December 1, 2010 Recent Legal News

Insurance

Healthcare

Physicians

Malpractice

Peer Review

Fraud

Insurance

CAL/ACEP v California
LA Superior Ct

The California Chapter of the American College of Emergency Physicians sued the state regarding the state's unilateral pay cut to physicians under the Medicaid system.  The court ruled for the physicians stating the state did not conduct the required reviews prior to cutting Medicaid payments.  This is the second time the state's attempt at cutting payments have been denied by the courts.  Earlier this year the pharmacists won in a federal court ruling.  The ER physicians did this since they are required to see Medicaid patients and the other physicians are not and don't.  

Hospital Workers v Partner's Healthcare 
Settlement

In a class action law suit Partner's Healthcare in Massachusetts has agreed to pay $17.3 million for failing to pay employees for working through scheduled breaks and meals.  The attorneys have filed ten of these claims against multiple healthcare systems.     Top

Healthcare

States v US
Amicus

Over seventy state legislators have asked to intervene in the case in Florida.  They want to file a brief against the case going forward.  It is their contention that the health care law does not infringe on states rights especially as it pertains to Medicaid.  The group is from 12 of the states whose Governor or Attorney General have joined against Obamacare.  This comes days after the AHA and their clones have also filed for an Amicus brief do they can get paid for ED visits. 

The Virginia case on the same merits as Florida appears to be headed for victory and perhaps even a ruling delaying the implementation of the individual mandate until the higher court rules.  If this happens watch for the feds to ask for an injunction against the ruling to allow Obamacare to go into effect.

Congressman Boehner has also filed an Amicus Brief in support of the challenge to the Obamacare law.     

A Federal judge in Ohio had now allowed the third law suit against Obamacare go to court.  Two other ones have been dismissed.  The judge allowed the claim that the forced payments are unconstitutional to be heard.

The suit against the part of Obamacare that limits physician owned hospitals has been dismissed by the federal judge.  The trial was cancelled.

Vermont's law to stop the mining of pharmacy information on prescribed drugs has been declared unconstitutional by a majority of a three judge panel of federal justices.  They stated it violated commercial free speech. The ruling may be appealed.         Top

Physicians

US v Lanting
Charged

Dr. Felix Lanting, an 83 year old physician in Staten Island, has been charged with selling Oxycontin prescriptions out of his house.  He is accused of writing about 15 scripts per day every day.  The physician had been threatened and hired bodyguards for the house office.  The guards are accused of giving money to the fake patients to pay the physician and again when they bring the pills back to the guards.  The guards would then resell the pills on the street for a large amount of money.

US v Weeks
Settlement

Dr. William Weeks of Dartmouth and the VA was accused of directing federal research money to his personal account.  He was acquitted and now has agreed to leave the VA, pay the Feds $47,500 to settle civil claims and collect from the VA $469,000.        Top

Malpractice

Ned v Parkland
Not Yet Filed

In one of the most damning articles I have ever seen the Dallas News blasts Parkland for lying, falsifying medical records and unbelievable poor medical care.  Mrs. Ned worked at Parkland as a custodian.  She was fired two weeks prior to her scheduled total knee surgery at the hospital.  She denied the charges against her and she was then listed without her consent as voluntarily resigned.  Later the  removal was changed to after her initial surgery so the surgery would be covered under the hospital insurance.  The surgery was done by a second year resident instead of the faculty member who was supposed to do it.  Post op she developed vascular problems and this was not taken care of properly.  She later had infections and eventually needed her artificial knee removed.  Still later the artificial knee was put back and this time a nerve injury occurred.  She ended up with an amputation, no compensation for her injuries and broke.  No lawyer would take the open and shut case since Parkland Hospital stonewalls too long.  I have always been a proponent of county hospitals as a way that new physicians get trained and patients receive good care.  In this case I could never recommend anyone get care or be a resident at Parkland.  By their own admission they do serious harm to two patients every day at the hospital.  Parkland is a disgrace to medicine.        Top

Peer Review

Kirksville Hospital v Jayne
Mo Ct App

Jayne sued in a med mal against the hospital and a physician.  Jayne wanted the records of an outside surgeon that the hospital hired to evaluate the physician.  The court ruled that the outside physician was not part of a peer review committee no attended one, therefore his notes were not protected under the peer review statute.   

Ryskin v Banner Health
D Colo

 In a ruling that is sure to shake up peer review, the physician in 2007 was investigated, in 2008 the Credentials committee recommended he not be reappointed and then the MEC in late 2008 did reappoint him but only for three months instead of the usual two years.  He sued and the court stated that the first investigation was not an adverse review action but were only fact finding and therefore they were not subject to HCQIA. However, the court held that the plaintiff physicians did not provide sufficient evidence against physicians in the 2007 hearing and gave the physicians immunity.  In the two 2008 actions they were definitely restrictions in privileges and as such fell under HCQIA.  The physician raised enough evidence to show the Credentials committee did not make a reasonable effort to find the facts.  The MEC action was also under HCQIA and the physician again produced evidence that they may not have given him a fair hearing.  This made all the physicians involved potentially liable for interference with contract and interfered with the physician's employment.  This goes to trial.  It sounds like the attorney for the medical staff really screwed up and put all the reviewing physicians and the hospital at significant risk.    Top

Fraud

US v Janke
Settlement

Dr. Walter Janke of Vero Beach, Florida will pay $26 million to resolve allegations of fraud by using false diagnostic codes for billing Medicare.        Top

Archive

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.