Articles Posted in Health Care Law

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The Office of the Medicaid Inspector General (OMIG) terminated a physician's participation in the Medicaid program on the basis of a Bureau of Professional Medical Conduct (BPMC) consent order, in which the physician pleaded no contest to charges of professional misconduct and agreed to probation. Supreme Court annulled the OMIG's determination. The Appellate Division affirmed, concluding (1) the agency acted arbitrarily and capriciously in barring the physician from treating Medicaid patients when the BPMC permitted him to continue to practice; and (2) the OMIG was required to conduct an independent investigation before excluding a physician from Medicaid on the basis of a BPMC consent order. The Court of Appeals affirmed but for another reason, holding (1) the OMIG is authorized to remove a physician from Medicaid in reliance solely on a consent order between the physician and the BMPC, regardless of whether BPMC chooses to suspend the physician's license or OMIG conducts an independent investigation; but (2) because OMIG did not explain why the BPMC consent order caused it to exclude the physician from the Medicaid program, the agency's determination was arbitrary and capricious.View "Koch v. Sheehan" on Justia Law

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Dr. Tommie Granger was a certified cardiac surgeon who had hospital privileges at defendant Christus St. Frances Cabrini Hospital. One of his patients was hospitalized at Cabrini and developed complications. While the doctor was called to the hospital to check on the patient, he and Cabrini staff got into a heated exchange of words within earshot of the patient. The doctor performed an in-room procedure and left. En route, the patient developed further complications, but the doctor was unable to go back to Cabrini to help. He called a colleague to perform the necessary surgery on the patient Cabrini's Board of Directors suspended Granger pending a review of the doctor's conduct regarding that patient. Finding that unprofessional behavior was a contributing factor that adversely affected the patient's care, the Board recommended that the doctor be placed on probation and to self-refer for anger management. When he did not comply, the Board revoked his privileges. The doctor sued, and ultimately won nearly $3 million in damages with respect to Cabrini's peer review proceedings. Upon review, the Supreme Court found that an award of lost income that was included in those damages was given in error, and was vacated. View "Granger v. Christus Health Central Louisiana" on Justia Law