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Emerus Hospital v Health Care
Service Corp.
ND Ill
The physicians and the hospital sued the Corporation doing business in Texas as Blue Cross and Shield for non payment late payment and reduced payments of out of network payments for care of the insureds patients. The insurer attempted to get out of the claims by saying the Texas law did not apply to denied claims. The court did not buy that and said the plaintiffs could continue with their suit. It is not the insurers determination that the claim is payable or not that is controlling.
Physicians v Florida
Settlement
After about 10 years Florida has agreed to improve access to healthcare for low income children. The state paid so little that physicians did not see children on the program. They lost in federal court and were ordered to mediation.
ACLU v Trinity Health Corp.
ED Mich
The ACLU lost again in their bid to force Catholic hospitals to provide abortions. The judge called the ACLU claims dubious.
Illinois v Kennealey
Filed
Illinois is accusing oncologist Ann Kinnealey of Evanston of purchasing misbranded drugs from Canada and using them on patients. This occurred even after she was warned by the FDA about the drugs. The oncologist has agreed to pay $129,000 in restitution to the feds and now is fighting for her license.
ACLU v Florida
Florida Supreme Court
The Florida high court banned the law that requires a 24 hour waiting period for an abortion until it hears the case. This is the law in 24 other states.
Herrera v JFK Medical Center
11th Circuit
The circuit court reversed the district court and is allowing a case against HCA hospitals for excessive billing to continue as a class action. They allegedly billed excessively for radiology in the ERs. The patients say they were billed up to 65 times higher than others. These patients were covered under insurance but met their maximums sooner than they should. The court allowed breach of contract.
US v Pfizer/ Wyeth
Settlement
Pfizer has agreed to pay $784.6 million to resolve allegations that Wyeth overcharged the feds by hiding discounts to hospitals. This meant Medicaid spent millions of dollars more than it should for meds. This all happened prior to the purchase of Wyeth by Pfizer. Two whistleblowers will get $98.1 million.
Public Citizen v FDA
Filed
The publicity seeking organization sued the feds for hiding information on its experts. Top
US v Ajrawat
Sentenced
Dr. Paramjit Ajrawat of Potomac, Maryland, to over nine years in jail for health care fraud. He also has to repay $3,103,874.58. He and his physician wife owned a pain management clinic by filing claims for procedures not performed. They claimed they did nerve blocks using a image guidance device which they did not have. They also changed files and lied to investigators.
US v Lora
Sentenced
Dr. Henry Lora of Florida was sentenced to over nine years in jail and ordered to repay $30 million in restitution. He was the medical director of Merfi, a clinic that employed physicians . He forged prescriptions for home health that was not indicted in exchange for kickbacks. The owner of Merfi was charged separately and was also sentenced to nine years.
US v Toccoa Medical Associates
Settlement
The clinic and their physicians Drs. Margaret Kopchick and Russell Burken agreed to pay $1.9 million to settle claims they billing improper EM codes. They billed both EM and procedure codes the same day which is not allowed.
US v Elhorr
Guilty
Dr. Ali Elhorr of Dearborn, Michigan, pled guilty of health fraud. He conspired with his brother Dr. Hicham Elhorr to bill for services not performed. He admitted to about $2.4 million in false claims.
US v Chaney
Guilty
Dr. James Chaney and his wife of Hazard, Kentucky, were convicted of health care fraud and illegal distribution of drugs. He allegedly left signed prescriptions for use when he wasn't there and sold drugs to abusers and addicts. The Chaneys denied the charges and will appeal the verdict.
Aetna v South Bay Surgical
Management
Verdict
Aetna sued the Saratoga, California, company for recruiting physicians to refer patients to their out of network facilities for procedures. This resulted in high claims and payments. the jury in state court agreed with Aetna. The judgment was for $37,4 million.
Colquitt v Abbott
Verdict
Whistleblower Kevin Colquitt accused Abbott of submitting false claims to Medicare for unimproved stents. Abbott used biliary stents for vascular procedures and billed. The jury sided with Abbott.
