Physician awarded $1.5M in defamation suit against UnitedHealth's OptumRx

Jose Ignacio Lopez, MD, has been awarded $1.5 million in a lawsuit he filed in 2014 alleging Minnetonka, Minn.-based UnitedHealth Group's OptumRx incorrectly included him on a list of physicians banned from Medicare participation.

In 2013, an OptumRx vendor compiled a list of physicians barred from the Medicare program using records from HHS' Office of Inspector General. The records showed Jose I. Lopez, who worked at a Miami-based billing company, was barred from participating in Medicare, as he was convicted of fraud in 2003. However, the vendor mistakenly included Dr. Jose Ignacio Lopez — a Tampa, Fla.-based internist who had never been in legal trouble — on the banned providers list, according to a WUSF news report.

The vendor sent the list of physicians banned from Medicare to pharmacies, informing them that any prescriptions written by the physicians on the list would not be covered by Medicare in 2013.

In December 2013, Dr. Lopez contacted OptumRx about updating the list. Five months later, OptumRx sent letters to more than 100 of Dr. Lopez's patients, warning them that he was excluded from participating in federal health programs and offering to help them find new providers.

After Dr. Lopez hired a law firm to represent him, OptumRx sent out a second letter to patients in June 2014 retracting the first letter, according to the report.

Dr. Lopez subsequently filed a slander suit, naming UnitedHealth Group, UnitedHealthcare and OptumRx as defendants. On Dec. 30, 2014, the U.S. District Court for the Middle District of Florida sent the case to arbitration in accordance with a contract the parties entered into in November 2004.

The arbitration evidentiary hearing occurred before a three-member panel of the American Arbitration Association in Tampa from June 7 through June 9, 2016. A final arbitration award of $1.5 million, consisting of $500,000 in compensatory damages and $1 million in punitive damages, was entered Aug. 11, 2016.

The arbitrators determined OptumRx had published false statements about Dr. Lopez that injured his reputation in the community.

Although the final award was entered in August, it was not made publicly available until December, according to the report.

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