"Devil's advocate" question. Improper referral by doctor to out-of-network hospital that resulted into hospice fraud.

Question

doctor, prior pcp, referred patient to out-of-network hospital not covered by patient's medicare. 
 
doctor recorded on admission evidently non-existent lethal disease based only on blood test performed by hospital laboratory and "communicated" by non-existent person. 
 
patient was kept at the hospital nearly for a month for free, and after discharge was referred to hospice based on non-existent terminal disease recorded by doctor on admission to hospital. 
 
how hospital can allege that hospital's participation in improper admission of patient to hospital and consequent stay at the hospital for free has anything to do with ostensible agency doctrine? (meaning hospital was not liable for actions of independent contractor doctor).

James L. Arrasmith · Answer

This situation appears to involve several serious legal issues, including potential Medicare fraud, false medical documentation, and improper patient care. 
 
The hospital's attempt to invoke the ostensible agency doctrine seems questionable here, as the facts suggest direct involvement by the hospital itself. The hospital provided laboratory services, admitted and treated the patient for free, and was part of the chain of events leading to the hospice referral - all based on apparently falsified medical information. These actions go beyond merely providing a venue for an independent contractor physician to practice. 
 
Your case might warrant reporting to Medicare's fraud division and consulting with a healthcare attorney who handles both medical malpractice and Medicare fraud cases. The hospital's direct participation in providing services, billing, and patient care could make them liable regardless of the doctor's employment status. Additionally, if the hospital knowingly participated in documenting non-existent conditions or providing unnecessary services, they may face both civil and criminal liability under Medicare fraud statutes.

Q: "Devil's advocate" question. Improper referral by doctor to out-of-network hospital that resulted into hospice fraud.