US v Brown
Mathew Paul Brown pled guilty of impersonating a physician and wrongfully disclosing personal health information. He treated over 1000 people in Nashville and Atlanta for over two years. He had other physicians bill for his services under their provider number for allergy services he provided. He had purchased the equipment he needed via a commercial pharmacy. He will be sentenced in several months.
US v Weeks
Monica Weeks of Madison, Mississippi, has been indicted for fraud in giving chemotherapy and she refreshingly has pled not guilty. The clinic she worked for was charged with using the same needle on multiple patients and that she gave less chemo or cheaper chemo than billed. The reasoning for the former charge was that 11 patients went to a hospital with the same infection. She did the billing for the clinic. The founder of the clinic Dr. Meera Sachdeva was also indicted as was the the office manager. There is a question as to bail for the physician as she is a potential flight risk.
Whistleblower v Halifax Hospital and Halifax Staffing
In bad news for the hospital and billing company the feds have decided to intervene in the whistleblower law suit. The suit alleges payments to neurosurgeons and oncologists that were above fair market value.
US v Duran
Lawrence Duran of Miami is going to jail for life (he is 48 years old and was sentenced to 50 years in prison). This is the longest jail sentence for Medicare fraud in history. He ran a chain of mental health clinics (American Therapeutic Corp.) and perpetrated a $205 million fraud.
Massachusetts v Kishore
Dr. Punyamurtula Kishore of Brookline has been arrested for Medicaid fraud. He is a pain addiction physician who the prosecutors claim did kickbacks. They accuse him of obtaining over $500,000 illegally from MassHealth, another government plan that does a poor job of monitoring claims. He had about 30 offices and recently began shutting them down which made the authorities believe he was planning on fleeing the country and arresting him prior to all the charges being filed. He pled not guilty.
US v Chaimowitz
Podiatrist Chaim Chaimowitz of New York as agreed to pay $800,000 for filing false Medicare billings for routine foot care which is not reimbursable. He also billed for things he did not do such as would take him 35 hours in a day to accomplish.
US v Gibson General Hospital
The Princeton, Indiana, hospital settled for an undisclosed sum the allegation of false billing. This started as a whistleblower suit after the hospital took over the Surgery Center billing to get more money than if the Center billed.
US v Vidal
Maritza Vidal and Richard Diaz of Miami pled guilty of Medicare fraud for physical therapy and home health treatments that were not needed or never provided. They worked for ABC Home Health and Florida Home Health respectively. They received bribes from the owners of the companies. They will be sentenced January, 2012.
US v Daniel
Dr. Christine Daniel was found guilty of fraud for selling herbs to cure cancer. She would charge up to $150,000 for medication that was useless. She would lure people by using her degree in medicine as well as being a Pentecostal minister. She is scheduled for sentencing in December and can face up to $5.5 million in fines and 150 years in prison.
US v Stern
Dr. Steven Stern of Louisville and his company Kentuckiana Center for Better Bone and Joint Health agreed to pay $350,000 for alleged overbilling of Medicare. In this whistleblower case it was alleged that the practice split vials of Infliximab for rheumatoid arthritis between several patients and billed for a full vial. Stern will also pay the attorney fees, costs and expenses of the whistleblower.
US v St. Mary's of Michigan
The hospital chain will pay $3.5 million to settle a dispute with the feds over chemotherapy billings. The rule is that chemo may not be given as an outpatient unless a physician is present. They had no physician present. Top
American Acad. of Pediatrics v
Florida passed a bill requiring that no physician be allowed to ask patients whether they have firearms in the house unless they in good faith believed the information was relevant to the patient's medical care or safety or the safety of others. The bill went through both houses and was signed by the Governor. It was even amended to take out fiscal penalties for physicians who did ask. The judge stated that the law was against free speech and put in a temporary injunction against the law.
DAC Surgical Partners v United
DAC owns surgical centers that allows surgeons to operate there for a facility fee. For years the insurers have paid the fee. In 2009 United not only stopped paying but sent a bill for overpayments. DAC sued for multiple claims and United wanted summary judgment for ERISA or failure to state a claim. Both failed and the case continues to trial.
