Surgeon sues health system claiming forced in-network radiology referrals

A Florida-based surgeon is suing Orlando Health, claiming administrators demanded he perform procedures and make imaging referrals within its network, only to be fired for refusing.

Ayman Daouk, MD, filed the whistleblower lawsuit against Orlando Health, Physician Associates, Orlando Health Physician Group and Orlando Health Imaging Centers, alleging administrators repeatedly asked him to send more patients to the in-network imaging center, violating both the Stark Law and anti-kickback statutes, according to the lawsuit filed last month.

Daouk worked for Physician Associates LLC since 2009, which was bought three years later in 2012 by Orlando Health. After the turnover, Daouk noticed that in-network referrals started as “merely a suggestion,” and were emphasized during board meetings and in reports.

Those referral nudges soon became a “mandate,” and providers who did not fall in line were repeatedly threatened, according to the lawsuit. Over the years, this pressure continued to build, until it came to a head in 2017, when the physician group moved its office to a new facility owned by Orlando Health.

The site—Orlando Health Medical Pavilion at Spring Lake—shared its location with the hospital systems’ imaging provider. MRI, CT and ultrasound images taken at Orlando Health Imaging Centers are all read by Medical Center Radiology Group-employed radiologists.

During a May 9, 2017, board meeting, which included Orlando Health’s CEO, David Strong, Physician Associates’ board members were reminded of the “need” to refer patients to OHIC. 

Daouk initially complied, but as time went on, he determined service at the Orlando imaging facility was lacking. He had trouble opening images through the center’s portal, nobody answered calls from his staff seeking to schedule appointments, immediate availability was rare and patients complained about long wait times, according to the suit.

Then, in February 2018, Physician Associates’ president sent an email to the organization’s clinicians that, once again, urged providers to refer patients to in-network imaging centers.

“[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 support them in every way possible,” the lawsuit read.

The hospital asked Daouk to “cease performing surgery at Florida Hospital” in March 2018, and Physician Associates fired him in August, according to an Orlando Sentinel report.

Orlando Health has chosen not to weigh in on the suit, the Sentinel stated, citing policy that it doesn’t comment on pending litigation.