April 15, 2015 Recent Legal News





Peer Review and Employment


US v Lajewski

Drs. Wayne Lajewski and Glenn Leslie of New Jersey were sentenced to prison and fined $10,000 as well as supervised release for accepting bribes to refer patients to the infamous Biodiagnostic Laboratory Services.  Lajewski received $2000 per month for over two years and Leslie got $5000 per month for his referrals.  Lajewski must also forfeit $48,000 and Leslie $350,000.

US v Halper

Dr. Brett Helper of Glen Head , New York, pled guilty of taking bribes in the same illegal Biodiagnosic scam.  He is scheduled for sentencing in June.

US v Calabrese

Dr. Angelo Calabrese of Pine Brook, New Jersey, was sentenced to 37 months in prison, one year supervised release and a fine of $5000.  He also must forfeit $334,000.  He was convicted in the Biodiagnostic scam.

US v Robinson Health System

The Ohio health system agreed to pay $10 million for their improper payments to physician groups for referrals.  

New York v Physicians

Nine physicians were among the 23 indicted for health care fraud.  Skid Row people with Medicaid cards were rounded up and sent to various clinics around New York City where many thousands of dollars of tests were done for no medical reason.  The "patients" then got free sneakers. The head of this scam according to the story in the New York Times is Eric Vainer and his mother Polina.  Some of the physicians arraigned are Drs. Joseph Grossman and  David Glass.

US v Desai

In a piling on on charges the feds went after Desai, a former physician who is already serving 18 years to life for state charges, for federal health care fraud.  They got their pound of flesh in the form of a payment of $2.2 million of property.  Ex doctor Dipak Desai was the head of the infamous Las Vegas endoscopy center that due to his money saving illegal tactics gave hepatitis to many patients.

US v Phoebe Putney

The FTC finally said that the hospital system does not have to divest Palmyra Hospital but it does have to agree to not contest any CON in the Albany, Georgia in the next five years and must give the FTC advance notice for 10 years regarding the system taking over any other hospital or providers.  The only reason for the non-divestiture is the state's CON laws preclude it.

US v Kuperlian


Gevorg Kuperlian of El Centro, California, was sentenced to 30 months in the pokey and ordered to pay restitution of $964,011 for masterminding a scheme to bilk Medicare out of money.  He hired a frontman physician to use his Medicare number to bill.  He then used cappers to round up seniors to come to the clinic.  He did the same tests on all and give them free sneakers and use their Medicare numbers to bill.  He also hired a PA to see patients when the physician was not present.  The PA was not licensed in California.

US v Brown

Raymond Brown, MD, of Cleveland, Ohio, was sentenced to 28 months in prison and ordered to pay $6.76 million from his bank accounts as well as an additional $717,000 for using misbranded Botox and billing as if he gave the FDA approved stuff or billed for injections never given.

 Massachusetts v Kishore

Dr. Punyamurtula Kishore had Preventative Medical Associates, a drug analysis center with offices throughout the state.  He collected urine from others and did unnecessary drug tests.  He was caught several years ago as he was preparing to flee the country.  He is sentenced to 11 months in jail and ordered to repay $9.3 million to the state.  He also lost his license.  His attorney said that the good doctor "dedicated his life's work to treating, assisting and serving those who have suffered from addiction.  He has taken responsibility for the billing errors at his clinics.  He hopes that his accomplishments in treating those suffering from addiction will not be overshadowed by this."  Lots of luck.

US v Health Diagnostics Lab

Health Diagnostic Labs (HDL) of Richmond, VA and Singulex of Alameda, CA agreed to pay the feds a total of $48.5 million (almost all from HDL).  The allegation is that they paid physicians processing and handling fees to induce referrals and routinely waived co-pays and deductibles.  These are both no no.  The companies also agreed also to enter into separate CIAs.         Top       


Malone v LA County

LA County agreed to pay Justin Malone $4.5 million as well as $790,000 in treatment costs and $200,000 for his Medicaid repayments.  He had a stent placed a year prior at Cedars Sinai for an aortic aneurysm.  He presented at USC LA County ER after collapsing and was admitted.  He was in severe pain and had some loss of sensation in his lower extremities.  It took two days to find that he had a clot in his stent and operate.  By that time it was too late to prevent permanent paralysis.  He had also sued Cedars Sinai and a court found that the hospital and the surgeon were not at fault.  

Bass v Cook County Hospital
Ill App Ct

The court ruled that since physicians who prepare patients for transfer and who ride with the patient are immune from suit via the state statute regarding the EMS system, the hospital can not be liable.

Rumble v Fairview Health Service
D Minn

Although not a malpractice case, it sounds like it.  The patient sued for discrimination under the ACA.  He is a transgender patient that claims he was discriminated in the ED by an independent practitioner physician.  The hospital moved to dismiss since the ACA doe not provide a cause of action for transgender patient and the discrimination, if it was done, was by independent physicians.  The court disagreed and said the ACA extends to gender stereotyping.  The court also said that two hospital employees knew of the physician's actions and did nothing so the hospital may be liable. 

Patients v Johns Hopkins

A $1 Billion suit was filed against the hospital for being part of a 1940s government study that gave patients STDs in order to study how to prevent the spread.  This suit was dismissed before when an attempt was made to sue the feds.  This time the  attorney is attempting to sue those with minimal contacts with the program, a legal stretch at best.   

