Case Analysis of United States ex rel. Drakeford v. Tuomey Healthcare

This case analysis examines United States ex rel. Michael L. Drakeford vs. Tuomey Healthcare System, focusing on a non-compete agreement and potential violations of the Stark Law and False Claims Act. The case, heard in the Sumter Jurisdiction of South Carolina, involved allegations that Tuomey Healthcare System incentivized physicians to generate revenue, potentially leading to improper billing practices. The analysis covers the facts of the case, the legal issues involved, the court's rulings, and the implications for healthcare administration, risk management, and physician compensation. The case highlights the importance of adhering to legal and ethical standards in healthcare business practices and provides valuable lessons for hospital risk managers to ensure patient care and appropriate physician compensation. The analysis references key legal concepts, court proceedings, and the impact on healthcare professionals.

CASE ANALYSIS
Student name –
University name –

Subject
◦ The case was registered in the Sumter Jurisdiction of South
Carolina.
◦The case that is being analyzed is the United States of
America ex rel. Michael L. Drakeford vs. Tuomey of Tuomey
Healthcare System.
◦The Senior District Judge, Margaret B. Seymour was the
individual who was writing the opinion for this case in the
South Carolina court.

Facts
◦One of the major facts of the case was that plaintiff, Michael
L. Drakeford had challenged in the court that he had been
asked to sign a non-compete agreement with the Tuomey
Healthcare System as it will make them eligible for earning
131% of the revenue that could be earned from Medicare
program for services by physicians (Garner, 2015).
◦It was reportedly noted by the government that Tuomey had
determined to lose at least $9.6 million worth of revenue if
the gastroenterologists conducted their examinations away
from Tuomey Healthcare Centre.

Statement of Issue
◦Whether the physician’s signing the agreement to be
liable to earn 131% of the total revenue earned were
entitled to breach the Stark Law and False Claims
Act?

Rule of Law
◦In the initial trial, it was found by the court that Tuomey did
not violate the False Claims Act and Stark Law by the jury.
◦It could be determined that the tort law in United States is
the ruling law which helped the judges to make an efficient
decision for the plaintiff.
◦However, a re-trial was conducted where the healthcare
system was found liable in paying a penalty for breaching
the Stark Law and the False Claims Act.

Application
◦In a two-year period from 2005 to 2006, Tuomey had entered to
numerous contracts with physicians which included the same terms as
mentioned in the terms provided to Michael.
◦Initially, it was found by the jury that the Tuomey Healthcare System
did not violate the Stark Law; however, after conducting a post-trial
motion, it was found by the judge that the Tuomey Healthcare System,
indeed, violate the law of Stark.
◦It was reportedly noted by the government that Tuomey had
determined to lose at least $9.6 million worth of revenue if the
gastroenterologists conducted their examinations away from Tuomey
Healthcare Centre (Bollerman et al., 2016).

Conclusion
◦In concluding remarks, it can be understood that this case
required critical trials and court proceedings such that an
outcome is established for the plaintiff and the defendant.
◦It could also be observed that Tuomey had sought legal
advice from their long-time counsel, Nexsen Pruet while
drafting the non-compete agreements contracts while also
taking necessary advice from healthcare law firms and
consulting firms who have maximum expertise in structuring
the compensation of the physicians under the contract.

Other Opinions
◦It is because of the compensation being provided to the
physicians that second and concurring opinions from different
judges in the district court is undertaken.
◦The Circuit Judge, Wynn agrees with the resolution of the
colleagues with legal nullity of the Stark Law being related to
the Interrogatory answer of the jury under looking this case.
◦It is in the view of the judge that the judgment is unable to
be based solely on the Seventh Amendment and the legal
nullity of the Stark Law.

Final Thoughts
◦The case of the Tuomey Healthcare System versus Michael
Drakeford provides crucial lessons to individuals regarding the
relationship of the business of the hospital workers with the
physicians.
◦It is a huge learning lesson for the hospital risk managers
who, after this case, have to look forward to the papers of
contracts of the individuals and the nurses such that the level
of care delivery to the patients is not compromised and the
physicians are paid whatever they are liable to be provided.

References
◦Bollerman, K., Egbert, A., Fazio, M., & Graves, B. (2016).
Health Care Fraud. Am. Crim. L. Rev., 53, 1393.
◦Garner, C. B. (2015). Medicare–Bridging the Gap Between
Ridiculous and Sublime. California Healthcare News, Online
(2015).