Orthopedic surgeon files whistle-blower lawsuit against Orlando Health, Physician Associates

An orthopedic surgeon has filed a whistle-blower lawsuit against Orlando Health and three of its subsidiaries, alleging that his superiors violated federal laws by requiring him to perform surgeries and make referrals within the Orlando Health network only and then fired him when he refused to comply.

Dr. Ayman Daouk is suing Orlando Health, Physician Associates, Orlando Health Physician Group and Orlando Health Imaging Centers, alleging that he was fired by Orlando Health and Physician Associates “because he performed surgeries at a non-Orlando Health facility and referred patients for imaging at a non-Orlando Health facility.”

The lawsuit alleges that because Orlando Health owns Orlando Health Imaging Center, Orlando Health Physician Group and Physician Associates, there is an unbroken chain of financial relationships that constitute self-referral, which is prohibited by the federal Stark Laws.

An Orlando Health spokeswoman said the health system doesn’t comment on pending litigation.

Marni Jameson Carey, executive director of the Association of Independent Doctors, said Daouk’s lawsuit doesn’t surprise her.

“If a doctor knows that another site is less expensive, has better quality and is more convenient [for the patient] they’re still chastised and heavily reprimanded for referring outside the system,” she said. “It’s called leakage and it’s strongly frowned upon, and I know many doctors who have been called into the administrators’ offices and reprimanded and even fired for this behavior.”

Daouk had been working for Physician Associates since 2009 when the 95-physician practice was bought by Orlando Health in late 2012.

In the lawsuit, he alleges that what started as a nudge to refer within the system eventually turned into a mandate.

At first the Physician Associates doctors were told that “they should endeavor to refer more patients to Orlando Health entities,” according to the lawsuit. “Pretty soon, however, such referrals became a mandate, with threats made against those who failed to comply.”

The lawsuit cites an instance in 2014, when the Physician Associates chief operating officer emailed a podiatrist who was performing surgeries at Florida Hospital, now AdventHealth, in addition to Orlando Health.

“[Physician Associates] board has asked me to remind you that you are an employee of an Orlando Health owned company and, therefore, should show some loyalty to the system. They have asked me to find out why you are still using Florida Hospital North for surgeries,” read the COO’s email cited in the lawsuit.

Daouk was also targeted for the same issue even though nothing in his employment agreement prevented him from performing surgeries at Florida Hospital, according to the lawsuit.

The lawsuit alleges that several months later, Physician Associates executives told Daouk and the podiatrist that they were terminating their privileges with Florida Hospital and that if the two wanted to continue using non-Orlando Health facilities, they would have to get their own privileges and malpractice insurance. The lawsuit doesn’t state whether that actually happened.

When Daouk objected, Physician Associates’ president said that performing surgeries at other health systems was “sending a very negative message to your employer,” according to the lawsuit.

Then in 2017, Physician Associates relocated to a new facility, which also houses Orlando Health Imaging Centers.

The lawsuit alleges that in a board meeting that year, in which Daouk was present and so was Orlando Health president and CEO David Strong, Physician Associates’ president emphasized “the need to refer patients to Orlando Health Imaging Centers.

Daouk was also sent emails in 2017 asking him to refer more patients to the imaging center.

He tried to comply, according to the lawsuit, “but he found the quality of [Orlando Health Imaging Centers’] services to be unacceptable.” Those issues included long wait times, difficulty opening images and unanswered phone lines, the lawsuit alleges.

In February 2018, Physician Associates’ president sent an email to the group’s physicians, writing, “[w]e are now a part of Orlando Health, who has their own imaging centers, and it is crucial that we choose to use them first, and to support them in every way possible,” according to the lawsuit.

In March 2018, the practice’s COO told Daouk that Orlando Health “would like you to cease performing surgery at Florida Hospital now,” according to the lawsuit. In the ensuing months, Physician Associates removed Daouk from its board and in August they fired him.

The Justice Department, which investigates whistle-blower lawsuits such as Daouk’s, has declined to be involved in the case, as it does in about 80% of the cases, but Daouk can pursue the case on his own.

If proven guilty of Stark Law violations, Orlando Health may be excluded from federal health programs such as Medicare and Medicaid and face financial penalties including up to $15,000 for each false claim.

Daouk could get as much as a 30% whistle-blower reward if he wins.

His attorneys did not respond to requests for comment.