US v Marquez
Ihosvany Marquez or Miami was convicted and sentenced for Medicare fraud. He billed for false Medicare claims for HIV treatments never given nor needed. He was sentenced to 19 1/2 years in prison. He also is supposed to repay $21.6 million to Medicaid. His partner Michel De Jesus Huarte was previously sentenced to 22 years.
US v CVS Pharmacy
CVS Pharmacy was fined $75 million for selling pseudoephedrine, the main ingredient for methampehtamines in large quantities. CVS will also forfeit about $2.6 million in profits earned from the sales of pseudoephedrine.
US v Mateos
The 11th Circuit upheld the sentence of Sandra Mateos, RN and Dr. Ana Alverez of Miami for doing a bogus HIV clinic. Mateos was sentenced to seven years and Alverez was sentenced to 30 years.
US v Collins
Christopher Collins pled guilty of one count of conspiracy to commit healthcare fraud. Collins was a nurse hired by Muhammad Shahab of All American Home Health and he offered people cash kickbacks for their Medicare patient information. Collins then became the owner of the home health agency and continued to file false claims. He was sentenced to 63 months in prison and ordered to pay restitution of $6.97 million. Good luck with that.
US v Duran
The feds raided two Miami companies, American Therapeutic and Medlink Professional Management Group for kickbacks to Florida assisted living programs. They would bill Medicare for unnecessary sessions according to the news. Four people were also charged. Those that were supposed to be getting intensive therapy were in realty watching TV and playing games.
US v Schneider
Dr. Stephen Schneider and his wife were both sentenced to prison for 30 years in a "pill mill" case. They were involved in 68 drug overdose death cases. The government wanted life sentences but the judge settled on the 30 years for the doctor and 33 for the wife who had a prior felony conviction. The judge also went after the Pain Relief Network.
US v Drakhler
Yefim Drakhler of Brooklyn has pled guilty of Medicare fraud. The 74 year old patient who received kickbacks for getting unneeded treatment at Solstice Wellness Center. This offense carries a possible five year prison term and a $250,000 fine. Sentencing will be at a later date.
US v Fernandez
Dr. Manuel Fernandez, 77, of Miami was sentenced to three years in prison for billing Medicaid for services never rendered.
Florida v Antolic
The police arrested two central Florida physicians for drug charges. Drs. Mladen Antolic of Orlando was arrested at his home where large quantities of narcotics were found. The same day in Osceola County the police arrested Dr. Jose Menendez on prescription drug abuse charges. Top
CMA v California
CMS has a rule that physicians must supervise nurse anesthesiologists unless the state asks for a opt out. California did opt out and the CMA and the California Anesthesiologists sued for quality of care issues. The physicians lost as the state had the right and asserted that right. The legal problem was that the Governator did not ask the nursing and medical boards prior to filing for an opt out as required by law. The court said this was not necessary. There may be an appeal.
US v Justin
Dr. Rodney Justin of Woodford, NC, was convicted of tax evasion. He was sentenced to three years in prison and ordered to pay $600,000 in back taxes. The Medial Board gave him a one year probation since the crime did not relate to any medical quality issue. Top
Virginia v US
In one of the challenges to the healthcare law Virginia is arguing that if the judge rules that any part of the law is unconstitutional, that all the law should be dismissed since the Congress left off any severability clause. The judge said he will rule by the end of the year.
More Law v US
The case against Obamacare was completely thrown out by the judge and will be immediately appealed. It is interesting that this judge was appointed by a Democrat and the other two cases in Florida and Virginia that seem to going ahead are in front of judges appointed by Republicans.
CA Assn of Rural Health Clinics v
The case of the State halting some Medicaid services due to financial problems was decided against the State. The halted programs will be re-started but the Association will get no money from the suit. Top
US v Blue Cross Michigan
The Justice Department filed an antitrust law suit against Blue Cross/Shield of Michigan. The government states that the dominant insurer (60% of the commercial insureds) has forced the Michigan hospitals to raise rates for other insurers to make up for the low rates paid by the Blues. The contracts state that the providers could not get better rates from anyone that what they get from the Blues. Some of the contracts using the "most favored nation" clauses stipulate that the lowest price a provider could obtain had to be at least 30% more than the Blues rates. This raises prices to all consumers, discourages discounts and prevents others from entering the market.
LA v Goldman Sachs
The LA City Attorney filed charges of "junk insurance" on a company and its major stakeholders. The company is HealthMarkets Inc. and the stakeholders that the attorney is accusing of knowing about the scam when they purchased a majority stake in the company are Goldman Sachs, and Blackstone Group. The company has had suits filed against it in 30 other states for deceptive business practices. The company paid $17 million to Massachusetts and was barred from selling insurance in the state for five years.
North Cyprus Med Ctr v Blue
The hospital sued the insurer when the insurer stopped paying the hospital directly and paid the patient instead. The Association was not an insurer in Texas and processed no claims. Therefore there is no case against the Association.
