September 1, 2013 Recent Legal News

Fraud

Malpractice

Peer Review and Employment

HIPAA

Fraud

US v Planned Parenthood
Settlement

Planned Parenthood of the Gulf Coast in Houston paid a settlement of $4.3 million for allegedly billing for medically unnecessary procedures, not indicated or not performed.  This is a whistle blower case and she will get $1.25 million.

US v Shands Healthcare
Settlement

The healthcare system will pay to the feds and Florida a total of $26 million.  This is yet another in a long line of whistle blower suits where hospitals billed for inpatient procedures and stays that should have been outpatient.  The system self reported the errors after the consulting auditor found the problems and filed suit.  He also claims Shands did many things without a physician order.  Therefore his cut is not yet determined.

US v Emory University
Settlement

Emory University has agreed to pay a fine of $1.5 million to settle allegation in a whistle blower suit of billing Medicare for clinical trials services which the sponsor was to pay.  There were some cases that the University actually got paid twice for the same service.

US v Dubuis Health
Settlement

In a whistleblower case the management of long term care facilities paid $8 million to settle allegations of false claims.  They were accused of having patients stay longer than needed to increase payments, they had patient admitted to a facility even though they did not meet the requirements to be admitted and they billed for DME not necessary for the patient.  The whistleblower got $2.16 million.  She was a nurse who realized what was going on and reported it to her supervisors who did nothing.  She then filed suit.

Oregon v Two Physicians
Settlement

In a case of questionable ethics on the part of the state, it sued Drs. Fedor and Turk, cardiac surgeons in Salem for not telling their patients they were being paid by a medical device company to use their device.  There has not been a law either in the state or nationally that required physicians to disclose to their patients whether or not they had any tie with a medical device company.  There is the Sunshine Act which requires the payment in cash or kind of any amount over $10 to be placed on line.  This just started.  The physicians paid the huge sum of $25,000 each and promised to be good citizens in the future and tell their patients if they received any money from a medical company.  This cost Salem one cardiac surgeon as Turk retired to Hawaii.  Please remember ethics is not law.

US v Schwartz
Sentenced

Dr. Irving Schwartz of Yuba City, California, was sentenced to 5 months in prison and an additional 5 months in a halfway house for writing false prescriptions for wheelchairs.  He also has to pay over $500,000 in restitution.  He got a $300 kickback for each prescription.  He admitted writing over 185 false prescriptions and receiving about $55,000 in kickbacks.  These false prescriptions led to Medicare being charged over $1 million illegally.

FTC v Phoebe-Putney
Settlement

The FTC has folded its attempt at undoing the merger of Phoebe-Putney and Palmyra Park Hospital due to the strict Georgia CON law.  The FTC attempt would bring it into direct conflict with the Georgia statute.  In return the merged entity may not contest other providers increasing acute care services.  Phoebe states they may still contest CON applications but must just tell the FTC they are doing so.  The argument had reached the US Supreme Court which tossed out the lower court rulings in favor of Phoebe as being too loosely construing the state law exception.

US v Obedian
Settlement

Dr. Richard Obedian, Orthopedist of Long Island, has agreed to pay the feds $388,000 for submitting claims for kyphoplasty under codes not used and paying higher than the kyphoplasty codes. 

US v Miller
Indicted

Dr. Joel Miller of Craig, Colorado, was arrested and indicted on 34 courts of various drug charges including billing Medicare and Medicaid for prescribing drugs without a good faith medical exam.  He is accused of causing the deaths of two patients due to over prescribing.  He has been previously been reprimanded by the Medical Board for mis-prescribing meds.

US v Ajiri
Indicted

Dike Ajiri and Banio Koroma MD have been charged with healthcare fraud in the business of Mobile Doctors out of Detroit, Chicago and Indianapolis that made house calls.  The government charges that they billed with higher codes than actually performed.  The feds are attempting to seize $2.6 million in various bank accounts.  They also have been accused of falsely stating patients are homebound and therefore qualified for home health services.