Morales v Central Mississippi Med
Dr. Adolfo Morales, ophthalmologist, sued the hospital for breach of contract. He had a contract with Health Management Associates the parent company. The company then had a change of management and the contract was rescinded. Dr. Morales won $2.27 million and the hospital will appeal.
Austintown ACS v Mansour
And then there is the opposite. The ACS sued the physician head of the ED for fraud and unjust enrichment for taking money for sick leave etc for which he was not entitled. The jury found for the ASC in the amount of $50,000. He appealed and lost.
Nevada v Desai
The Court agreed with the prosecutors that Dr. Dipak Desai is competent to stand trial on criminal charges relating to a hepatitis C outbreak from unsterilized endoscopes in his clinic. He also is being tried for health care fraud for inflating the length of the procedures in order to get more money from insurers. Over 250 are suing for malpractice for getting Hepatitis C and thousands of others are suing for emotional distress for having to be tested. It seems to be from the reuse of vials of Propofol that were contaminated.
Barfield v St. Tammany
Dr. Barfield was hired to work with the clinic and his contract contained a clause that he would not have to take call. At some point he was no longer covered and had to take call. He sent invoices for his time taking call to the hospital which refused to pay. He sued and won. He did things that were not required under the contract and was entitled to extra compensation for doing those things (call). Top
Tate v Nevada Medical Board
Dr. James Tate of Las Vegas was fined $1000, given a public reprimand and told to do 10 hours of continuing medical education for "bringing disrepute to the medical profession." The suit alleges that there is no evidence regarding disrepute and that the physician was not allowed to speak at the hearing. He got into a very heated argument with the family of a hospitalized 14 year old as to whether the patient was well enough to be discharged. The suit states that the finding of the Board are in complete contradiction to a hearing officer's finding of fact.
California v McCall
A judge found a midwife guilty of overstepping her bounds when several years ago as a student she could not find her supervisor and delivered a baby on her own. She was sentenced to three years probation. In this case there was a report made to the California Medical Board since the shoulder was stuck resulting in a vaginal tear. Besides the probation on the criminal charge she has to pay $10,000 to the Medical Board as well as never practice midwifery again. She now has a felony conviction so it will be easy for the Board to act on the removal of her license.
James v Nebraska
Dr. James was given a probationary license when she stated she had bipolar disease and a heart condition. She sued the state and the individuals involved for various state claims and the ADA violation. The court ruled that all the individuals and the state had immunity for all the claims except the ADA. the Board never stated she was not an otherwise qualified person.
Gonzalez-Droz v Gonzalez-Colon
The Medical Board of Puerto Rico made a ruling that only those trained and board certified in plastic surgery or dermatology could do plastic surgery. They were sued by an OB who for the past 15 years has been doing a lot of plastic surgery. The 1st Circuit stated that the rule was legitimate. The physician continued to do plastic surgery in PR and had his license suspended his license until a hearing. The doctor moved to California and opened an office. He did not appear at the hearing and was fined $5000 and had his license suspended for five years. Now I wonder what California will do to his license in that state. Top
Villines v N. Arkansas Hospital
Villines entered the hospital with kidney stones. The following day he was scheduled for surgery for open removal of the stones. He was given the standard consent by the surgeon and he signed the appropriate form. He apparently was not given the consent form nor the talk regarding the type of anesthesia and the risks until after he was sedated. He received spinal anesthesia. There was difficulty getting into the correct space and multiple attempts were made. Post operatively he got arachnoiditis. The lower court granted summary judgment for the hospital after the other parties had settled. The court of appeals said there were issues of triable fact to be decided and reversed the summary judgment.
Buck v Henry
The New Jersey Supreme Court ruled that when physicians are sued for med mal that in their response they must tell their medical specialty. In this way the plaintiff may get an expert in the same specialty as the defendant to give an affidavit of merit.
Yocabet v UPMC
The patient received a renal transplant at UPMC from his partner, a nurse at the hospital where she works. Apparently UPMC did not do the necessary tests on the donor or did them incorrectly. This shut down the transplant service at UPMC for several months. It sounds like the hospital should get its checkbook ready.
