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Wednesday, April 22, 2015

Ind. Courts - "Suit: IU Health and HealthNet cheated feds, risked pregnant women's care"

That was the headline to this lengthy April 17th story in the Indianapolis Star, reported by Shari Rudavsky.

Sandra Chapman of WTHR also had a report, with video, on April 17, updated on April 20.

Some quotes from the Star story:

A federal whistleblower lawsuit claims IU Health and the state's largest midwifery practice bilked the government of millions of dollars and compromised patient safety by letting nurse midwives care for hundreds of high-risk, low-income pregnant women who should have been seen by doctors.

The suit, filed by a doctor who served as director of women's services at HealthNet as well as medical director of ob-gyn services at IU Health Methodist Hospital, says that HealthNet and IU Health shunted Medicaid high-risk patients to less-expensive nurse midwives. Then, the suit says, the providers submitted bills as though doctors had treated the women. * * *

Robinson filed her suit under seal in December 2013 under the False Claims Act, which allows individuals with knowledge of fraudulent claims submitted to the U.S. government to sue on behalf of the government. The law requires that such suits must remain under seal for at least 60 days. This suit was unsealed in March, making it public.

The False Claims Act allows the government to collect three times the amount of damages as well as a penalty of up to $11,000 for each false claim. Robinson's suit also asks for compensation for Robinson, including two times her back pay plus interest and other damages, such as lawyer's fees.

If the suit is successful, plaintiffs say, potential damages could reach around $100 million for IU Health, the state's largest health system, and HealthNet, an IU Health affiliate that serves poor patients through eight inner-city clinics. MDwise, a local managed care insurer, is also named in the suit. * * *

Dr. Judith Robinson, the former employee who filed the suit, claims she was terminated in 2013 after raising questions about patient safety at HealthNet. Her suit claims doctors often never saw HealthNet patients with high-risk pregnancies or were called in only on an emergency basis, sometimes when it was too late.

The suit alleges a lack of doctor involvement may have contributed to one mother's death, and brain damage in children.

"I went to everybody and anybody I could because I was concerned about these patients," Robinson said in a recent interview. "Why is it that it seems to be OK to have this population of indigent patients … get less care? It is just not right."

The lawsuit cited an email Robinson sent her employers in spring 2013, shortly before she was fired. In it, Robinson identified 14 clients with near misses and two "terrible outcomes" within a six- to eight-month span and said she wanted to fix "a broken system." * * *

Robinson's suit says HealthNet, MDwise and IU Health all benefited financially by using nurse midwives, who command a lower salary than doctors.

HealthNet, a not-for-profit corporation, was set up to provide primary care to the medically underserved. More than half of the about 4,000 women who visit a HealthNet clinic for prenatal care each year deliver at Methodist. MDwise processed many of the claims.

ILB: The ILB had some difficulty locating the complaint using PACER; an inquiry to the reporter requesting the case number went unanswered.

However, this morning's search proved successful. Here is the current docket plus the 60-page amended complaint (now unsealed) in UNITED STATES et al v. INDIANA UNIVERSITY HEALTH INC. et al (1:13cv02009TWPMJD), SD Ind., Judge Pratt.

Posted by Marcia Oddi on April 22, 2015 10:58 AM
Posted to Indiana Courts