US v Reddy
11th Circ

The appellate court overturned the lower court's conviction of Dr. Reddy on fraud for not reading the x-rays sent to him for readings.  The reason is that Dr. Reddy hired an expert witness to review the x-rays to see that the x-rays reflected the readings.  The lower court refused the testimony since the physician was not an expert in statistics.  The appellate court stated he was well versed in statistics and was there to testify about medical issues.  The jury should have heard the case and there needs to be a re-trial.        Top

Malpractice

Chernyakova v Puppala
Filed

The plaintiff is a young woman who was seen by a person that knew her Dr. Puppala in the ED of Feinberg Northwestern Hospital for drunkenness. She alleges that he took pictures of her in her drunken state and posted them on line without consent.  She is suing the hospital and the physician for invasion of privacy and emotional distress.  

Forty John Does v Northwestern University
Filed

Northwester had a power failure and the sperm banked there from 40 donors were destroyed.  They are being sued for negligence in putting all the samples in one tank when many were available.

NFL Players v NFL
Settlement

The NFL has agreed to a $765 million fund to compensate present and former players for concussive injuries.  There are limits to the compensation with a max of $5 million with Alzheimer, $4 million for traumatic encephalopathy post mortem and $3 million for those with dementia.        Top

Peer Review and Employment

Cole v Jersey City Med Center
New Jersey Supreme Court

In a well deserved victory for the plaintiff the Supreme Court allowed her to sue her former employer medical group.  She originally sued the hospital after the hospital terminated her.  The hospital brought into the suit the CRNA's medical group and then settled with the plaintiff.  The medical group was left in the suit and had all but several causes of actions dismissed.  Several days before the trial was to start the medical group said "Surprise, there is an arbitration clause and we want to arbitrate instead of trial".  The court said the group waived its right to trial by waiting until it was too late.  They did not play fair so to trial.

In re Higby
Texas App Ct

In an interesting case Dr. Higby and an Ob were on opposite sides as expert witnesses in a med mal trial.  After the trial Dr. Higby accused the OB of false reporting during the trial to the College of OB/Gyn which both belonged.  The OB sued Higby for defamation and during deposition Dr. Higby refused under orders from her attorney to answer nine questions.  They contended they were in the purview of peer review.  The court agreed that the committee of the College was equivalent to a peer review body and that certain information was protected by privilege.

Shurb v Univ. of Texas 
SD Texas

Shurb, a medical student, had multiple documented mental diseases and eventually took a leave of absence from school to get the diseases under control.  Upon return the student was asked to provide full access to all psychiatric records and sued.  The school was a state institution so was immune from all state damage issues.  However, Shurb did enough to get by summary judgment on the ADA claim and must be reinstated into the school with no damages.

Genova v Banner Health
10th Circ

Remember, these folk vote.  A physician found an attorney who would file suit against Banner after the ED physician was terminated for complaining that there were too many ED patients resulting in overcrowding.  Of course the suit was terminated and to all's chagrin was appealed and lost again.  To make matters worse the physician had signed a contract stating he would not sue the hospital.

Love v Permanente Medical Group
D N California

In the suit in federal court the court re-affirmed the rule that there is no peer review protection in this court.  The chemical dependency therapist sued for termination in federal court.  She requested multiple documents from Permanente and they were not given.  The court said to turn over all the documents although with some restrictions.

Malempati v Independent Inpatient Phy.
Ohio Ct App

In yet another idiotic suit, the group had promised a bonus to the physician if she purchased a med mal tail insurance for the benefit of the group.  She did and they didn't give her the promised bonus.  The group not only lost the suit to pay the bonus but also had to pay money to defend the suit on the promised bonus.  I wonder who was advising this group?  I certainly hope it wasn't the same attorney who profited by suing and appealing the case.

Ehling v Monmouth-Ocean Hosp
D  NJ

I think some people believe they are not covered under workplace laws.  The nurse was fired after she had multiple dings on her record as well as not fulfilling the criteria for Leave.  She was also a union rep.  The court said there was sufficient evidence to allow the hospital to fire her after she posted a criticism on Facebook.        Top

HIPAA

Patients v Advocate Medical Group
To Be Filed

In yet another example of the problems with EMR, Advocate had four computers in its Illinois office stolen.  The computers had information on 4 million people.  This happened in mid-July and is now being revealed.  They are providing credit checking for all the patients.        Top

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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.