Defamation of a Medical Provider
What is Defamation of a Medical Provider?
Typically, the filing of a lawsuit is protected speech under the First Amendment. Therefore, when an insurance company sues a medical provider for fraud, there is no “defamation” per se. Usually, the insurance company will protect themselves by requesting a sit down between the parties to discuss the issues. This “good faith basis” further allows the insurance company an extra layer of protection from a defamation case.
In April 4 2020, an interesting twist, Florida Spine and Joint filed a lawsuit in Dade County against Geico for sending patients a denial letter that said “Geico has a reasonable belief that a fraudulent insurance act has been committed with respect to your claim. Geico is therefore investigating your Claim for suspected fraud.” The lawsuit filed by the Clinics included deposition testimony from multiple Geico adjusters stating that they “wanted more time to investigate if a fraudulent act took place” and “had nothing in their file showing there was fraud” which is clearly different from the letters that patient’s received.
A few days after the lawsuit was filed in Dade County, Geico filed their own lawsuit in federal court claiming fraud. Both cases were consolidated and settled confidentially between the parties.
Case Study Disclaimer
This is based on a real court case that was previously filed against a medical provider/doctor. The case number has been partially redacted and names have been changed to protect the Defendants’ names. This example is posted to help educate others on the laws and potential pitfalls. This posting is not intended to embarrass or defame anyone. I have limited the information and simplified some of the facts in the lawsuit to reflect key points and make a complicated case easier to understand. This “example” is directly from a complaint filed by an insurance company; therefore, I am using the facts THEY presented. There are always two sides to a story so please understand this is just one side of the story. This information was found through records available to the public.