Harrigan v Tobey Hospital
Mr. Harrigan, an 87 year old patient at the hospital, filed a case in federal court against the hospital and a nurse after no one responded to an alarm. His pacemaker battery went out and was out for two hours. He had a cardiac arrest and no one came since they ignored the warning buzzers.
Mozino v Stanley Medical Research
The plaintiff is suing the defendant for removing the entire brain of her husband instead of just some small pieces that she consented to have removed. This is just one of about a dozen suits against the company for doing the same thing on other bodies. Mozino lost this case but the others are in the wings.
O'Brien v Bruscato
Bruscato was under therapy by Dr. O'Brien, a psychiatrist. He stopped several drugs to see if the patient was developing a syndrome due to the drugs. While off the meds he killed his mother, was sentenced to a mental facility and then sued the psychiatrist. Georgia has a law the someone may not benefit from their wrongdoing. However, the Supreme Court stated that that the suit may not be one of profit but one of making the plaintiff miserable in a mental facility.
Pointer v St. James Olympia Fields
Pointer, a seven year old asthmatic boy, awoke with a severe attack. He was taken via car to the closest hospital St. James Olympia where he was told they did not have the ability to treat him. He has Medicaid. They transferred him to Franciscan St. James Hospital via ambulance which has the same facilities as the original hospital. Again he was transferred by ambulance during rush hour almost an hour away to St. Joseph Medical Center in Joliet, Illinois where he died. The family attorney wants to know why he was transferred to the different hospitals and to a hospital so far away when there were nearer ones that could treat him. They are suing the ambulance company, the two hospitals and the two ED hospitals that transferred him.
Holly Summit v Tony Tam
The California Ct. of Appeals upheld California's cap of $25,000 on non emotional damages. The ruling acknowledges that the California Supreme Court had already ruled on the constitutionality of the law.
Rodriquez v Surgeon
Dinora Rodriquez went to a physician for plastic surgery reports the Huffington Post. They do not name the surgeon nor the state that the surgery occurred. The surgery for bilateral breast augmentation and eyelid surgery were both botched by the surgeon. Ms. Rodriquez sued and won money from the surgeon and is now a spokesperson for the American Academy of Plastic Surgeons warning people not to have plastic surgery until they check out the physician and make sure they are members of the American Academy of Plastic Surgery.
Patients v Koo
Five patients are suing Dr. Michele Koo, a St. Louis plastic surgeon for posting patient pictures on line. The pictures were before and after pictures of their torsos along with their names. Dr. Koo has issued an apology to the women who are suing for invasion of privacy and punitive damages.
Oliver v Magnolia Clinic
The patient was seeing a nurse practitioner at the clinic who missed a cancer in the child. The child now has significant problems and sued. the jury awarded over $6 million which was reduced to $500,000 under Louisiana's cap. The Supreme Court of the state heard the case and stated that nurse practitioners were not under the cap. They sent the case back to the court to affirm the damages.
Cope v Miami Valley Hospital
Cope got a blister (third degree burn) on her arm following an MRI. This would happen if the sides are not padded. Believe it or not she sued for the blister and took the blister case to the court of appeals. She did not name any particular technition. She sued for general negligence and not malpractice. She won the summary judgment motion in the court of appeal and will now go to trial. This could be another cup of coffee in the lap case. Top
States v US
The Obama Attorney General has decided not to appeal the 11th Circuit three person ruling against Obamacare to the full 11th Circuit. This means that the health law will probably go to the Supreme Court in its Spring term with a decision during the 2012 election campaign. The way it looks from the lower court decisions is that it will be a 5-4 decision with, as usual, Kennedy having the deciding vote. The Chamber of Commerce and the 26 states have asked the Supreme Court to review Obamacare and the individual mandate. The next day the Obama administration joined in asking the Court to hear the case. Ex Supreme Court member Stevens thinks the Court should hear the case sooner rather than later. Top
UC Davis v Sacramento County
UC Davis has been taking care of the Sacramento County indigent patients for years and billing the county. The county had refused to pay since they had no contract with the hospital. The hospital sued the county and won. There will be another trial later to determine the amount the county will have to pay. It will probably be in the tens of millions of dollars which the county does not have. The irony is that the hospital is a state funded university and the state is the one taking money from the county so they can not pay their bills.
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.