Florida Cardiologist Faces Government Lawsuit

The United States Department of Justice (“DOJ”) brought medicare fraud charges against a prominent cardiologist after joining in on separate but ongoing whistle-blower cases.

Among the allegations, the doctor and medical group that performed the services are charged with padding bills, undergoing unnecessary procedures, offering and giving kickbacks to patients that waived their copayments, even potentially  lethal operations such as catheterization of the heart.

The liability theory falls under the Federal Civil False Claims Act under 31 U.S.C. Section 3729, (“FCA”); which is one of the government’s harshest mechanisms in prosecuting waste, fraud, and abuse of public funds.

The law of the False Claims Act requires in part, that the person or entity fraudulently claims payments or approval, makes false records or statements that are material to a fraudulent claim, or conspires to get a false claim paid by the government.

These acts can be made in dozens of ways.  Namely, providing medically unnecessary procedures, falsely claiming procedures that were never done, and falsifying documents.

Critics and advocates face diametrically opposed viewpoints on practitioners that coordinate large-scale operations because volume procedures that require heavy workloads can make intelligent minds disagree as to whether foul play was at hand.

The Dangers of No-Knock Search Warrants

RaidPolice.10.31.14

 
By Rizuan (Own work) [CC-BY-SA-3.0], via Wikimedia Commons
 

You’re sleeping quietly at home, and so are your family members. Suddenly the door is torn down and a flash-bang grenade explodes in your apartment and several intimidating men with body-armor, helmets, and semi-automatic weapons storm inside. And one more thing, you’re naked.

What you soon find out, is that the police were not there to find you. They entered the wrong house.

This scenario may not happen every day. In fact, it’s safe to say it doesn’t happen often. But unfortunately it does. And the way it happens is from a combination of two very dangerous elements: Confidential Informants and No-Knock Search Warrants.

The scenario above occurred in December 2010. It caused the small family to experience extraordinary trauma from the encounter and seek counseling. This should not be surprising given that the stress and utter panic from being attacked or having an intruder in the house is identical to that of a trained police force.

What we all must know, however, is that the courts allow recourse. Among the reasons to sue for this kind of an intrusion, the primary causes of actions are negligence, false arrest, negligent hiring practices, and general municipal liability statutes for customs and habits of the department.

Despite the apparent wrongdoing, cities and counties will still fight to absolve their officers of any liability claiming “qualified immunity.” In other words, attorneys for the government will routinely argue that even though something wrong happened, officers should not be liable.

The framework for Qualified Immunity analysis is usually composed of two distinct steps: (1) the facts taken in the height most favorable to the party asserting the injury (those who are suing) show that the defendants conduct violated a constitutional right and (2) the right was clearly established at the time of the alleged violation. Saucier v. Katz, 553 U.S. 194, 201 (2001).

When analyzing a claim against a public entity such as a police department or county sheriff’s department, this is one of the biggest hurdles for plaintiffs to meet. Once it’s met, however, the case can proceed to trial. That is called a genuine issue of material fact.