A Florida internist won $1.5 million in a lawsuit against healthcare giant OptumRx after he was mixed up with another man with the same name and as a result was placed on a list of physicians who were barred from Medicare participation.
Jose Ignacio Lopez, M.D., of Tampa, first knew something was wrong when he started hearing from patients in 2013 that they were not able to fill their prescriptions because he had been blocked from participating in federal health programs, according to Health News Florida. The problem began for Lopez when a vendor for OptumRx, a pharmacy benefits management company associated with United Healthcare, compiled a list of physicians who were no longer allowed to participate in Medicare based on records from the Office of Inspector General. Those records included a man named Jose l. Lopez, who worked for a Miami-based billing company and was convicted of fraud in 2003. The company mistakenly placed the Tampa doctor on its list of sanctioned providers which was sent to pharmacies saying prescriptions he wrote would not be covered.
Lopez had never been in trouble but the vendor did not compare Medicare identification numbers to check to see if he was the man in OIG records, according to the report.
Lopez called and wrote to OptumRx trying to correct the mistake, but despite reassurances nothing was done. Five months after his initial contact with the company, OptumRx sent out letters to more than 100 of his patients saying he was barred from participating in federal health programs, their prescriptions would not be covered and the company would help patients find another doctor.
It was then that Lopez hired a law firm. However, it took OptumRx more than a year after the initial letter to send the doctors’ patients a letter correcting his Medicare status. The law firm filed a slander suit against OptumRx and after a week-long arbitration a panel of three lawyers awarded Lopez $1.5 million. The arbitration found Lopez was entitled to punitive damages of $1 million due to the company’s “intentional misconduct or gross negligence” and required the company pay all costs associated with the litigation.
“This case was not about money,” the doctor said in an announcement from his law firm Weekley Schulte Valdes in Tampa. “This case was about sending a strong and clear message that faceless companies that libel and slander doctors must be held accountable for their actions.”
It's unclear how common such mistakes are, but attorney Paul M. Weekley said that during the litigation process he learned Lopez was one of many physicians defamed by similar misconduct or gross negligence but did not provide details. A new federal rule, published last month in the Federal Register, would update the OIG’s exclusion authorities.