Bomkamp v Go
An eight year old girl was permanently brain injured when the physician used a morcellator to remove her spleen. He had never used the instrument before and did not tell the family he was going to use this instrument. The award was $17.3 million. St. Mary's Hospital obviously is paying a large chunk of this money since it allowed the physician to use the instrument without credentialing him.
Fuller v Crabtree
In this case it is learned once again about conflicts and wearing too many hats. A physician attorney made an affidavit regarding the patient's complaint and then also became the patient's attorney. He was not allowed to do that and was removed from the case.
Smith v Pratt
The Court ruled that peer review qualified immunity applies to when a patient sues a hospital for credentialing decisions as well as when a physician sues the hospital for suspending his privileges. The question is whether the peer review was made in good faith.
Wargo v Michelow
A Cleveland, Ohio, jury awarded the plaintiff $1.2 million for injuries caused by the defendant. The plaintiff was having a mole removed from her eyebrow. Oxygen was being administered to the sedated patient when Dr. Bryan Michelow decided to use an electrocautery. The ensuing fire caused the patient second-degree burns to her face and neck. The jury found that $425,000 of the damages were punitive since the physician attempted to hide the cause of the fire.
Ronca v Bolognese
In a story that has yet to be played out, a patient was scheduled for neurosurgery. She was taken to the OR and her head shaved and then put to sleep. Upon awakening she found she had not had the surgery. The reason she was given was that the neurosurgeon had a family emergency. This was not true and the neurosurgeon's associate would not operate on the patient when the surgeon did not show. Both Dr. Paolo Bolognese and Dr. Thomas Milhorat of North Shore University Hospital in New York were suspended and the state Department of Health is also investigating. She did have the surgery several days later by a different set of physicians. She did not find out the truth until three weeks after the fiasco. Top
Horizon Blue Cross v E. Brunswick
Horizon sued the ASC in state court for interfering with its network. The ASC was alleged to drop out of the network, raise their prices and stop charging co-pays and deductibles in order to get Horizon's network business. The ASC had the case removed to federal court and the court due to ERISA. The court sent it back to state court because it did not involve ERISA since Horizon did not bring the claim on behalf of Horizon's beneficiaries.
Regency Hosp v Blue Cross
The hospital sued the insurer for falsely stating an insured coverage. The hospital twice provided services to the patient who was insured by the Blues via an employer. The bills to the Blues topped $200,000 and the payments were about $25,000. The hospital did a poor job of pleading its case and the insurer was alot smarter since it taped the conversation with the hospital. This showed that the insurer would pay the hospital out of network payments based on 60% of what the insurer would normally pay not what the hospital charged. Yet another hospital needs new attorneys. Top
US v WellCare
WellCare has settled with the feds over Medicare and Medicaid fraud charges for inflating what was spent for care. WellCare will pay $80 million to settle the case. They will also need to enter into a CIA and put in policies to prevent future fraud. WellCare has since dropped fee for service Medicare Advantage.
Brookdale Hosp. v HIP
A judge has allowed the hospital to return to court to sue HIP, Cogent Healthcare and Central Brooklyn Medical Group for RICO violations. Brookdale states Cogent sent in hospitalists to do utilization review of patients referred by the Medical Group in order to deny coverage. The judge said the claims were short on fraud but may be part of a widespread scheme depending on new allegations.
US v Fonesca
In the usual place, South Florida, two more people were arrested for Medicare fraud. Michel De Jesus Huarte and Ramon Fonesca were arrested for running sham operations out of empty store fronts. They filed over $20 million in claims for services never done. They sent claims for HIV and chemotherapy treatments. This is yet another reason why government medicine doesn't work. They do not control the claims and the bureaucrats just pay mindlessly. Top
Pierson v Orlando Regional
Dr. Pierson went wild after having his privileges revoked. He sued 26 individuals for the usual stuff and of course lost each and every one of the charges. His pleadings were wrong for antitrust, civil conspiracy, who he was suing, defamation and negligent hiring and supervision of the physicians of the peer review body. His other claims were also tossed for other reasons including that HCQIA was a violation of the 10th Amendment. When will physicians outside of California learn not to waste money suing under HCQIA? Top
Giacalone v Helen Ellis Hosp
An uninsured patient sued the hospital after the hospital said he was not eligible for charity care and billed him the full amount. The patient wanted the information about charges, discounts and cost structure. The patient won in the court of appeal. He had counter sued the hospital the supplies and materials used on him were unreasonable. The hospital should have just allowed him to pay part of the bill. This is what happens when hospitals believe they can bully people and now all their internal information will be public.
Children's Hosp of Oakland v
Health Plan of Nevada
The hospital did medically necessary treatment on a patient after a contract between the entities stated the payment would be Medicaid rate minus copays and deductibles. The bill was over $2 million and the payment was $341,000. The parties then entered into a like agreement for another patient. The dispute was over the term 100% of the Medicaid contracted maximum allowable reimbursable rate. The hospital wanted the higher interim rate and the insurer wanted the lower published rate. The insurer won and was found to have overpaid the two patients by over $111,000 and was due a refund. The moral is to know your downside before you try to get the upside.
California v Insurers
California had settled with the insurers for their illegal insurance rescissions. All patients who wished could join the settlement and be paid. It seems the patients do not want any part of the settlement. Only 5% participated in the settlement offers. Most are suing the insurers privately and reaching individual settlements. Top
Medicine v Nursing
The Louisiana high court upheld a lower court order forbidding nurse anesthetists from doing interventional pain management. This went along with Kentucky's Supreme Court's ding on physical therapists. The physical therapists sued an ortho group for doing PT. PT is a medical procedure and physicians are allowed to do it. Top
The court stated that physicians have the right to withhold permission to have their prescribing data sold for use in pharmaceutical marketing. This went along with New Hampshire and Maine. Top
Martinucci v Kaiser
Dr. Martinucci went to court for wrongful termination against Kaiser's Permanente Medical Group. He won $11,441,559. He stated he was fired for alleged excessive advocating for improved patient care. That may hurt the Permanente bonuses for rationing care this year. Top
California v Hollywood
The hospital gave an unneeded blood transfusion to a patient and the wrong type blood was given. The error was not noted for about 15 minutes. The patient died and the hospital was fined $25,000 by the state. No mention of how much the med mal suit will be.
Sinclair v Southern Hills Hosp
The Sinclairs filed suit against the hospital after their 18 month old son died at the hospital. The Sinclairs were not at the hospital when the son was taken to the hospital unconscious. The Sinclairs wanted to see their son and say their good-byes. They were forbidden to see the body and were alleged to have been lied to by the hospital who stated the body had been transferred when it hadn't. They did get to see him six days later post-embalming. The parents are suing for $5 million in the Nashville, Tennessee courts. 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.