Health Care Law Litigation in Ft Lauderdale, Florida and Atlanta, Georgia

Health Care Law Litigation and Its Impact

The healthcare industry is growing rapidly and continually. While new healthcare developments open new possibilities, this progress is not without challenges. Economic demands increased scrutiny, and government regulation has raised the stakes on the issues that healthcare providers are involved in.

Healthcare law litigation is an important aspect to consider for many reasons. Hospital administrators and doctors understand this all too well as they often spend considerable time and resources on managing legal issues on top of providing care for their patients. The effects of this medical/legal multitasking can be far-reaching, negatively affecting the healthcare industry and the public.

Below discusses some of the severe legal aspects that can arise in healthcare and provides an overview of how it affects the industry and the public. It will also address how an experienced appellate lawyer can help when tough.

There are four key areas to consider:

  • Breach of contract
  • Fraud, including Medicare and Medicaid fraud
  • RICO
  • Claims arising from disputes with ERISA and COBRA

What is a Breach of Contract?
Breach of contract is a type of litigation where the plaintiff alleges that the defendant breached an agreement or contract. The breach can be regarding a service or treatment.

The plaintiff usually seeks damages, including medical expenses, pain, suffering, lost wages, or other damages. The plaintiff may also seek specific performance or injunctive relief to compel the defendant to perform its obligations under the contract.

What Constitutes a Breach of Contract in Healthcare?
A breach of contract claim might be raised if a doctor promised or warranted something other than the legal obligation to provide proper treatment, and that promise was not kept.

It's worth noting that the concept of breach of contract differs from the definition of malpractice. Medical malpractice claims are tort proceedings based on a physician's responsibility to a patient, the failure to fulfill that duty, and the resulting damage to the patient. A tort is an action or omission that causes injury to another person and is considered civil guilt by the courts.

So, although malpractice entails physicians' essential duty to use adequate medical abilities to give the best care for their patients, breach of contract entails failing to maintain a specific promise or guarantee that is not part of the fundamental standard of care.

What Constitutes Fraud in Healthcare Law?
Healthcare fraud involves falsifying medical claims to generate a profit. Fraudulent healthcare schemes exist in several different forms, including:

  • The obtaining of prescription medication fraudulently to sell for a profit
  • Billing patients for services that were never rendered
  • Submitting two or more claims for the same service
  • Billing for non-covered services as if they were covered
  • Making changes to medical records
  • Intentional misreporting of diagnosis or treatments to maximize payments
  • Taking or offering incentives in exchange for member referrals
  • Waiving member copays
  • Prescribing treatment that is unwarranted or excessive

Insurance members can commit healthcare fraud by:

  • Lying on applications for services
  • Counterfeiting or selling prescriptions
  • Using transportation benefits for non-medical purposes
  • Borrowing or using another's insurance card
  • When there is an agreement between 2 or more individuals to commit fraud or other healthcare crimes, it's considered a conspiracy.

Medicare or Medicaid Fraud
Some fraudulent practices aim to obtain large payments from the government-funded healthcare programs Medicare and Medicaid. Medical professionals, healthcare facilities, patients, and others who may pose as one of these individuals can be accused of Medicare and Medicaid fraud. Billing for services that were not performed, having unneeded testing done, and obtaining benefits when one is not eligible are all forms of fraud, as is filing reimbursement claims for which the claimant is not legally entitled.

Anyone who participates in Medicare or Medicaid fraud can face prosecution in almost any state in the US, depending on their involvement in fraudulent claims. Prosecution and conviction of a healthcare provider could have dire effects, including the possibility of facing jail time, fines, and the loss of medical license.

Claims Arising from Disputes with ERISA and COBRA
ERISA, which stands for the Employee Retirement Income Security Act, is a series of federal laws intended to safeguard employees of private companies who offer pension, retirement, profit-sharing programs, or health insurance. ERISA sets minimum requirements for these plans and gives employees certain rights. ERISA violations generally occur when a party fails to meet specific legal obligations, such as health insurance coverage obligations.

Common ERISA violations include illegally withholding benefits to current or former employees and breaching a fiduciary duty to plan participants. There may be civil penalties or criminal penalties for ERISA violations. The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows workers and their families to keep their group health benefits for a limited time after a job loss, reduction in hours worked, job change, death, divorce, or other life events.

Employers charged with failure to comply with COBRA's regulations can face severe penalties. Failure to send the COBRA election notification during the allotted time frame can lead to penalties of up to $110 per day and the cost of the qualifying beneficiary's medical expenses. Employers must remain on top of the developments affecting these benefits programs to reduce compliance risks.

What is RICO?
RICO stands for the Racketeer Influenced and Corrupt Organizations Act. A federal statute provides for extended criminal penalties for racketeering activity within specific industries. It was enacted in 1970 to combat organized crimes such as counterfeiting, illicit gambling, prostitution, embezzlement, and extortion. The act's original purpose was to help industries that organized criminal efforts had compromised.

One of the crimes covered by the RICO Act is drug trafficking. Individuals may face charges of illegally transporting or selling prescription medications without legitimate prescriptions or distribution authorization. This includes transferring or selling otherwise legal medications like Xanax, Hydrocodone, and Adderall if transported or sold without legal authorization. The Controlled Substances Act lists medications and narcotics that licensed pharmacists can only dispense with valid prescriptions from approved physicians.

The Medical Industry and RICO
A pharmacist permitted to sell pharmaceuticals could be vulnerable to RICO Statute drug trafficking charges if they are accused of conspiring with others to transfer and sell drugs illegally. Participation in any part of a racketeering enterprise's actions may be enough to get a person charged with drug trafficking under the RICO Act. This is one of the factors that can put medical professionals in a challenging position. Anyone charged with a drug offense under the RICO Act or whose family member has been charged under the act should get legal advice as soon as they can.

Overarching Effects of Healthcare Law Litigation
It's essential to understand the legal risks involved in healthcare since the impact is comprehensive. Potential patients may be troubled by news or suspicions of misconduct at a medical office or hospital, making them unwilling to seek care. Patients may become concerned about negative legal rumors, hindering trust between doctor and patient. Healthcare litigation can also impact healthcare costs, causing expenses to increase.

Experienced Legal Professionals Can Help You Navigate the Issues in Healthcare Litigation
Experienced healthcare lawyers are equipped to deal with a variety of complex and unique healthcare legal issues, such as Medicare, Medicaid, breach of contract concerns, RICO, COBRA, ERISA issues, and more. These attorneys remain up to speed on the laws and regulatory compliance to help providers avoid allegations of breach of contract or fraud. Knowledgeable attorneys also collaborate with medical professionals and patients to ensure that patient's rights are protected. This can serve as a proactive resource for all involved.

Hunker Appeals focuses on laying the groundwork for success when the stakes are high. We have extensive experience in appeals, having successfully represented clients in state and federal courts throughout various practice areas. If you have questions about healthcare law, contact us at 877-841-8808. Hunker Appeals serves clients throughout Florida and Georgia as well as other states, including Atlanta, Tallahassee, Jacksonville, Orlando, Tampa, Fort Lauderdale, Boca Raton, Weston, Coral Springs, Hollywood, Miami, West Palm Beach, and surrounding Florida communities.

Get in Touch

Call us now for a consultation and let us help you find the right path in your case.

Scroll to Top