The University and Yale-New Haven Hospital could face more than $1 billion in Medicare billing violations for seeking efficiency at the cost of patient care in new lawsuits brought by a radiologist who was recently part of a successful case against the two institutions, the doctor’s attorney said.
A six-member jury ruled in favor of Drs. Morton Burrell, Arthur Rosenfield and Robert Smith MED ’85 in July, awarding them $1.4 million, $3.85 million and $259,000, respectively, for past and projected future economic losses. The neurologists convinced the jury that hospital administrators had demoted them and cut their pay for speaking out against allegedly unsafe and fraudulent hospital practices, but the Waterbury District Superior Court case only addressed harm to the plaintiffs, not the complaints’ factual bases.
Though Smith seeks to address those claims in two separate suits brought under the False Claims Act, Burrell and Rosenfield are still employed in the hospital’s radiology department and are not involved in those suits. University and hospital attorneys have filed a pending motion to dismiss the cases, but no court date has been set.
Smith’s attorney, Jacques Parenteau, said the complaints his client has submitted for governmental review allege incomplete diagnoses and premature billing by the hospital’s resident physicians — who Parenteau said file incomplete claims without the required analysis and approval of senior hospital staff — under an automated billing system called “auto-sign.” Parenteau said the claims themselves are small but the penalties for false reporting can reach $11,500 per violation, and he estimated the existence of more than 100,000 such offenses.
University officials dismissed such charges as baseless, saying the auto-sign system was designed specifically to prevent such abuses.
“It’s a means by which the department ensures that it does not issue a bill for certain studies,” Yale Associate General Counsel Harold Rose said. “We do not understand how that could possibly represent a false claim.”
Rose said the University and the hospital were cleared of falsifying billing reports and skimping on patient care before the first trial. He said an investigation conducted by Hogan and Hartson, a Washington, D.C.-based law firm, found nothing incriminating.
But Rosenfield’s attorney, Joseph Garrison, said the investigation was conducted in concert with University officials according to the aims of the defense and was not objective.
“That report was nothing but a whitewash,” Garrison said.
Rose denied the claims of bias on the part of Hogan and Hartson, and said the investigation was thorough and fair.
The Joint Commission on Accreditation of Healthcare Organizations, a nonprofit medical standards and practices watchdog group, has consistently awarded the hospital with high marks comparable to most other national hospitals, commission spokesman Mark Forstneger said. The commission’s most recent report, filed in 2002, ranks Yale as “average” or “above average” in most categories, though it is ranked weaker in initial assessment procedures, data assessment and staff competence assessments.
Rose said Yale officials expect to see the false claims cases dismissed and are turning their attention to appealing the first case, which was decided in July, though he declined to comment on specific aspects of the appeal.
Parenteau said Smith, now a law student at Fordham University, is optimistic the new cases will be tried, in light of the radiologists’ victory earlier this year.
“I think it was a wonderful vindication of the intent of Yale University’s freedom-of-expression policy,” Parenteau said. “It’s unfortunate that the Yale administrators could not see their way to protecting free speech the way a jury could.”
If the cases proceed to trial, the complexity of the case law means the court proceedings will be lengthy regardless of the outcome, said Hank Greely, a Stanford University law professor specializing in health and contract law.
“Billing practices are very complicated, often very Byzantine,” Greely said. “In fact, calling them Byzantine is probably an insult to the Eastern Roman Empire.”