December 15, 2008 Recent Legal News

Fraud

Peer Review

Insurance

Employment

Antitrust

Malpractice

Licensure

Assisted Suicide

Fraud

US v Condell Med Ctr
Fined

Condell Medical Center of Libertyville, Illinois, will pay a $39 million fine for improper loans to physicians to get them to send patients to the hospital.  The hospital self reported after finding the errors in a due diligence check while being sold to Advocate Health Care.  The fine will be paid out of cash reserves.  

US v Manchester Hosp
Settlement

 Manchester Memorial Hospital in Manchester, Conn., will pay $712,000 for for billing for multiple infusion therapies per session when they were only allowed to bill for one per session.

US v Aurignac
Arrested

 Dr. Fabian Aurignac, a Cardiologist of McAllen, Texas, was arrested by the feds for Medicare fraud.  He was accused of eight counts of billing for services not provided and using unlicensed physicians. He faces 10 years in prison if convicted. 

US v Jackson Madison County Hosp.
Settlement

The above Tennessee hospital has agreed to pay a fine of $2.6 million for fraudulent ambulance services.

US v Milan General Hosp.
Settlement

Milan Hospital of Tennessee has agreed to pay $5.3 million for fraudulent psychiatric care.  

US v Brigden
Settlement

Dr. Malcolm Brigden has agreed to pay $30,000 and to not rejoin Medicare.  Dr. Brigden is a Canadian who while working at Wisconsin's Riverview Cancer Center generated bills for services never rendered.  The Clinic had already settled with the government for $165,000.   

US v Medic Management
Indicted

 The government claims the above clinic in Port Arthur, Texas, its owner Ashley Walkes and some physician employees billed for never provided services and services using unlicensed personnel.  In showing the government fraud the article states that the Clinic billed for $7.5 million  in physical therapy services and received only $4.2 million in payments.  The complaint also states that the Clinic billed for $2.5 million in inflated office visits and was paid $633,749.  Neither side comes to the table with clean hands.         Top

Peer Review

Physicians

Nine cardiologists who had their angioplasty privileges removed at a Florida hospital have sued for discrimination.  They filed nine law suits in Federal court.  This happened four years ago when an outside review of the cath lab showed problems with quality.  The same physicians have filed state court claims against the hospital in 2006.  The allegation is that minority members of the Board were asked to recuse themselves during a vote on the physicians and that the outside review did not recommend any action against the physicians. Looks like the hospital will be spending big bucks for attorney fees.      

Cohimia v Ardent Health
ND OK

 Dr. Cohimia sued Ardent for antitrust for his denial of medical staff privileges.  He has asked for peer review records, financial data and contracts.  He contends that he is considered an economic competitor and that is the reason for his inability to get privileges.  The hospital has denied access to the requested peer review records.  The court has allowed the records but limited the scope to the peer review and/or the credentialing files of cardiovascular surgeons, like Dr. Cohimia, interventional radiologists and cardiologists over the past ten years. The court rightly ruled that there is no federal antitrust rules against peer review files.

Wang v King Drew
Ca Ct Appeal

Dr. Wang was a practicing physician in Taiwan for many years.  He moved to the US and was in a residency program in OB at the worst hospital in the country.  Dr. Wang had to leave the residency due to depression and refused to come back unless certain conditions were met by the hospital.  The hospital refused to allow him only to work in a stress free environment for only several hours a day.  The physician was then released from the program and sued for discrimination.  The trial court ruled for the hospital and the court of appeals agreed and the conditions wanted by the physician were unreasonable.

Florida Hosp Assn v Viamonte
ND Fla.

The plaintiffs sued multiple defendants to overturn Amendment 7.  The court stated that the plaintiffs sued the correct plaintiffs and that the case was ripe and could go forward.       Top

Insurance

Callil v Blue Shield
CA Ct App

The plaintiff sued the insurance company for illegally rescinding her health insurance.  She was a long time member of Blue Shield and received conditional permission for a hysterectomy but was found to have undisclosed uterine fibroids.  The insurer then cancelled her insurance but after she had her hysterectomy and was discharged from the hospital.  The insurer refused to pay.  The insurer won summary judgment in trial court when sued by the plaintiff and lost summary judgment in the court of appeal.  The court agreed with an earlier decision in Hailey v Blue Shield that it is an issue of fact whether the patient willfully lied on the application.  In Callil, the insurer never even checked the records of the physician even though the patient's answers were inconsistent.  The appeals court also let stand the punitive damage claim stating the plaintiff has proven by clear and convincing evidence that bad faith was evidence of malice. 

Med Mutual of Ohio v Amalia Enters
6th Circ

The insurer sued the patient for fraud for not putting a pre-existing condition in her application.  The insurance idiots paid the claims for over three years (the statute of limitations) for hemophilia.  They then woke up and found there was no mention of the disease in the application.  Too late says the court. 

