Physician wins $1.5M suit after mistakenly being put on a list of Medicare-barred providers: 5 key notes

Practice Management

A physician whose patients had trouble filling prescriptions after UnitedHealth Group's OptumRx mistook his identity and placed him on a list of physicians who were barred from Medicare participation won $1.5 million in a slander suit against the company, according to a WLRN report.

Here are five things to know:


1. OptumRx compiled a list of physicians who were no longer allowed to participate in Medicare. The list was based on OIG records, which contained information about a Jose I. Lopez, who worked for a Miami-based billing company and was convicted of fraud in 2003. OptumRx mistook Tampa-based internist Jose Ignacio Lopez, MD, for Mr. Lopez and placed Dr. Lopez on the list.


2. An OptumRx vendor sent its list of physicians barred from Medicare participation to pharmacies, warning any prescriptions written by those physicians wouldn't be covered in 2013. Dr. Lopez began hearing from patients about not being able to fill their prescriptions in December 2013 and began contacting OptumRx to update their records.


3. Five months after making initial contact with OptumRx, Dr. Lopez's name was still on the list. The company sent out letters to more than 100 of his patients saying he wasn't able to participate in the federal health programs and prescriptions he wrote wouldn't be covered. The company offered patients assistance in finding new providers.


4. After Dr. Lopez hired a law firm to represent him, OptumRx sent out another letter more than a year after the initial letter to Dr. Lopez's patients retracting the first letter. Weekley Schulte Valdes filed a slander suit against OptumRx on Dr. Lopez's behalf and the case went to arbitration. A panel of three lawyers issued a report recommending the $1.5 million award.


5. The mistake could have been avoided if the individuals compiling the list of barred providers had cross-checked Mr. Lopez's Medicare identification number with Dr. Lopez. It's unclear how common such mistakes are, but there is at least one other similar case of mistaken identity in the Miami area.


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