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  1. #1
    Join Date
    Nov 2008
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    Default Slandered by Medicaid HMO

    My question involves defamation in the state of: Ohio

    I went on Medicaid a year and a half ago, and was assigned to a Medicaid HMO. I am in my 50's and had never been on Medicaid before. Within a few months, I had been seriously and permanently harmed by a doctor who did three unnecessary surgeries. (I was unable to sue him--long story.) I complained about him to the HMO. The HMO reported my complaint to my GP's office, and added a slanderous comment that I did not make. It was written into my patient record. They assigned a nurse case manager to me who used her position to malign my character and mental health to my medical providers. I was verbally abused by most of the doctors I saw for my injuries. Several parroted the same verbal abuse that the "nurse case manager" spoke to me. Doctors wrote untrue mental health diagnoses into my charts. It took me four and a half months to get the records of the nurse case manager. The records are filled with lies and distortions and character assassination. She wrote over a hundred pages from about eight conversations with me. My subsequent nurse case manager told me that she had spread it all over the office building that I was crazy and not sick. (My injuries are documented and severe.) I have proof of several HMO employees passing lies about me to care providers. I have spoken to lawyers but have not found one willing to represent a plaintiff against a Medicaid HMO. A lawyer told me today that I probably can only sue in "the court of claims" since this is like suing the state. Is this true? What is the court of claims? Do any lawyers represent this type of case? Does it sound like I have a case? Can Medicaid HMO's get by with destroying human beings because members cannot sue them? Thank you in advance.

  2. #2
    Join Date
    Oct 2006
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    supratentorial region
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    818

    Default Re: Slandered by Medicaid HMO

    Are you saying your PCP and the HMO conspired to performed 3 unnecessary surgeries they knew would harm you?

    When a patient files a complaint against a contracted Physician, the insurance company/HMO forwards the complaint to the Physician and asks for comment regarding the complaint. Of course, that documentation will be kept in your file.

    You cannot sue the HMO.

  3. #3
    Join Date
    Nov 2008
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    5

    Default Re: Slandered by Medicaid HMO

    Thank you for your response.

    Goodness no, I'm not saying that my PCP and HMO conspired to do anything. My PCP had nothing to do with this. My GP was out of the office when the surgery was approved. Also, the surgeon lied about what he was going to do. The doctor who approved the surgery thought it was a polyp removal. So did my GP think that, afterward. It was what I thought also. Several inches of bone was removed from my face and skull. My face and breathing were destroyed. The pre-op reports show that I had none of the conditions for which these surgeries were done.

    I condensed some things to make my story shorter. Unfortunately, I think I changed the meaning. I did not actually file a complaint about the surgeon. I spoKe to someone at the HMO and expressed some complaints. When asked if I wanted to file a complaint, I said no. I have copies of their files stating that I said no. The HMO told me they were doing an investigation of him--on their own-- because of what he had done to me. They then called my GP's office and reported "my complaint" along with statements I had never made. This is just one example of what they did. They did something similar with every care provider.

    Why can I not sue the HMO? Some lawyers to whom I have spoken believe that I can. They just say that they do not do this type of case.

  4. #4
    Join Date
    Jan 2008
    Location
    Toledo, OH
    Posts
    16,307

    Default Re: Slandered by Medicaid HMO

    Quote Quoting lealea1005
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    You cannot sue the HMO.
    In Arizona, California, Georgia, Maine, Oklahoma, Texas, Washington, Illinois, Ohio and West Virginia, you surely can, under certain narrowly defined circumstances.

    Among them, treatment (or denial thereof) that causes injury to the patient.

  5. #5
    Join Date
    Nov 2008
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    5

    Default Re: Slandered by Medicaid HMO

    Missy,

    Thanks for your input. That info supports my suspicion that the HMO did the slandering to poison doctors' view of me so that I would not have their sympathy and support. A side effect is that I have not had appropriate treatment, either.

    Love the snake charming photo!

  6. #6
    Join Date
    Oct 2006
    Location
    supratentorial region
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    818

    Default Re: Slandered by Medicaid HMO

    Quote Quoting LawResearcherMissy
    View Post
    In Arizona, California, Georgia, Maine, Oklahoma, Texas, Washington, Illinois, Ohio and West Virginia, you surely can, under certain narrowly defined circumstances.

    Among them, treatment (or denial thereof) that causes injury to the patient.

    I stand corrected. Thanks for that info.

  7. #7
    Join Date
    Nov 2008
    Posts
    5

    Default Re: Slandered by Medicaid HMO

    Quote Quoting LawResearcherMissy
    View Post
    In Arizona, California, Georgia, Maine, Oklahoma, Texas, Washington, Illinois, Ohio and West Virginia, you surely can, under certain narrowly defined circumstances.

    Among them, treatment (or denial thereof) that causes injury to the patient.
    Missy, Can you direct me to the place where you found this information? I am having difficulty determining what the law is exactly.

  8. #8
    Join Date
    Dec 2007
    Location
    Ohio
    Posts
    2,006

    Default Re: Slandered by Medicaid HMO

    I agree that you can sue an HMO, but what I don't agree with is that the OP can sue for what she is going after. That is, if I got this correct, bc it seems to be jumping around a bit.

    For starters, if a surgeon operated on you for something, it was outlined in the consent to operate. Regardless of WHO approved it, your insurance company and your GP. If your saying that he had permission to do the surgery and removed something else, then you may have grounds to sue. I'm also telling you that I HIGHLY doubt that this is what happened.
    As far as the case manager and her notes...physicians and nurses are bound to write subjective and objective data regarding you and your state of mind. You may not agree with them and what they say, but they are required to write it. That's why you will see a lot of what they write in quotes. If diagnosis are made by physicians, they make them based on this data (subjective and objective data) and are willing to back up those diagnosis' if they write them. The case manager already gets the chart with the diagnosis and is allowed to share any information with others who are involved with your case/care. The fact that you don't agree with it, doesn't make it wrong and doesn't make a lawsuit, it makes it a difference of opinion.
    Your best bet would be to find a new HMO.

  9. #9
    Join Date
    Nov 2008
    Posts
    5

    Default Re: Slandered by Medicaid HMO

    Yes, the surgeon did things that were not consented to. For one thing, he gave me a nose job. He also removed my inferior turbinate which is considered, by otolaryngologists, to be a "nasal crime." My life is one of intense suffering because of what this surgeon did.

    The nurse case manager was not expressing opinions. She was denigrating my character and mental health. The notes are filled with clear-cut lies and extremely nasty, unprofessional ridicule and ugly, hateful slander. No one could read it and think of it as anything but what it is. It is shocking. It does not read like the notes of a nurse. It reads like the notes of the meanest girl in junior high school ripping apart her worst enemy. It is sickening.

    The nurse case manager who inherited the case after I had the first one removed, told me that her predecessor had spread it all over the entire office building that I was crazy and not sick. The second nurse case manager said that, from reading my records and speaking to me, she knew it was not true.

    The first nurse case manger wrote approx 100 times as many notes about me as the second one did. She generated five to ten pages from every contact. The second one generated one line. The second one marveled at the time the first one spent doing this to me.

    I have found a different HMO. It is not right that this HMO did this to me. All it takes for evil to rule the world is for good people to do nothing.

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