Are You Subject to a Civil RICO Claim by an Insurance Company?

Are You Subject to a Civil RICO Claim by an Insurance Company?Many legal scholars have theorized that the civil Racketeer Influenced and Corrupt Organizations Act statutes (RICO), which are designed to go after businesses that are inherently manipulated and corrupted to the point that they function as criminal organizations, were not intended to be applicable to the healthcare industry. However, in the last 10 years, many insurance companies, particularly in the realm of no-fault insurance, have filed such claims against providers. Every so often one of the large insurance companies tends to file another RICO claim in an effort to “clean house” from providers that they feel are billing inappropriately or are operating with non-doctors in a “dummy doc,” or “doc in the box” situation.

Typically, civil RICO claims put a huge amount of pressure on the defendant. This is due to the far reaching ability of a plaintiff to look beyond just the defendant and individuals or the entity in the lawsuit. An insurance company bringing such a suit also has the ability to look into the payments and finances of third parties and the relationship of third parties with the defendant and its owners. This means that any claim of fraud under a civil RICO action could potentially expose any entity, in addition to a management company or other organization that is regularly doing business with the practice (such as a landlord that holds the lease and provides specific services), to scrutiny or inclusion in the civil RICO lawsuit.

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The Corporate Practice of Medicine Doctrine: What it Means and How it May Affect Medicine Today

The Corporate Practice of Medicine Doctrine: What it Means and How it May Affect Medicine TodayIn many northeastern states, including New York, as well as many other states across the country, the theory behind the Corporate Practice of Medicine Doctrine is the belief that a medical practice not owned by a physician or medical professional, is not going to function and provide the same quality of care as a physician-owned practice or similar health care provider. This belief is due to the fact that the practice would become beholden to non-doctor shareholders who would dictate treatment based upon economics rather than quality of care.

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