Health Care Civil Litigation
There are a variety of situations in which healthcare practitioners become involved in civil litigation. The most common example is medical malpractice lawsuits. Sometimes healthcare practitioners are sued by insurance companies for recoupment of benefits paid or for fraud resulting from the alleged submission of knowingly false HCFA 1500 claims forms. Some states, like Texas, offer the practitioner some relief from recoupment actions in the form of a relatively short statute of limitations for which claims for recoupment (absent fraud) can be made by an insurance company. This type of statute should substantially reduce the risk of practitioners to recoupment lawsuits, though it will probably have no effect on fraud claims asserted by insurance companies.
Federal and state authorities often investigate health practitioners. While the government has to right to investigate allegations of wrongdoing, it must do so in a reasonable manner and investigators cannot violate an individual’s constitutional rights, or commit criminal acts to further an investigation or obtain settlements for alleged violations of law. I have handled a number of cases for healthcare practitioners against government officials for overzealously or illegally pursuing investigations of healthcare practitioners. The basic claim is under 42 U.S.C.1983, civil rights. I have also used the federal RICO statute against groups including government agents.*
Some years ago a state fraud agency sent out hundreds and indeed thousands of letters to healthcare practitioners accusing them of insurance fraud, but not specifying what the fraud was. Upon being contacted by the practitioners they would give little information about the alleged fraud but would demand exurbanite fines and threaten practitioners with criminal prosecution unless they paid the fine. Such conduct is illegal under state law. Eventually we filed a racketeering and civil rights action against officials of state agency and eventually received a very favorable settlement, which among other things stopped the practice.
In another case, state investigators used an investigation to interfere with a practitioner’s clinic and divert patients to other practitioners in the area. Such actions if sufficiently egregious could constitute an actionable civil rights violation, which could allow for damages and possibly injunctive relief.
The down side of these kinds of federal lawsuits is that they normally take several years to complete and are time consuming and expensive. But sometimes a practitioner has no other choice to stay in business. (See “Articles of Interest” section of this website for some examples of these types of lawsuits).
I have represented health practitioners in a wide variety of civil litigation in many states, including New York, New Jersey, Ohio and Texas.
* See for example, Chiropractic Alliance of New Jersey v. Parisi 854 F.Supp. 299; In re Burzynski 989 F.2d 733.