US v Melgen
Retina specialist and presumed co-conspirator with New Jersey Senator Bob Menendez in a conspiracy trial, Florida ophthalmologist Salomon Melgen was found guilty of 67 counts of fraud for billing the feds for eye exams not necessary or never performed. Menendez is accused of taking money from Melgen to intervene with Secretary Sebelius of Melgen's behalf.
US v Poplar Healthcare
The Tennessee company will pay the feds to settle $900,000 to settle allegations it promoted a test for mast cell enterocolitis. The promotion was not supported by scientific evidence.
US v Piedmont Pathology Lab
The North Carolina lab agreed to pay $601,000 to settle allegations that it did special stains and billed for them prior to doing the standard H&E stains. Since it did not know the diagnosis it is considered an unnecessary exam.
US v Quest Diagnostics
The lab will pay the feds $6 million to settle allegations that is subsidy Berkeley HeartLab of Alameda, California, paid kickbacks to physicians for using their services. They automatically waived co-pays on the physician's patients and paid illegal consulting fees to the physicians.
US v Schnitta
Brian Schnitta, DO in Kansas City has paid the feds $1 million to settle allegations that he did procedures not medically necessary or not covered.
US v Iglehart
The 5th Circuit agreed with the verdict in the lower court that Dr. Sharon Iglehart, a psychiatrist at Riverside General Hospital, committed fraud by admitting people to PHP programs that did not need it and also agreed the penalty of 144 months in prison was also appropriate.
US v Daneshvar
Dr. Gerald Daneshvar of West Bloomfield, Michigan, was convicted of fraud for billing to Medicare visiting physician services for which the people did not qualify. He billed for over 20 per day of complex visits which is impossible.
US v Pos-T-Vac, Inc.
The Dodge City durable equipment supplier agreed to pay $1 million to settle claims for male vacuum devices which were not medically necessary, were not documented and lacked a physician prescription.
US v Jones
Four physicians, Drs. Michael Jones, Henry Evans, Sheltobn Barnes and Gregory Molden all of New Orleans, along with Jones' wife and another were found guilty of fraud for ordering home care services for people that did not need it via Abide Home Care. The owner of Abide Lisa Crinel and the mother of Tyrann Mathieu, the great defensive player for Green Bay, Sheila Mathieu had previously plead guilty.
US v Valley Tumor Medical Group
The group in Lancaster, California, has agreed to pay almost $3 million to settle billing fraudulently for almost ten years. They billed radiation treatment services without having a physician present on site as required by law. This was a whistleblower case and he got $550,000.
US v Memar
Dr. Omeed Memar of Chicago was found guilty by a jury of fraud. The dermatologist had billed for procedures done under false circumstances
US v CaRECORE National LLC
The benefits management company agreed to pay $54 million to settle allegations that it authorized medical diagnostic procedures without properly assessing whether the procedures were really necessary. This is a whistle blower case. Top
FTC v St. Luke's
The court gave its final approval of the divestiture of Saltzer Medical Group from St. Luke's Hospital due to antitrust concerns in Nampa, Idaho.
Memorial Hospital of Sweetwater
County v Klein
The former CEO of the hospital filed suit for wrongful termination and now the hospital has countersued for concealment of financial information, breach of contract and fraud. The suing board states that unknown to them the CEO was in talks to have the University of Utah to acquire the hospital. They believe Klein was purposefully draining assets so the university could acquire the hospital and Klein would make money. Top
Engleman v J&J
Ms. Englemen had a vaginal mesh placed for urinary incontinence and had significant post op problems. The jury awarded her $2.5 million in compensatory damages and an additional $17.5 million in punis. The latter will not stand. J&J has lost about 25 of these cases in the past 3 years. It has also won some of the cases.
Boudreaux v J&J
This is the first trial against J&J and Bayer for Xarelto, a blood thinner. There are 18,000 more to go. The case revolved around the prescribing information and labeling. The question is if there should be a test done to determine the patient risk for bleeding as there is no antidote.
Slemp v J&J
Lois Slemp sued after using J&J's baby talc and developing ovarian cancer. There is controversy as to the link between the two entities. The claim here is not only the failure to warn and the link but also that the talc was contaminated with asbestos. This jury awarded $5 million in damages and $105 million in punis. This will be cut way back if the verdict stands at all.
Cuevas v Contra Costa County
The child sued for birth injuries and the court during the trial did not allow collateral source to be told to the jurors for future damages. The appellate court overruled the trial court and said they could be introduced and it could allow the payments from Medicaid or discounted ACA plans. The trial court awarded $100 million discounted back to $9,577,000. The new trial will be for damages.
Dixon v Atogho
The mother was in labor and Dr. Ata Atogho was the OB. According to the records Atogho left the OR for 8 minutes to call his broker and then lied on the record stating the mother refused a C-Section. The mother got $33.8 million to care for the brain damaged baby. Atogho does not have to pay anything since he worked for a federally funded Community Health Center at that time. At the time Atogho worked for the Miami center the nurses did all the patient contact until the Ob came in for the delivery. Now they have hired full time OBs.
Julian v Mission Community
A teacher, Katia Julian was removed from the school by police and she was detained overnight at the hospital for observation. She sued saying her rights under the state's law was violated. The lower court ruled she had no private right of action under the law. The appellate court agreed since the law only allowed suit by administrative agencies. The people were not state actors and therefore could not be sued under federal or state constitutions.
Smith v Providence Hood River
Smith went to the hospital ED with acute onset of vision problems, slurred speech and headache. A CT showed no brain bleed and he was told it was probably secondary to a sleep aid. The following night he returned with worsening symptoms and was seen by the same ED physician who again said it was not much as discharged him. The next day he was his GP who ordered a MRI but not emergent. He is suing for loss of opportunity, not allowed in Oregon. The courts all tossed the case but the Supreme Court allowed it stating it is a valid course for malpractice if the standard of care is not followed and the person loses the chance. Top
Ferry v McKenzie Physician
Dr. Kristian Ferry sued his medical group for breach of contract and defamation against McKenzie-Willamette Medical Center. The jury stated that his contract was breached and awarded him $156,333 in economic damages. They rejected the defamation claim. The jury also found that Ferry was overpaid by $35,190. The jury found that it was not defamation to state Ferry was in transition after he was fired. He had sought $6 million in economic damages and $3.8 million for humiliation.
Physicians v Steward Health Care
The physicians in Compass Medical Group, an affiliated medical group of Steward, is suing for breach of contract. They accuse Steward of not paying due incentive payments since 2013 and not paying their lease payments. Steward is counter suing for deceptive financial practices, fraud and breach of contract. This is one of Steward's largest medical group. Top
Cross v Superior Court
The California Medical Board subpoenaed Dr. Cross' psychiatric records for an alleged over-prescribing of controlled substances. She refused to comply but the court ruled in the Board's favor. She appealed and the appellate court and lost on the issue of which code ruled. The court ruled for the board in the patient privacy area but ruled against the Board in this case since the subpoena compelled overly broad disclosures of "complete" medical records and had included a category of the overbroad "all other data". Top
Patients v LSU Health
A stolen hard drive had the patient information of 2200 people. Of course, the data was not encrypted. Can not wait to see how large the fine will be.
US v Memorial Hermann
The system continues to screw up. This time they need to pay the feds a fine of $2.4 million for releasing a patient's name to the press 15 times without authorization. The OCR blasted senior management for this goof.
Patients v Bronx-Lebanon Hospital
The hospital posted online the records of 7000 people including HIV status and sexual assault reports. They have no idea how long it was posted. Ain't EMR wonderful. 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.