Aguillera v Loma Linda University
Ca App Ct

Infant Aguillera was injured due to medical malpractice.  The suit was settled for $950,000 wich included a $253,000 payment to the attorney and $85,000 for the parents.  DHS liened $211,191 for payments made by them under Medicaid.  The plaintiff filed stating the lien should be only $10,046.  They wanted the Ahlborn method used.  The US Supreme Court ruled in 2006 the appropriate lien would be a ratio of the total settlement amount divided by the full value of the claim that was settled times the value of the benefits provided.  Aguillera said the full value of her claim was $15 million based on future medical needs.  The trial court then used the ratio to say the lien should be $15,311.  The court excluded future payments by the Department aw they are speculative as to the need to the Department to pay.  The court included future attendant care and the payment of attorney fees and costs.  The Court of Appeals ruled the attorney fees should be used to reduce the the Department's lien.          Top


Pennsylvania v Kitchen

Kimberly Kitchen of BMZ law firm in Huntingdon County, Pennsylvania, has been indicted for fraud for pretending to be an attorney.  She was pretty good at it since she became the president of the local bar association.  It sounds like the firm did not do its homework and maybe liable for all the estate planning she did.  Her name is now off the web site.

Iowa v Rayhons

In one of the most interesting cases I have seen, two 70 year old people met and wed in.  She was vivacious and he was a respected member of the state House of Representatives.  Several years later she had Alzheimer's Disease and her daughter had her removed from the house to a care center five minutes from the home.  The husband disagreed with the daughters over how she should be cared for in the facility.  The daughter spoke to the facility about the care plan which included no sex and the husband was told about this.  A week later a video showed him going into his wife's room and coming out 1/2 hour later and dropping the wife's panties into the laundry bag.  The wife's roommate said she thought he was having sex with his wife.  The daughter had the mother sent to the hospital for a rape kit.  Indeed his sperm was on the bed sheets and panties.  He is now on trial for rape.  The issue is can a dementia patient give consent for sexual intercourse.  The experts are split.        Top


Massachusetts v Cassandra

The Massachusetts court denied Cassandra, who is under court order to stay at a hospital for treatment of her Hodgkin's Lymphoma, the ability to see her mother or to leave the hospital and continue to receive treatment at home.  

CIGNA v Humble Surgical Hospital
SD Tex

In a David vs Goliath scenario the huge insurance company sued the five bed hospital for charging Cigna's in network rates while billing the remainder of the total amount to Cigna at the higher out of network rates.   The hospital won a dismissal since the insurance company had no standing to sue under ERISA.

Methodist Health v OSF Healthcare
CD Ill

In a battle that started decades ago in my hometown of Peoria, Illinois, the two major hospitals are across the street from one another.  No love lost.  Methodist is suing St. Francis for antitrust for allegedly threatening to withdraw from the insurers network if the insurer engaged with a competitive health care provider.  St. Francis has the majority of the business in the area an is the fourth largest hospital in the state.  St. Francis went for summary judgment dismissal.  They lost as Methodist did their homework.  They pled the relevant markets and a potential foreclosing of competition.  The case continues.

Broome v DHS
D Ore

Melinda Broome uses fentanyl lozenges for breakthrough of severe chronic back pain.  She was notified by CMS that coverage would be discontinued since the lozenges did not match the definition of a medically accepted indication.  She exhausted all her administrative remedies and then sued.  She lost when the law was parsed.          Top

Peer Review and Employment

Oguntoye v Medstar
NY Superior Ct.

Dr. Aderonke Oguntoye applied for a position at Jacobi Medical Center in New York.  She requested  Dr. Alan Newman give her a reference.  Jacobi told her to withdraw her application due to a concerning recommendation.  He sued Newman and Medstar.  She requested the recommendation letter and the questionnaire.  The lower court dismissed her request as they are protected.  The appellate court agreed.  

Kim v Humboldt County Hospital
D Nev

Dr. Kim was the only general surgeon at the hospital.  She also sat on the hospital's Board of Trustees.  She, over the years, had brought many complaints about the hospital's internal operations.  After four years on the Board, the Board amended its corporate policy to prohibit hospital employees from serving on the board.  Kim still filed for reelection.  The Board then terminated her contract and said they were going with a third party surgical service.  She sued for the usual state claims.  The hospital claimed she was terminated due to the no cause clause and not her free speech.  The court did not believe the hospital and said there was a material fact that needed to be decided, the motivation for the termination.  The court stated that further discovery was needed regarding the barring of her seeking re-election.  

Milner v Johns Hopkins

Dr. Stephen Milner is suing the university for failing to follow the whislteblowing laws.  The suit states that for two years he has complained of the care at the children's burn center by Dr. Stewart.  Dr. Stewart is a co director of the burn unit.  He states that after he complained internally about the care he was demoted and had some of his staff removed.  He wants his position back and his staff returned as well as compensatory damages. Should make for an interesting case.



DISCLAIMER: Although this article is updated periodically, it reflects the author's point of view at the time of publication. Nothing in this article constitutes legal advice. Readers should consult with their own legal counsel before acting on any of the information presented.