Colone v Wardell
A physician sent out a mass E-mail to employees of a medical center criticizing an employee. He got transferred to another facility. He sued for retaliation and sexual harassment. The trial court ruled for the physician but the higher court ruled for the hospital on the summary judgment motion. The court stated that the email did not necessarily report a break of the law therefore it did not come under the state law. He had previously complained about the care in the ED and inappropriate sexual behavior therefore the transfer was not in retaliation to anything but the mass E-mail. That seems to be ok with the court.
Kandel v Nebraska Medical Ctr
In a case that proves the dictum that you need to know what you sign before you sign it, Dr. Kandel signed an employee contract with the medical center. Just prior to his contract being up and the need for renewal and also just prior to a peer review investigation being started, Dr. Kandel stated he was leaving for a new position. The medical center turned him in to the NPDB and he lost his new position. He sued and lost since when he was hired he signed a contract that stated that he would not sue the medical center for any reports made regarding his quality.
US v CHW
Catholic Healthcare West has agreed to pay the feds $275,000 for hiring discrimination against legal immigrants. Top
Boggia v Wood
Boggia sued Wood for med mal and a hospital for negligent credentialing of Wood. Wood settled the case with no admission of negligence. The plaintiff then continued the case against the hospital. The hospital countered with since there was no negligence in the suit there could be no negligent credentialing. The court bought the argument.
Deno v Lifemark Hosp.
The Court ruled that the cap on non economic damages on med mal applies to all defendants together and not each. It is a per incident and not a per person cap. Each Plaintiff is allowed the $250,000 cap not the defendant. Therefore if three people or entities sue and win against six defendants the total cap to be paid will be $750,000 (one per plaintiff).
Speaker v CDC
Although not really a malpractice suit, the 11th Circuit overruled a judge and is allowing Mr. Speaker's suit against the CDC to go forward. Mr. Speaker is the attorney who was publicized by the CDC of being the target case of a TB scare in 2007.
Zander v Craig Hospital
Zander sued a physician for med mal and wanted the hospital to produce documents regarding the incident. The hospital refused citing confidentiality. The court (federal) stated that all root cause documents were protected but any document created by an independent investigation of the physician were not protected.
Barkes v River Park Hosp
Tie Qian v Shinseki
Dr. Tie Qian was a temporary at the VA hospital and was dismissed and reported to the NPDB. He sued for lack of due process. He was accused and counseled several times for quality of care issues and inappropriate accessing of patient charts. He was then suspended for up to 30 days for quality of care issues. While on suspension a formal investigation took place and then his privileges were suspended. He was told about his due process ability. He appeared at a review panel and lost. He appealed to a higher up in the organization and that appeal was rejected. Suit was then filed for lack of due process. Since he was not a full member of the staff (temporary) he was not entitled to the full due process. He did receive a significant amount of what he would have been entitled to so the suspension and reporting stood and the VA won on summary judgment.
Midei v St. Joseph Medical
Dr. Mark Midei, a cardiologist, sued the hospital for fraud for doing "irreparable damage" to his reputation by a campaign of corporate deception, trickery and fraud. A year ago he had his privileges removed, had dozens of lawsuits against him and is under state investigation to have his license revoked. He states that he was made a "decoy" in the federal investigation of the hospital and his former employer. He states that the hospital has been reporting falsely that he was inserting unnecessary cardiac stents. He is asking for $40 million in compensatory damages and an additional $60 million in punis. As part of the investigation the hospital sent letters to 600 patients stating that the stents they received may not have been necessary. The hospital claims the letters were for "clinical reasons". Associated with this was a prior claim by MidAtlantic Cardiology, the former employer of Midei, for scuttling a deal that would have allowed MidAtlantic to get $25 million to join with a competitor of St. Joseph. The deal was contingent on Midei being part of the purchase. Midei was hired by St. Joseph and the deal fell through. The CEO of MidAtlantic threatened to "spend the rest of his life trying to destroy Midei personally and professionally. The CEO expressed regret for the remarks during a deposition and the lawsuit was dropped. However, that started the investigation of MidAtlantic and St. Joseph by the feds. The investigation led to a shakeup of the administration at the hospital. At the same time a patient complained that Midei had done unnecessary stents. The hospital rule was stents were to not placed if there was less than 50% blockage of an artery. The same year (2009) Midei was removed from duty and the letters sent. The investigation was then settled. The hospital states it had several cardiologists review the films and they found that only Midei's patients had less than 50% blockages. Midei claims the hospital dismissed other cardiology opinions that his work was within the standards. The hospital asked Midei to resign and offered to get him another position. They then sent the letters only focusing on one element, the 50% portion and not the clinical picture. This should be an interesting case since it does not sound as if HCQIA would be involved.
Izhar v Kaiser Permanente
Dr. Izhar, a radiologist at a Kaiser facility had his privileges reduced in 2003. Five years later he sued for a lack of due process. He never filed a writ of Mandamus. He was outside all of the areas of the statute of limitations. I would fault the attorney but in this case the physician acted as his own attorney. 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.