US v Boston Medical Center
Settlement
The hospital was accused of violating the global billing, billing for doses of an anti cancer medication not given and billing for out patient podiatry claims not needed. the hospital has agreed to pay $1.1 million.
US v Warner Chilcott
Fined
A federal judge said the the drug company had to pay $125 million for being found guilty of giving kickbacks to physicians to use their drugs. This company is now Allergan which just broke off talks with Pfizer
US v Charleston Medical Center
Filed
The feds have filed against the Charleston Medical Center and St. Mary's Medical Center in West Virginia. They are accused of agreeing to allocate territories in which to market their competing services. The feds also suggested a proposed settlement of prohibiting these type arrangements.
US v Weiss
Indicted
Dr. Michael Weiss and three others of the Detroit area were indicted for conspiracy to illegally distribute prescription drugs. He is alleged to have written prescriptions for people were were really addicts or sellers. He is also accused of filing false claims.
US v Safier
Sentenced
Dr. Gary Safier of Randolph, New Jersey, was sentenced to two years in jail and the payment of $353,152 for his role in accepting bribes from the infamous Biodiagnostic Lab Services of the state. He received bogus lease and service agreements in return for sending specimens to the lab. He also failed to report $90,000 in bribes on his tax returns. To date 39 people have pled guilty and most are physicians now in jail.
US v St. Marks Hospital
MD Tenn
A whistleblower physician sued in qui tam for false billing for foramen ovale repairs. In 210 the hospital and one physician did 210 repairs while all the physicians at the Cleveland Clinic did only 37 procedures. The case was dismissed as the parent company could not be liable for the acts of the hospitals where no facts showing they knew were alleged. He also did not allege enough facts to overcome the higher scrutiny for fraud.
US v Chang
Settlement
Bon Secours Health System and Dr. Eugene Chang, a surgical oncologist agreed to pay $400,000 to settle claims of false billing. Dr. Chang falsified reports to get screening mammograms paid for by saying there was a mass in the breast where none existed. This made the mammogram diagnostic not screening. It is alleged that the management of the hospital knew of the the false diagnoses.
US v Qamar
Bankruptcy Court
Dr. Asad Qamar, an Ocala, Florida, cardiologist under a lawsuit for Medicare fraud has filed for bankruptcy. Medicare paid him $16 million in 2013 and $18.3 million the following year. He says in filings that his assets and liabilities are between $10 million and $50 million. His practice, he says has liabilities of $10 million but assets of only $50,000. His Medicare payments for 2015 have been revoked.
Dennis v Memorial Hospital
Judicial Decision
A judge has ordered the Martinsville, Virginia, hospital to accept the insurance payment as payment in full. Mr. Dennis came to the hospital with a heart attack. He was treated with cardiac stents and discharged. The insurance paid $27,254 of $111,115.37 billed charges. The patient stated in court that the payment was enough since the hospital routinely accepts 25% of its chargemaster charges as payment in full for uninsured patients.
Kern Health Systems v Allied
Management Group
Ca Ct App
Kern County's $1.38 million dollar jury verdict has been overturned. It also now has to pay attorney fees and costs to the defendants. Kern had been offered more than the jury verdict in settlement but refused. Someone's head will roll. It had accused the auditing firm of fraud.
US v Gordinho
Sentenced
Dr. Jose Jorge Abbud Gordinho of Beckley, West Virginia, was sentenced to 8 years in jail for heath care fraud. he admitted to prescribing pain pills for illegitimate purposes and defrauding the feds when he sought and received payment to his illegal deeds. He also agreed to surrender his DEA license.
US v Gosy
Indicted
Dr. Eugene Gosy of Clarence, New York, was charged with conspiracy to distribute controlled substances and health care fraud. He is a self described pain management physicians and gave prescriptions for illegal reasons.
