Yes Doctor, You Must Follow the Hospital’s COVID Policy
A physician whose medical staff appointment was terminated when he refused to be vaccinated after his request for a religious exemption from a hospital’s COVID vaccination policy was denied, sued the hospital and its management claiming that the hospital’s vaccination policy violated the Health Care Quality Improvement Act (“HCQIA”) and Section 1983 of the civil rights laws. The court quickly dismissed the HCQIA claim. It then focused on the physician’s Section 1983 claim, which required an action under the color of state law. The district court decision dismissing the Section 1983 claim was upheld by the 5th Circuit Court of Appeals which held that a private hospital’s vaccination policy was private conduct, not the state conduct required for a claim under Section 1983. Julapalli v. Methodist Hospital et al.
Regardless of Harm, Malpractice Claims Can Only Be Asserted by a Patient
A hospital discharged a patient from its psychiatric ward and the next day he stalked and used a handgun to kill his former girlfriend and then himself. The former girlfriend’s mother sued the hospital claiming a failure to warn her daughter and a failure to adequately treat the patient. The Connecticut Superior Court ruled that in Connecticut the duty to warn as well as the other claims alleged in the complaint were medical malpractice claims. It then ruled that under Connecticut state law, a malpractice claim can only be asserted by a patient. Since the daughter of the plaintiff in this case was not the hospital’s patient, the court granted the hospital’s motion to strike all of her claims. Ashworth v. Town of Branford et al.
Another Bite at the Qui Tam Apple
A qui tam claim relator brought a False Claim Act (“FCA”) claim against his former employer that claimed that the former employer’s Medicare claims submission process violated the FCA. The district court dismissed all of the relator’s claims holding that because the relator was not directly involved in the claims submission process, he had failed to state an FCA claim. On appeal, the 11th Circuit Court of Appeals considered the district court’s dismissal of the relator’s claims in light of the U.S. Supreme Court’s 2024 decision in US ex rel. Schutte v. SuperValu, which held that a defendant’s subjective belief about the falsity of their claim is central to determining whether they violated the FCA. The appellate court then determined that based on an alleged internal audit of the former employer and other indicia of reliability, the qui tam relator had stated a claim under the FCA that his former employer’s failure to obtain an assignment of benefits from Medicare beneficiaries alleged an actual submission of false claims. The appellate court then reversed the district court’s decision that had dismissed this FCA claim, reinstated the relator’s conspiracy claim, and remanded the case back to the district court. Olhausen v. Arriva Medical, LLC
OOPS!!!!
A group of hospitals sued HHS claiming that in 1983 when the IPPS system was first developed, HHS miscalculated certain figures called the “standardized amounts.” Because each subsequent year’s IPPS Hospital reimbursement amounts are based on the previous year’s standardized amounts, this error was alleged to result in depressed Hospital payments that continue to this day. In 2019, several hospitals filed an administrative appeal to the PRRB. They were not seeking past reimbursement, but wanted the PRRB to correct the calculation of the standardized amounts for 2019. In 2023, the PRRB ruled against the hospitals holding that the applicable Medicare statutes precluded administrative or judicial review of the challenged calculations. The U.S. District Court for the District of Columbia reversed the PRRB’s decision holding that the PRRB did have jurisdiction to hear this case. The court then remanded the case back to the PRRB. Recognizing that this dispute has been dragging on, in one form or another, for nearly two decades, the court then required the PRRB to report back to the court on the progress of this case every 30 days. St. Mary’s Regional Medical Center et al. v. Becerra