A prominent Fort Lauderdale cardiologist at the center of a federal investigation into alleged Medicare and Medicaid fraud at Broward Health has signed a new contract featuring a hefty pay cut and an unfamiliar requirement that he treat poor people.
Dr. Michael Chizner, chief medical director of tax-supported Broward Health’s Heart Center of Excellence, signed the deal in December – weeks ahead of his scheduled termination date on Jan. 2.
Broward Health previously announced Chizner would be dismissed on that date for refusing to accept changes to his 10-year contract “in light of changes in the application or interpretation of laws and regulations…which now render your employment agreement illegal or unenforceable.”
To adapt to those changes, Broward Health’s governing board in June approved a new “matrix of compensation” and other internal changes intended to make its physician compensation practices “commercially reasonable.”
LOOMING FEDERAL INVESTIGATION
The move was apparently in response to an ongoing anti-kickback inquiry by the U.S. Department of Health and Human Services (HHS) and the Justice Department that’s focused on alleged wrongdoing in the business relationships between Broward Health and its physicians.
Asked about that, Broward Health general counsel Sam Goren said, “I am not able to comment.”
Chizner’s new five-year contract calls for Broward Health, whose legal name is the North Broward Hospital District, to pay him a maximum salary of $867,200 in 2015, down from $1.2 million last year. His actual pay is not guaranteed and will depend on his volume of work.
Chizner’s total salary since 2009 was $6.9 million, according to district records.
Chizner’s earnings were more than double the national average for “invasive-interventional” cardiologists. His new, lower salary will nevertheless continue to keep him among the nation’s most highly paid heart doctors.
The new contract also omits prior elitist language that allowed Chizner to limit his patients to “existing, new and referred non-indigent patients,” a restriction at odds with publicly-funded Broward Health’s role as a medical safety net for local residents. Last year, Broward Health levied and collected $146.1 million in property tax revenues.
The new contract requires Chizner, former chairman of the Florida Board of Medicine, to provide services to all patients, “without regard to a patient’s ability to pay for such services.”
More than a dozen other Broward Health physicians previously signed similar agreements in accord with the approved changes.
A PUBLIC CAMPAIGN
Chizner’s resistance, however, was high profile. Within days of receiving a Nov. 4 letter from then Broward Health CEO Frank Nask notifying him of the Jan. 2 termination date, a group of local business leaders began a public campaign to pressure Broward Health’s board of commissioner’s to keep Chizner.
“Dr. Chizner has saved the lives of many of our friends and colleagues throughout the years,” said an email by Charles Caulkins, a labor lawyer and partner in the Fort Lauderdale office of the Fisher & Phillips.
Federal authorities have been investigating Broward Health since at least May 2011 when agents subpoenaed records relating to the public health care system’s business dealings with 27 doctors since January 2000, including Chizner. Most of those physicians belong to the Broward Health Physician Goup, meaning they are district employees and not in private practice.
The subpoena demanded records about the district’s contracts, negotiations and various agreements. Broward Health has since turned over millions of pages of documents.
Broward Health Commission Chairman David Di Pietro said publicly in 2012 that the district faced $100 million in potential civil liability in the probe.
Broward Health officials have said the investigation appears to have begun with a whistleblower’s confidential complaint. Under the False Claims Act, private citizens with knowledge of fraud against the government can sue on its behalf. If successful, they reap a reward.
Broward Health has hired at least two law firms to represent it in the matter. Arent Fox has been on the job since 2011. Last year, the district retained Holland & Knight to advise it regarding compliance with a pair of federal laws – the Anti-Kickback statute and the Stark Law – that are the focus of the federal ongoing investigation.
The Anti-Kickback statute is a criminal law that prohibits the exchange of anything of value to induce referrals of federal healthcare program business. The Stark Law prohibits physicians from referring Medicare and Medicaid patients to a hospital when the doctor has a financial relationship with the hospital.
At the regular meeting of Broward Health’s board on Nov. 19, more than three-dozen people turned out to speak on Chizner’s behalf, including well-known business leaders Terry Stiles, Alan Levy and Tom Tworoger.
‘NOT ABOUT THE MONEY,” SAYS SENATOR
Former Republican Florida Senator George Lemieux represented Chizner. According to the meeting’s minutes, he argued that Chizner’s then-existing agreement was fair, and supported by various market opinions.
Lemieux “again reiterated that this is not about the money – it is about negotiating in good faith.”
But Broward Health CEO Nask said a good faith effort was made. He said Chizner had rejected the results.
“It is every bit about the money because that is the issue at hand from the subpoena,” the minutes say, summarizing Nask’s remarks.
In the end, chairman Di Pietro, a Republican appointee of Gov. Rick Scott, arranged to hire a mediator to see if an agreement could be reached. The negotiator was Ed Pozzuoli, a Republican strategist and president of Fort Lauderdale’s Tripp Scott law firm.
Chizner signed his new contract, accepting a $335,000 pay cut and the requirement that he treat indigent patients, on Dec. 9th.