US v Ordog
Guilty
Dr. Gary Ordog of SoCal pled guilty of healthcare fraud. He admitted to doing false claims for visits that never occurred and billing for services for deceased patients. he submitted over $2 million in false claims and was paid about half. Top
Easter v Lyndon B. Johnson
Hospital
To Be Filed
Ethel Easter had a run in with her surgeon pre operatively and ended up hiding a recording device in her hair during the surgery for a hernia repair. She did not like what she heard. She states the surgeon told the OR crew she threatened to go to an attorney and she was called Precious. She states she was distraught. The tape was sent to the hospital and they used it to remind the staff to be mindful of what they say.
Patients v Pfizer
Verdict
A federal judge dismissed the suit by hundreds of patients against Pfizer for Zoloft causing birth defects. She ruled there was not enough evidence to link the cause and effect.
Doe v Aultman Hospital
Ohio Supreme Court
The Ohio high court ruled that a medical record is a medical record no matter where the information is stored. The hospital did not turn over to a plaintiff attorney cardiac monitoring strips taken just before the patient died. They were stored in risk management.
Chanko v American Broadcasting
Company
NY Ct Appeals
This interesting case stems from the shooting of a medical TV show. The crew shot film of patients in an ER without telling patients that a camera crew was present and without consent. The plaintiff saw her husband die on the program 16 months later when it aired. The suit was for emotional distress and lack of consent. The court ruled that the suit could go forward but only for a breach of confidentiality between the patient and the physician. This suit could be against the hospital and treating physician, not the TV company. Following the decision the NY Presbyterian Hospital agreed to pay $2.2 million to the OCR settle the HIPAA claim.
Ford v Jawaid
Ind Ct Appeals
The patient sued the physician for med mal and the hospital for vicarious liability. The court ruled for the patient and overturned the trial court. They said that the patient was not given adequate notice that the physician was independent since th hospital registration stated only that the physicians in the hospital may be independent contractors, not are.
Florida v Omulepu
License Hearing
Florida is attempting to remove the license of Dr. Osakatukei Omulepu of Miami for multiple counts of medical malpractice. He is alleged to have used the wrong concentration of local anesthetic, he perforated organs and he failed to discharge patients undergoing lipo to a facility capable of handling the care. He is under an emergency order not to do lipo nor to do fat transfers to the buttocks. The doctor does not have med mal insurance as it was not required. An administrative law judge will hear the case and report to the medical board. The board is not required to follow the law judge's recommendation.
Wilson v Parkland Hospital
Filed
The patient filed suit after being told that a broken off piece of catheter tube had been left in her seven years prior. The catheter was first visible in a chest x-ray in 2007 and she had 22 x-rays in the seven years since. She was never told about the problem until 2014. The catheter has become calcified and the patient now needs anticoagulation therapy for it.
Langston v Milton S Hershey
Medical Center
MD Pa
A surgeon performed an ileostomy for a perianal fistula. She was discharged from the hospital with leg cramps to take a taxi ride to an empty house. The patient went to a different hospital ED a day later with dehydration and renal failure. She was transferred back to the original hospital. When she was being discharged she arranged herself for a nursing home for two weeks. She continued to have multiple problems with osteotomy leakages, dehydration and renal failure. these reuird multiple transfers between hospitals and nursing homes. She sued for med mal and EMTALA violations. The court ruled against the patient for most of the EMTALA violations but did rule in her favor on an EMTALA violation for having pain and not being treated (stabilized ) for the pain prior to transfer.
Dodson v Mercy Medical Center
Missouri Supreme Court
Dodson died after an artery puncture during a heart test. The family was awarded $9 million in non-economic damages and $2 million in compensatory damages. The non-economic was reduced to $30,000 under state law and the family appealed. The high court upheld the ruling stating that the cap does not violate the right to a jury trial. The limit had been struck down on med mal cases but this was a wrongful death case.
Blatchley v Cunningham
D Colo
The plaintiff sued for malpractice and wanted the factual information in a peer review report. The court denied the request since the state law made no provision for that exception. The requesting attorney probably knew this and only wanted to make new law.
