What’s New in Health Law
No-Cost Medical Director Services as Basis of Fraud and Abuse Claims
A federal district court denied the motions to dismiss of two hospitals and their exclusive radiology group in a lawsuit brought by a former physician employee, as a relator on behalf of the government, who alleged that the hospitals and group violated the Anti-Kickback Statute and the False Claims Act. The relator’s primary allegation was that the exclusive contract between the hospitals and radiology group violated the law by failing to compensate the group for medical director services provided pursuant to the contract.
United States v. Millennium Radiology, Inc.
Question of the Week
While conducting routine verification of an application for appointment, we learned that the physician applicant may have been involved in a couple of behavioral incidents at another hospital. We asked the physician to obtain that hospital’s peer review file so that we can consider it as part of our credentialing process. Stating that its file is confidential and privileged, the hospital has refused to release a copy and will not provide any information other than a statement that the physician is “in good standing, with no pending adverse actions.” Since this matter is outside of the physician’s control, should we just accept the physician’s version of the behavioral incidents and move forward with the credentialing process? What choice do we have?
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