US v Beckwith
Chaunsay Beckwith of Georgia pled guilty of fraud for running an alternative medicine clinic with a hyperbaric chamber. She had no license of any type but billed for therapies to Medicare. She is to be sentenced in mid June.
US v Quest
Quest Diagnostics will pay a $302 Million fine to clear civil and criminal charges against it for misleading marketing of a parathyroid hormone test. It will also pay $6.2 million to some state Medicaid programs. Quest's subsidiary Nichols pled guilty to a criminal misbranding charge and pay a $40 million fine. Top
Minnesota v Allina
Allina has agreed to pay $1.1 million to thousands of patients who were overcharged interest of money due. The hospital is not actually going to pay out anything. They sweet talked the government into letting them give credit for future services to those they already soaked and have those current patients get their amounts owed reduced. If the patient has no further bills in 24 months they will get actual money back. They charged 18% when the state law caps it at 8%. The State will pursue (I am sure not very strongly) a civil penalty of $25,000 per violation.
EEOC v Skilled Healthcare Grp
The Group settled with the EEOC by paying those Latino workers in California and Texas who were punished for speaking Spanish in the workplace up to $450,000 and free English classes. The company punished the Latino people but not those who spoke other languages such as Tagalog. English only is allowed if there is a business need for the rule. Here the patients were Spanish speaking and the workers spoke to them in their on language. The workers were also chastised for speaking Spanish on breaks and in parking lots.
West Penn Allegheny v UPMC
In a feud that has been smoldering, there is finally a lawsuit. West Penn accuses UPMC and Highmark of antitrust conspiracy that have illegally raised prices in the community. There is a issue of monopoly by the two conspirators. The suit goes on to state that UPMC sought to destroy West Penn by raiding their physicians by excessive pay. The suit goes on to state that UPMC forced Highmark to not restructure a loan to West Penn. Top
Physicians v HHS
Physicians in California have filed a class action suit against the HHS for paying differing amounts to physicians in different communities for the same service. Some physicians in one county would get up to 25% less than the physician in the next county for the same service. HHS says that the suit can not change the total amount of the pie. If the physicians win the suit other physicians will get lower amounts to make the same total cost. Another form of this is now at an Appellate Court.
Texas v Texas Blue Cross/Shield
Texas Blue Cross and Shield agreed to cease using a physician rating system that relied on costs. The insurer also agreed not to terminate physicians for referring out of network.
Massachusetts Medical Soc. v Group
As a follow-up to the case immediately above, the physicians of the Republic sued and won in summary judgment against the insurers to allow the case to go forward. The physicians are claiming that that the tiered programs of the insurers are a sham. The are based on money and not quality. The physicians can sue to claim the program defames them and defrauds patients. The insurers rated physicians on procedures not performed and on patients not seen and gave the physicians little chance for correcting the mistakes. This suit is also ongoing in Connecticut an new York already changed their methodology due to the AG. Why don't other stat AGs sue the insurers for Ingenex and tiering? Top
Maryland Board v Rudman
Dr. Rudman had his license revoked by the medical board after he was accused of second degree assault for inappropriately touching a patient. Dr. Rudman pled guilty in a specialized plea that allowed a continuation of denial of guilt. The court found that the plea was still of guilty and was moral turpitude. Good-bye license. I hope the doctor's criminal attorney has good legal malpractice insurance.
California v Hageseth
I put this criminal case here because it involved telemedicine and lack of a state license. Dr. Christian Hageset of Colorado prescribed a Stanford student Prozac over the internet. The student committed suicide several months later. The physician has been sentenced to up to a year in prison for a single count of prescribing without a license. The doctor may serve his sentence in Colorado due to recovering from heart surgery. He will also have to pay $4200 to the Medical Board of California for their investigation. Top
D'Souza-Klamath v Cloud County
The physician lost his privileges for substandard care. He was reported to the NPDB and sued for multiple state actions and retaliation against a whistleblower. The court ruled that the hospital could not be given immunity since it did not offer evidence of good faith but the physician had not offered any evidence to prove his case.
Wahl v Charleston Med Ctr
Wahl sued Charleston after he lost his privileges. This was at the same time that CV surgeon was considering becoming associated with another practice. The hospital suspended Wahl for unknown reasons and reported him to the NPDB. The state medical board then investigated and dropped any further investigation. Wahl sued for conspiracy under the antitrust act and multiple other actions including lack of due process. The rationale was that he never received a hearing. The courts looked at the law and stated that the hospital was entitled to HCQIA immunity since the lack of a hearing was due to the physicians refusal to select dates for the hearing. The law allows immunity if the physician is given due process or after other procedures as are fair to the physician under the circumstances. The court also stated that the bylaws do not constitute a contract between the hospital and the physician under West Virginia law. The attorneys defending Charleston Hospital believe that HCQIA permits the minimizing of discovery related to the immunity of the hospital, there does not have to be exact compliance but only the totality of the circumstances to get immunity, the HCQIA immunity provisions should be read expansively, motive of the hospital has no bearing on the outcome of immunity even if later it is shown that the facts were not true or the standard of care was in fact met by the physician and the hospital should carefully document all information on which it acts and that the physician is advised of all the charges and the opportunity to explain or rebut any charges. This is another dagger in the hearts of sham peer reviewed physicians.
