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December 1, 2015 Recent Legal News

HIPAA

Fraud

Hospitals

Malpractice

Physicians

Peer Review and Employment

OLIO

HIPAA

Patients v Santa Barbara County
To Be Filed

A staffer illegally accessed information on 260 patients for an unauthorized academic research program.

New York v Univ. Rochester Medical Center
Settlement

The entity got a slap on the wrist by the state AG for a breach caused by a NP who was leaving for private practice asked for a list of patients she was treating and received the list of 3,403 patients with their addresses and diagnoses.  She turned that over to her new employer which was a breach.  The hospital interviewed, suspended and then fired her for their own screw-up.  The fine was all of $15,000.

US v Lahey Hospital
Settlement

The non profit hospital agreed to pay a fine of $850,000 to settle charges of lax security in their HIPAA program.  They had a laptop stolen from an unlocked room.  The computer had the information on 599 patients.  When they were investigated the HHS found widespread non-compliance with the HIPAA rules.  Lahey basically did nothing to protect patient records.  

Patients v Quest Labs
Filed

Sometimes companies do dumb things that attract bottom feeder attorneys.  Here providers erroneously sent PHI to a marketing group instead of Quest.  This was human error.  The marketing group alerted Quest and was told they would take care of it.  They did not.  The misdirected faxes continued and Quest was again notified.  This time they did do something.  However, the bottom feeder filed suit due to inadequately handling of the situation.  The bottom feeder wants a class action so he can make even more money.

US v Triple-S Management Corporation
Settlement

The Puerto Rican corporation will pay $3.5 million to settle HIPAA charges for failure to safeguard privacy, impermissible disclosure to an outside vendor without a BA agreement, disclosure of PHI for mailings, no risk analysis and failure to implement security measures.  In other words they are the lowest common denominator.  Besides paying the money they also have to bring their HIPAA stuff up to snuff.

Patients v University of Colorado Health
To Be Filed

The organization began to notify about 800 people that their information had been accessed by an employee.  The employee has been fired and there has been retraining of the staff on HIPAA.  It is a shame that it takes something like this to made an organization do what it is supposed to do.

Patients v Lenox Hill Hospital
To Be Filed

Lenox Hill Hospital in New York found that an employee and his wife stole identities of over 80 patients.  They then charged about $300,000 of items to these people.  The wife had been previously charged with identity theft and stealing from Victoria's Secret.  Great job on background checks Lenox.

Patients v Middlesex Hospital
To Be Filed

The Connecticut hospital had four employees fall for a phishing scam that put the information of patients at risk.  The hospital did not say how many people were potentially affected.

Frisco Medical Center v Bledsoe
ED Texas

The hospital sued its COO and her husband for downloading hospital files prior to leaving the hospital.  She claimed she left since she knew where too many bodies were buried.  The couple, prior to trial, filed for bankruptcy.  The hospital then filed a second suit wanting their claims not discharged in bankruptcy.  The two suits were merged and the hospital won summary judgment where the pair were guilty and the debt non dischargeable.  The debt is over $1 million in attorney fees and $28,000 in investigation costs.  

US v U. Washington
Settlement

The University of Washington agreed to pay $750,000 to settle for their negligence in downloading malware that might have exposed the data of 90,000 people.  They like most other hospitals did not fund the necessary safety features. Top

Fraud

US v Pharmasan Labs
Settlement

  The Wisconsin laboratory agreed to pay $8.5 million to settle charged of submitting false billing information.  They billed for services referred by non physicians.  The whistleblower will receive $1.1 million.

US v Piedmond Pathology Associates
Settlement

The South Carolina pathology group agreed to pay $500,000 to settle claims of physician kickbacks for referrals.  They provided EMR software licenses for referrals.  A was a former contract salesperson for the group.

US v Mt. Sinai Hospital
SD NY

The court did not allow the hospital's request for a dismissal in summary judgment of the False Claim case against it.  The whistleblowers allegedly had shown the hospital engaged in a pattern of false billing.  The hospital attempted to get rid of the case not by showing it was innocent but by saying the relators improperly obtained confidential patient records.   

US v LabMD
ALJ

The law judge ruled for the lab saying the FTC attorney failed to carry his burden of proof.  He did not show that the conduct was likely to cause substantial harm to consumers.  There needs to be more than theoretical harm.  This decision is subject of review by the full FTC or any party within 30 days.        Top

Hospitals

SEIU v Prime Healthcare
NLRB

To no one's surprise the Democratic NLRB agreed with the Democratic union that the hospital chain violated the National Labor Relations Act.  The chain had the gall to propose the changing of its health care insurance from a HMO, PPO administered by Anthem to one that required employees to utilize Prime hospitals.  Prime during the negotiations declared an impasse but in actuality continued to bargain and eventually made final offers.  The chain has been ordered not to declare an impasse and do what the union wants.

