Los Angeles, CA asked in Health Care Law for California

Q: Liability for hospital fraud

Plaintiff in hospice fraud case apparently will not have capacity to discover who exactly at hospital referred plaintiff to hospice. Does it mean attending physician and hospital are not liable?

Situation.

Terminal diagnosis was recorded on admission to hospital by attending physician, who referred plaintiff to hospital. Admission record of non-existent terminal chronic disease was based ONLY on defective blood test by hospital lab; communicated by unidentified person.

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James L. Arrasmith
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Answered
  • Estate Planning Lawyer
  • Sacramento, CA
  • Licensed in California

A: Under California law, both the attending physician and the hospital may potentially be held liable in a hospice fraud case, even if the plaintiff cannot identify the specific individual who made the referral to hospice. Here are a few key points to consider:

1. Vicarious liability: Hospitals can be held vicariously liable for the negligent or fraudulent actions of their employees, including physicians and staff, under the doctrine of respondeat superior. This means that if the attending physician or any other hospital employee acted negligently or fraudulently in referring the plaintiff to hospice, the hospital may be liable for their actions.

2. Negligent referral: If the attending physician referred the plaintiff to hospice based on a defective blood test and without properly verifying the terminal diagnosis, they may be liable for negligent referral. The physician has a duty to exercise reasonable care in making referrals and treatment decisions.

3. Negligent supervision and credentialing: Hospitals have a duty to properly supervise and credential their medical staff. If the hospital failed to adequately monitor or investigate the attending physician's practices or the validity of the blood test results, they may be liable for negligent supervision or credentialing.

4. Fraud and misrepresentation: If the hospital or attending physician knowingly or recklessly misrepresented the plaintiff's condition to justify the hospice referral, they may be liable for fraud or misrepresentation. This could apply even if the specific individual who communicated the false information cannot be identified.

5. Joint and several liability: In cases where multiple parties are found liable, California follows the principle of joint and several liability. This means that each defendant can be held responsible for the entire amount of damages, regardless of their individual level of fault.

It is important to note that the specific facts and circumstances of the case will influence the determination of liability. Consulting with an experienced medical malpractice or healthcare fraud attorney can help the plaintiff assess the strength of their case and develop an appropriate legal strategy. Additionally, the plaintiff may be able to obtain information about the identity of the individual who communicated the false diagnosis through the discovery process during litigation.

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