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Ohio Heart News
Address Issues in Christ Lawsuit
Apr 08th 2008
It is difficult to sort out the issues, charges and countercharges in a five-year-old whistleblower suit against Christ Hospital that federal officials intervened in last week, raising the possibility of a devastating $400 million in penalties to the landmark Cincinnati hospital.
Federal authorities say the hospital's method of assigning physicians to perform tests at its cardiac center - which it is alleged favored the Ohio Heart & Vascular Center physicians' group - constituted an illegal kickback scheme to doctors who referred patients to the center.
This is the first time such an accusation has been made anywhere, and the U.S. Justice Department is expected to file its own suit within 120 days.
Christ says that the doctor assignments didn't constitute payments - illegal or otherwise - that unassigned patients weren't more likely to go with the "favored" doctors, and that Medicare and Medicaid were not defrauded, as the government claims.
Similar arrangements with doctors' groups are found in hospitals across the country, Christ officials add.
It is an extremely complex case that will have national implications, but it's a very local issue that residents of our community should care deeply about. The case could affect the quality and availability of health care here for years to come. It could change the ways in which health care providers interact and patients deal with them.
We don't know what legal outcome might be or even should be. But we do know two things:
The controversy is bad for residents of Greater Cincinnati. Win, lose or draw, a long legal fight could be a crippling drain on the resources of Christ and the Health Alliance, which also has been named in the suit. It could compromise the medical care you and your family receive. The parties must try honorably and sincerely to reach a settlement - quickly - that preserves the integrity of our health care system.
The payment/referral question exposes one of many regulatory gray areas in health care, especially where programs such as Medicare and Medicaid are concerned. Inevitably, more such areas will emerge as Washington interjects itself more deeply into the industry. Legislation to clarify rules is needed. Congress has a responsibility to make the standards absolutely clear and consistent.
Both sides apparently agree that no patient care was compromised, no unnecessary procedures were performed, Medicare and Medicaid were not overbilled, and no money changed hands illegally.
If that's so, it raises a crucial question:
Why are federal officials pursuing a claim large enough to bankrupt Christ, as hospital officials claim, and bring down other area hospitals with it?
Are they, as Christ officials allege, motivated by the prospect of a big legal payday to help fund the Justice Department and feather the caps of ambitious U.S. attorneys?
Are they reflecting a recognition that fundamental changes need to take place in the relationships between doctors, hospitals, insurers and others in health care this a catalyst for such change?
Or is something else going on here?
Another question that must be addressed: Is the Justice Department trying to stretch laws to cover situations they weren't designed for?
The Civil War-era False Claims Act, enacted to go after those who sold sick mules and defective weapons to the military, has appropriately allowed the government - through private whistleblower suits - to recover billions of dollars from contractors who defrauded taxpayers.
But should it be used when there is no defrauded taxpayer money to be recovered? Or is that an overreach, like the government's recent attempts to use the 1970 RICO anti-racketeering statute, designed to combat organized crime, in applications that are novel, to say the least? Are we allowing "legislation by litigation" to overrule the will of the people as reflected in their elected representatives?
That's a debate for another forum, however. On this lawsuit, our messages are simple.
To Christ Hospital and the Justice Department: Settle it.
To members of Congress: Fix it.