El Centro Med Ctr v Leavitt
SD Cal

El Centro attempted to write of Medicare patients non payment as bad debts.  The CMS would not allow it and the hospital sued.  The hospital lost since the it did not go after Medicare patients for money with the same zeal as it went after non-Medicare folk.      Top

Employment

Bd. of Regents v Warren
Iowa Ct App

The employed physician and the University of Iowa had a non compete clause.  The physician left the University and went into practice against the non compete clause.  The University sued and lost since it could not show it was harmed by the physician going into practice and that the public interest would be harmed by enforcement since the physician went to a area in need of physicians.

Martinucci v Kaiser
Jury Decision

 Dr. Michael Martinucci was awarded $3.5 million by a jury for wrongful termination by Kaiser Hollywood Hospital.  The radiologist was forced to resign after he tried to improve quality at the hospital.  He was hired in 2003 and left three years later after a HR person and his supervisor accused him of being racist and making sexual advances toward a male technologist.  The jury found malice and in a second punitive phase awarded the physician an additional $7.5 million.  Kaiser is disappointed and will appeal.  It will be settled for alot of money.  Dumb Kaiser. 

Finnerty v Bd of Nursing
Ca Ct. App

 Finnerty was a nurse working on a floor at a hospital.  A resident ordered an immediate intubation on a patient.  The nurse did not believe the intubation should be done on the floor and transferred the patient to the ICU.  The resident and intern were both trained in intubation and the equipment was available on a crash cart.  The hospital fired her and later reinstated her so she could resign.  She was reported to the Nursing Board who disciplined her for disobeying an order.  She had a hearing with an ALJ who sided with the Board.  She requested and was denied a writ of mandamus by both the trial court and the Ct. of 
Appeal. The Court stated the safety issues had been resolved in favor of the resident and not the nurse.    
Top

Antitrust

Illinois v Carle Clinic
Settlement

Carle Clinic in Urbana, Illinois, settled it's suit by the state for antitrust in conspiring with Christie Clinic not to take Medicaid patients.  Carle Clinic agreed to increase the amount of Medicaid patients it will see by 2000 over the next three years.  It will also pay the state $200,000 to help cover costs of a low income health center and an additional $40,000 for a preventive care program for children.  Carle did not acknowledge that it had done anything wrong in the settlement.  Christie Clinic erroneous believes this means that they also did nothing wrong but the state will continue with the suit.  It behooves the Christie Clinic to also settle.        Top

Malpractice

Dickerson v Cook County
Settlement

Dickerson died while a patient at Cook County Hospital in Chicago due to failure of giving blood products to her.  The County agreed to settle for $9.8 million but disagreed over how these should be paid.  The Board President wants to borrow $280 million to pay med mal claims and others want the claims paid out of regular county revenue.    

Muno v Condell Med Ctr
Ill. Trial Ct.

 The plaintiff was a 12 year old who died on the operating table in Libertyville, Illinois for a cut tendon.  He was given an antibiotic that he had a known allergy to and died.  His family was awarded $9 million.  

Wilkins v Marshalltown Med Ctr
Iowa Supreme Ct.

The patient had multiple symptoms and presented to the ER of the hospital.  He was seen by an independent contractor ED physician who ordered a chest x-ray.  The radiologist the following day found a vertebrae that was blastic and he suggested prostatic cancer.  The patient was seen multiple times at the hospital and at the Univ. of Iowa until someone actually did a rectal exam and found the prostate cancer.  He died.  The wife sued the physician, the physician employers and the hospital.  The hospital went for summary judgment on both the statute of limitations and independent contractor basis.  The patient was not told he had prostate cancer until within the statute so the hospital lost on that.  The hospital also lost on the contractor status as it is a matter for the jury to decide whether or not the emergency physician may be implied employees and therefore the hospital liable under apparent agency.        Top

Licensure

Mao v Superior Ct.
Ca Ct App

Mao was convicted for the third time of shoplifting and the Medical Board of California disciplined her. She sued and won part an lost part.  The Board has the right to discipline her for the dishonest conduct and require psychiatric counseling.  However, the automatic not getting her license back if she failed to practice medicine for two years while residing in California was against due process. 

Lee-Bloom v Maryland
Md Ct App

Lee-Bloom was to be disciplined by the Maryland Board of Physicians.  They sent the case to the Maryland  Psychiatric Assn for review.  While still under review she sued to stop any action by the Board.  The court rightly threw out the action since she had not finished the administrative process.       Top

Assisted Suicide

Baxter v Montana
Trial Ct.

Mr. Baxter has a terminal cancer and sued the state for the right for physician assisted suicide.  The state argued that it was up to the legislature to make that decision and not the courts.  The court ruled that mentally competent adults with terminal illnesses have the right to die with dignity. The ruling will probably be appealed.  

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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.