For those of you who didn't see it a few weeks ago, here is an update on the Larkin Community Hospital lawsuit:
Larkin Hospital Hospital Wins Landmark Case
Miami, FL, July 25, 2004—In an unprecedented legal victory over the Agency For Health Care Administration (AHCA), Larkin Community Hospital made history by winning an injunction against the Agency. The Department of Justice (DOJ) filed civil charges against Larkin Community Hospital on 6/29/04 claiming that the Hospital and its Executives were engaged in fraudulent practices under the False Claims Act from 1997-1999, AHCA subsequently, withheld Medicaid payments to the facility. AHCA provided the Department of Justice with what they termed to be “Reliable evidence” of unnecessary medical care provided at Larkin Community Hospital from 1997-1999. These allegations were the basis of a Federal Lawsuit against the Hospital which made headlines approximately two weeks ago.
Larkin Community Hospital, in turn, filed suit against AHCA citing lack of credible evidence of fraud. The Federal Investigation is based upon evidence supplied by AHCA that such credible evidence exists. However, during a four hour civil hearing on July 16, 2004, before Circuit Judge Jonathan E Sjostrom, AHCA was unable to produce “reliable evidence” to support the allegations.
The following is a brief excerpt of the proceedings:
THE JUDGE: Okay. What did the records that you sent -- that AHCA sent, what did they show?
MR. STIVERS (AHCA’S BUREAU CHIEF): Medical records.
THE JUDGE: Well, I know, but what did they show that you would contend is reliable evidence that circumstances giving rise allegations of fraud, willful misrepresentation or abuse, what did those medical records show that satisfies the 24 (a) standard?
MR. STIVERS (AHCA’S BUREAU CHIEF): (No response.)
THE JUDGE: Do you understand what I'm asking you?
MR. STIVERS (AHCA’S BUREAU CHIEF): I'm not sure I can get where I am to where you want me to be.
THE JUDGE: I just want to know what the 24 (a) reliable evidence is, that's it.
MR. NAM (AHCA’S ATTORNEY): MS. ******* (AHCA’s ASSISTANT BUREAU CHIEF) might know. I don't know, but somebody does.
MS. ******* (AHCA’S ASSISTANT BUREAU CHIEF): Okay. The reliable evidence…….Judge, I think -- I'm not sure…. that I would particularly feel competent to do that, simply because clinically I'm not sure I could explain it to you. I don't have those records and have not reviewed those records…
But I do know I was the one that signed that referral.
Quoting the legal definition of fraud, Honorable Judge Jonathan E. Sjostrom concluded that the State had produced no reliable evidence to support their allegations and issued an injunction for the release of Medicaid monies owed to the Hospital.
Larkin Community Hospital further established that significant irreparable harm would be caused to community and charitable organizations if such funds were withheld. Larkin Community Hospital participates in numerous community outreach programs which benefit the underserved and uninsured population of Miami-Dade County.
The issue of community health was categorically dismissed by State Attorney, Mr. ***** W. Nam stating that, “it's not Medicaid's job to take care of, I mean, you know, whatever the societal ills may be that result from a lack of insurance coverage for the population.” The judge, however, did not agree, stating that, “the balance of harm in the public interest tips, in my view, heavily in favor of the continuing practice of medicine by these people and they have shown what they need to show, the balance of harm tips in their favor.”
Larkin Community Hospital, a 130 bed medical/surgical/psychiatric hospital, was acquired by Dr. Jack Michel in January, 1998. Since then its rating by the Joint Commission on Accreditation for Healthcare Organizations has consistently been one of the highest in Miami-Dade, receiving 97% and 98% scores for the past six years. As one of the handful of physician owned and operated hospital, Larkin provides prompt medical attention uniquely reflective of its community orientation.
RUSM 2006 Graduate