Whistleblowing surgeon claims hospital system forced him to use in-network radiologists

A Florida orthopedic surgeon is suing Orlando Health and its imaging center, claiming the hospital system fired him for failing to use its own in-network radiologists.

Ayman Daouk, MD, also alleges that the eight-hospital chain repeatedly reprimanded him for performing surgery outside of the system. He said these actions violate both the Stark Law and federal anti-kickback statutes and wants the hospital system punished for its business practices, according to the complaint, filed last month in U.S. District Court.

On the other side, the Orlando hospital system has declined to comment on the matter, citing a policy not to speak on pending litigation, according to published reports.

Daouk was a member of the Orlando-based Physician Associates LLC since 2009, which Orlando Health acquired and rebranded three years later. The surgeon and his attorney claim that, following the 2012 ownership change, hospital leaders frequently reminded providers that “all referrals needed to be made” within the organization’s integrated network of providers, according to the complaint.

It started as “merely a suggestion.” But, “Pretty soon, however, such referrals became a mandate, with threats made against those who failed to comply,” Daouk’s attorneys wrote. In one instance, the chief operating officer allegedly emailed a podiatrist to remind her to “show some loyalty to the system” after performing surgery at the out-of-network Florida Hospital, which has since been renamed Advent Health.

The hospital system’s referral demands continued to escalate, culminating in 2017 when the physician practice moved to a new facility, co-located with the hospital’s imaging provider—offering MRI, CT and ultrasound. In a board meeting where the CEO was present and through numerous emails, providers were strongly urged to keep any imaging work within the system, regardless of their practice preferences.

“Dr. Daouk initially tried to refer more patients to [Orlando Health Imaging Centers] simply due to its convenient location for his patients, but he found the quality of OHIC’s services to be unacceptable,” the complaint alleges. “He had a difficult time opening images through OHIC’s portal, his staff would call to schedule appointments, but nobody answered the phones, there was rarely immediate availability, and his patients complained about long wait times.”

In August 2018, the hospital terminated Daouk for continuing to perform surgeries at non-Orlando Health facilities. Daouk and his attorney claim that because the chain owns OHIC, “there exists and unbroken chain of financial relationships that renders these referrals as violations of the Stark Laws.” And any payment from government healthcare programs for imaging at OHIC are “tainted and violate the False Claims Act, they allege."

Such whistleblower lawsuits are typically investigated by the Department of Justice, however, the agency has declined to intervene in this case, the Orlando Sentinel reported last month. The DOJ only gets involved in about 20% of these cases, the newspaper noted, but the surgeon and his attorneys can still pursue the case on their own.

Daouk and his attorneys have declined to be interviewed on the matter, according to the Sentinel and other published reports.