A health system in Jacksonville, Fla., is paying $2.5 million to settle claims in a whistle-blower lawsuit that it was overpaid by Medicare
because its former chief neurologist was misdiagnosing patients with multiple sclerosis and other serious diseases. The neurologist, Dr. Sean C. Orr, was suspended in 2013 from practicing in Florida because of allegations of sexual misconduct with a patient.
The Justice Department alleges that officials at Baptist Health, a three-hospital system based in Jacksonville, knew that some neurology patients had been “misdiagnosed and mistreated” from September 2009 to October 2011 and the system failed to immediately tell government officials about it.
Baptist Health officials said they disagree with the government's claims, including the allegation that any patient was misdiagnosed. But they decided to pay the settlement anyway to avoid a civil trial and related expenses. (Baptist Health in Jacksonville is not related to the similarly named Florida systems based in Coral Gables and Pensacola.)
“The claims resolved by this settlement are allegations only, and there has been no determination of liability,” a statement from the system says. “Our focus remains on providing the best quality care for our patients and their families.”The settlement agreement with Baptist Health in Jacksonville
says the health system does not admit any wrong-doing as part of the agreement, but it will cooperate in the ongoing investigation in the case.
Justice Department officials are facing a July deadline to decide whether to pursue allegations that Orr had intentionally misdiagnosed “scores” of patients with MS, brain lesions and other conditions to provide medically unnecessary services and bill for unneeded prescription drugs. Those allegations against Orr were included in a 2012 civil whistle-blower lawsuit
from Baptist's former neurology coordinator Verchetta Wells.
Wells' lawsuit names Baptist and related corporate entities, as well as Orr personally. Justice Department officials joined in Wells' complaint against the corporate entities, leading to this week's settlement, and they have been granted an extension until July 14 to decide whether to join in the complaint against Orr.
Orr could not be reached for comment. He stopped seeing patients at Baptist in October 2011, according to the system.
Florida's Board of Medicine suspended Orr's medical license for one year starting in August 2013 and fined him $10,000 after he settled a complaint from the state Health Department (PDF)
that he had an inappropriate sexual relationship with a female patient from August to November 2011. Orr had been treating the 44-year-old patient weekly for MS.
Meanwhile, a spokeswoman for Baptist said the system contacted all of the patients in question in the Wells lawsuit with the chance to be reevaluated. Of those that chose to return to Baptist neurology for the reevaluation, many had their original diagnoses confirmed.
“Nationally, there is a wide diversity of opinion on the diagnosis of progressive neurological conditions,” spokeswoman Cindy Hamilton wrote in an email. “Some physicians diagnose MS when early signs suggest the presence of the condition and begin treatment to slow its progression. Others physicians though choose to wait for more signs or symptoms before treating the condition, and prefer to follow criteria recommended by national MS organizations.”
Prosecutors declined to comment for this story.
Baptist officials admitted to some overbilling in 2012, but government officials said that was limited only to patients who were misdiagnosed with dystonia, spasmodic torticollis or blepharospasm and subsequently treated with Botox and Xeomin.
Baptist officials have never admitted to the Justice Department's allegations that Baptist doctors misdiagnosed patients with MS, encephalopathy, cerebral atherosclerosis, or other neurological conditions, and then billed Medicare for unneeded doses of drugs including Interferon, H.P. Acthar Gel, and other medications.
sends a clear message that healthcare fraud
will not be tolerated in our district, particularly when there is the potential for harm to patients,” said A. Lee Bentley III, the U.S. attorney based in Tampa, Fla.
Wells will receive a $424,000 share of Baptist's settlement for her part in bringing the allegations to light.
“This case serves as another example of how the False Claims Act empowers Americans to help fight fraud on the government and American taxpayers, no matter how big or small the fraud may be. It demonstrates how ordinary citizens who care about following the law and doing the right thing can make a difference," said Kirk Chapman, a New York-based Milberg attorney representing Wells.Follow Joe Carlson on Twitter: @MHJCarlson