The University of Miami, which operates a variety of medical facilities and medical education institutions, must face a retaliation lawsuit filed by a former operations and compliance officer who claimed the organization violated the False Claims Act by firing him for raising concerns about Medicare billing practices, a Florida district court said Nov. 16.
Jonathan Lord, MD, served as the chief operations officer and chief compliance officer at the University of Miami Health System. In the lawsuit, which was initially filed in 2013, Dr. Lord alleges that he was fired 12 days after sending an email to the board pushing them to ensure completion of an external review of billing practices without interference from the administration or leadership.
In September, the university moved to dismiss the case, arguing that Dr. Lord's acts were not legally protected, that the university didn't know he raised concerns about the Medicare billing practices and that the allegedly protected acts didn't cause his firing.
In a Nov. 16 opinion, the U.S. District Court for the Southern District of Florida said Dr. Lord sufficiently asserted that he had a belief that the university was billing Medicare for unnecessary organ transplant testing, that he attempted to stop any violations of the False Claims Act and that the university knew about this activity.
The University of Miami partially settled the whistleblower suit earlier this year for $22 million, with two exceptions. One exception was that Dr. Lord could pursue a claim under the FCA's antiretaliation provision and claims for attorneys fees.
Under the whistleblower lawsuit, prosecutors alleged that the university billed federal healthcare programs for medically unnecessary laboratory tests for patients who received kidney transplants at an institute it operated with Jackson Memorial Hospital in Miami. Prosecutors claimed that when a patient checked in, the electronic ordering system triggered a predetermined number of tests to be run, but many were not necessary and "dictated by financial considerations rather than patient care."