex­ec­u­tives told Daouk and the po­di­a­trist that they were ter­mi­nat­ing their priv­i­leges with Florida Hospi­tal and that if the two wanted to con­tinue us­ing non-Or­lando Health fa­cil­i­ties, they would have to get their own priv­i­leges and mal­prac­tice in­sur­ance. The law­suit doesn’t state whether that ac­tu­ally hap­pened.

When Daouk ob­jected, Physi­cian As­so­ci­ates’ pres­i­dent said that per­form­ing surg­eries at other health sys­tems was “send­ing a very neg­a­tive mes­sage to your em­ployer,” ac­cord­ing to the law­suit.

Then in 2017, Physi­cian As­so­ci­ates re­lo­cated to a new fa­cil­ity, which also houses Or­lando Health Imag­ing Cen­ters.

The law­suit al­leges that in a board meet­ing that year, in which Daouk was present and so was Or­lando Health pres­i­dent and CEO David Strong, Physi­cian As­so­ci­ates’ pres­i­dent em­pha­sized “the need to re­fer pa­tients to Or­lando Health Imag­ing Cen­ters.”

Daouk was also sent emails in 2017 ask­ing him to re­fer more pa­tients to the imag­ing cen­ter.

He tried to com­ply, ac­cord­ing to the law­suit, “but he found the qual­ity of [Or­lando Health Imag­ing Cen­ters’] ser­vices to be un­ac­cept­able.” Those is­sues in­cluded long wait times, dif­fi­culty open­ing im­ages and unanswered phone lines, the law­suit al­leges.

In Fe­bru­ary 2018, Physi­cian As­so­ci­ates’ pres­i­dent sent an email to the group’s physi­cians, writ­ing, “[w]e are now a part of Or­lando Health, who has their own imag­ing cen­ters, and it is cru­cial that we choose to use them first, and to sup­port them in ev­ery way pos­si­ble,” ac­cord­ing to the law­suit.

In March 2018, the prac­tice’s COO told Daouk that Or­lando Health “would like you to cease per­form­ing surgery at Florida Hospi­tal now,” ac­cord­ing to the law­suit. In the en­su­ing months, Physi­cian As­so­ci­ates re­moved Daouk from its board and in Au­gust they fired him.

The Jus­tice Depart­ment, which in­ves­ti­gates whistle­blower law­suits such as Daouk’s, has de­clined to be in­volved in the case, as it does in about 80% of the cases, but Daouk can pur­sue the case on his own.

If proven guilty of Stark Law vi­o­la­tions, Or­lando Health may be ex­cluded from fed­eral health pro­grams such as Medi­care and Med­i­caid and face fi­nan­cial penal­ties in­clud­ing up to $15,000 for each false claim. Daouk could get as much as a 30% whistle­blower re­ward if he wins.

His at­tor­neys did not re­spond to re­quests for com­ment.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.