Cantrell v Mountain States Health Alliance
Filed

In a federal law suit against Johnson City Medical Center (Tennessee), the plaintiff husband and wife are suing for not being able to participate in their daughter's care.  the couple are deaf and the daughter was dying of cancer.  The hospital did not provide a qualified interpreter at all times as required by federal law.  The suit asks for damages and attorney fees of course along with training of staff and a policy of providing sign language interpreters.

FTC v Penn State Hershey
Filed

The FTC has filed a suit to block the contemplated merger of Penn State Hershey and Pinnacle Health.  The reason is decreased competition with higher prices.  The two entities are thinking whether to challenge the FTC and the Pennsylvania Office of the Attorney General in court.  

Health Care Foundation of Greater Kansas City v HCA
Circuit Court

In a six year long case the foundation has won a $434 million judgment against HCA for not fulfilling its commitments when it bought the assets of Health Midwest.  They did not come close to making the $450 million in promised capital improvements.  HCA will appeal.  Interest in the judgment is about $100,000 per day and it is expected to not be decided for several years.  HCA will also be on the hook for any additional attorney fees if they lose the appeals.        Top

Malpractice

Troilo v Michner
D NJ

The court did not allow the hospital's motion of summary judgment for malpractice for a stillbirth.  The mother had care at the facility on two occasion by a physician.  The hospital had posted a conspicuous disclaimer that physicians were independent practitioners and were not part of the hospital.  The court said this was not enough to avoid potential apparent authority that the physician was acting for the hospital.  The patient had problems reading and did not have an opportunity to reject the care of the physician.  The court had apparently made up its mind in advance and tried to rationalize it with unreasonable law.

Harris v Advocate Health
Ill. App Ct.

The hospital was sued by the estate of a patient who died after being in a MVA.  After coming to the hospital he was given 10 mg of Versed by a nurse without a physician's order.  The ER medical director found out several days after the event and it was determined that the family was not to be told.  This came from the CEO and not the physician.  The ED physician was later fired and sued for retaliation.  He settled for $1 million and it was during that case the daughter found out about the malpractice.  One might think this was cut and dried but its not.  The daughter did not follow through until after the statute of limitations had expired and the court said that how it rolls.        Top

Physicians

Connecticut Medical Society v Anthem Blue Cross and Shield
Settlement

The 2007 suit regarding unfair practices involving rates for out of network care has been settled.  The settlement is not being revealed but it does allow patients to know what providers are in the network and some money.        Top

Peer Review and Employment

Elkharwily v Franciscan Health
WD Wash.

The physician sued for loss of income and employment benefits after his application for privileges was denied and his temporary privileges were revoked.  Normally this would be a slam dunk for the hospital but their summary judgment motion was not allowed since the physician had bipolar disorder and had sued a prior employer for wrongful termination.  The HCQIA immunity did not hold in the discrimination part due to the hospital only had reports from coworkers that the physician was competent then it was reasonable to infer that a NPDB report saying he was not clinically competent was false.  In the state claims of disability discrimination he showed enough to get by the summary judgment phase.   The hospital did win the claim of retaliation under the False Claims Act.   Another wonder job by a hospital attorney. 

Stewart v American Association of Physician Specialists
CD Cal

The court denied the summary judgment of AAPS.  Stewart was a member of the organization and was notified of a hearing to be held regarding her membership.  She was allowed to appear in person with attorney to show she was qualified to remain a member.  She declined and sent a letter to all saying the deal was rigged since all the members had a conflict of interest.  She was terminated.  She sued for breach of contract, four counts of fraud, discrimination, defamation, interference etc.  Both moved for summary judgment.  Stewart won on fraud, bad faith and whether the business judgment rule should be applied by AAPS.  The court also could not find as a matter of law that she was terminated in a fair and good faith manner.  The court also found that she may have been terminated for her sex.  Watch for a settlement here.        Top

OLIO

Mississippi v Molleston
Charged

This story lead came from one of my readers.  Dr. Michael Molleston was arrested and charged with a misdemeanor malicious mischief for allegedly smashing the windshield of Dr. John Davis' car.  The physicians are in a dispute over privileges at River Oaks Hospital.  A surveillance camera saw Molleston getting out of his car with a golf club just before the windows were broke n on Davis' car.  

Cambodia v Chrin
Guilty

A Cambodian court convicted Dr. Yem Chrin of cruel behavior resulting in death by intentionally spreading HIV and practicing medicine without a license.  Cambodia often relies on unlicensed practitioners who have trained themselves to treat minor ailments and give injections.  Chrin must pay a fine and never practice medicine again as well as spend 25 years in prison.        Top

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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.