Chudacoff v Univ Med Ctr of S. Nevada
Dr. Richard Chudacoff, an OB at the hospital, emailed his chair of concerns regarding the quality of care. One month later he was summarily suspended without any prior knowledge. The medical center then filed a report to the NPDB stating the privileges were indefinitely suspended due to quality of care matters. Four months later he had a hearing where he was told there was a problem with his original application to the hospital. This had never been brought up before. The judicial hearing disagreed with the suspension but recommended peer review of the physician's practice. The MEC agreed but then gave him a second letter of suspension due to the problems with his initial application. The Board required the MEC to reconsider its initial decision to report the physician to the NPDB. Meanwhile the physician filed a lawsuit alleging violation of his due process and money damages. The court found for the physician on some of the charges stating he was suspended prior to any type procedure or opportunity to be heard. The court went on to disallow any HCQIA immunity including damages due to its lack of due process. It did not order a removal of the NPDB entry since there was a hearing ongoing.
Bissada v Arkansas Children's Hosp
The physician, a Urologist, was suspended for not communicating to patients and the families, competence and a high percentage of procedure cancellation. He sued in Federal Court for discrimination but that nor his state claims survived summary judgment.
Abu-Hatab v Blunt Mem. Hosp.
The physician used to work for a competitor and then went on his own. He unsuccessfully attempted to get the hospital to change from the competitor to him. He had multiple run-ins with the nurses and was warned by the MEC in 2001,2002, 2003 and 2004 about his conduct. He received a 29 day suspension in 2004. He was then notified that his privileges were to be suspended. The JRC agreed with the suspension of privileges as did the Board. He sued in federal court for breach of his first amendment rights which doesn't work in the workplace. The Court also stated HCQIA immunized the hospital against al damage claims. The court also found that the physician's refusal to communicate with nursing and not answering pages compromised patient care. Top
Scott v Helena Med Ctr
A recently fired nurse sued the hospital after she looked at another nurse's medical record. The fired nurse had shown by evidence that similarly situated white employees were treated differently. The hospital's motion for summary judgment was denied.
Lewis v UPMC Bedford
The physician, a locum tenens ED physician, has ADHD and when the chief of the ED found out he instituted a "shadowing program". The chief also denied the physician's request for accommodation where he wanted to see patients and do the charts later. Other ED physicians did the same thing and were not disciplined. The chief also required the physician to undergo a neuropsychiatric exam. The physician complied and when the neuropsychiatrist stated he could practice safely and refused to send the file due to HIPAA, the physician was fired. He sued and the hospital lost summary judgment for discrimination but won on lack of due process since he was not on the medical staff and was not entitled to the protection of the bylaws for a hearing. Top
Patients v Kaiser
Kaiser got off easy by paying only $1 million to patients who the HMO injured with their poorly thought out, poorly executed renal transplant program and then lying about it. All patients involved got between $100,000 and $300,000, the maximum under the state med mal laws for pain and suffering. in California is $250,000 but patients may also get money for economic damages. Dead patients only get non economic damages. Many died. These patients failed to "thrive."
Mintz v Blue Cross
Judge Mintz had lung cancer who had surgery, radiofrequncy ablation and chemo all with no help. His physician recommended an additional trial of radiofrequency ablation but Blue Cross denied it as experimental after covering it several months prior. The judge while still alive filed suit against Blue Cross for failing to tell him that he could have appealed the decision. The lower court denied the case since Blue Cross was under contract to CalPERS who acted as the intermediary for all state workers. The appeals court overruled stating that CalPERS paid the claims but Blue Cross made the flawed coverage (benefit) decision.
Patients v Siouxland Urology
Patients from Iowa filed a class action suit against a South Dakota Urology practice. The issue was using the same bag of fluid for more than one patient potentially putting up to 5000 patients at risk of HIV or Hepatitis. The risk is so low as to be almost non-existent but any risk is too much for a plaintiff attorney to pass up. The practice did go against the manufacturer's written recommendation. The Center is offering free testing for the diseases. Top
Shiniski v Sanders
The US Supreme Court ruled that the VA had it backward when it ruled that the VA had to prove that the veterans did not have to prove their burden if there was an error by the VA that potentially hurt the vets. In fact, the Court stated veterans had the burden to prove that the error did harm them. Top
Gonzalez v Choudhary
The patient claimed that she was treated differently than others and wanted the medical records of others to prove her case. The hospital refused and the court sided with the patient. She had presented with dyspnea and chest pain and sent home. The next day she returned and had a cardiac arrest in the waiting room. She claimed since the hospital had not policy on how to screen patients with chest pain the only way to look at the standard was to see other patient's records to see how they were treated. The discovery was limited to a two week period around her visit. The hospital lost. Top
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.