Christian v Kettering Medical
Center
Ohio Ct App
The patient went to the ED with hemorrhaging and could not get to the ED by herself. A friend went to the ED and received help and an attempt to transfer led to the patient on the ground with a torn Achilles tendon. The lower court ruled in favor of the hospital on summary judgment based on the filing after the one year statute. The appellate court ruled the mere transfer was not a medical claim and so had a longer statute. Top
Travelers Indemnity Co v Portal
Healthcare Solutions
4th Circuit
In a decision that is sure to gladden the scofflaw hospitals, the court ruled that general liability policies by hospitals will allow coverage against class action law suits when the hospital does not do its security job protecting medical information. The court ruled that the information on a public web site for four months could be a publication under the policies. This is also the ruling in a California appellate case Hartford Casualty v Corcino & Associates.
Patients v Northern Navajo Medical
Center
To Be Filed
An employee of the New Mexico hospital took 7500 medical records in paper form and put them in a storage locker.
Patients v CVS
To Be Filed
A password protected laptop was stolen with the medical information of patients. A vendor did not encrypt the patient information which is a violation of the business associate contract.
Patients v pain Treatment Centers
of North America
To Be Filed
The pain center used a management tool of Bizmatics and a hacker got the records from Bizmatics. There is no mention of a business agreement being in place.
US v North Memorial Health Care of
Minnesota
Settlement
In the settlement the company agreed to pay a fine of $1.55 million for the breach of protected data by a vendor. The company was fined since it had no business associate agreement with the vendor and did not have a security audit done. The vendor had an unencrypted laptop stolen from a car and over 9000 individuals were affected. The company had given data to the associate for seven months without an agreement which is an impermissible disclosure of information to over 289,000 individuals.
Patients v Kaiser
To Be Filed
A mail delivery truck was stolen with the information on 24oo people on board. The truck was not parked in a secure area and is a violation of the policies. Top
Talwar v Staten Island Univ.
Hospital
ED NY
A physician from India in the US on a O-1 visa was denied help by her supervisor in renewing her visa as the supervisor did not believe she met the qualifications. The physician sued for gender and work place discrimination. she of course lost as she could not present evidence to support her claims.
Cerciello v Sebelius
ED Pa
A physician sued to challenge the Secretary's decision regarding the provider's name in the NPDB. The physician was an expert witness for the plaintiff in a med mal case and the AAOS found that the physician's reasoning was flawed and failed to evaluate the patient and failed to have the knowledge of the standard of care in an expert report. The court ruled for the Secretary as she relied on the AAOS.
Aluru v Anesthesia Consultants
D Colo
The physicians sued for the usual discrimination after she was terminated by the group. She had performance deficiencies and was let go after the group lost a major contract and needed to downsize. The physician failed to show the group was biased.
Robinson v Children's Hospital
Boston
D Mass
Leontine Robinson was an intake admin associate refused to get a flu shot since she was Muslim and her beliefs prohibited it. She was given a choice of taking the shot or a position outside of patient care. She applied for a medical record clerk job and also requested two months leave. Both requests were approved. She did not get the job and was terminated. She sued for a violation of state law law and Title VII. The court ruled for summary judgment.
Liu v Cook County
7th Circuit
This Asian female surgeon did not believe in operating for appendicitis and after multiple complications in her patients she was fired. She sued for the usual stuff and of course lost.
Northern California Minimally
Invasive Cardiovascular Surgery v Northbay Healthcare
ND Cal
The court allowed a claim to go forward for antitrust by Dr. Ramzi Deeik. The doctor said he raised concerns about the NorthBay vascular surgery program he was squeezed out of the program. He says that the conspirator hospital and physician disparaged him to other physicians and not be his back up physician. he also claims they arbitrarily enforced surgical requirements only against him. He made a claim that he raised a reasonable argument at this stage for a geographic market. Top
Epic v Tata
Verdict
Epic sued Tata after it alleges it illegally downloaded trade secrets in a Kaiser installation to help a competing software company, Med Mantra. A jury found for Epic and awarded $240 million in compensatory damages and an additional $700 million in punis. Tata will appeal.
US v Theranos
To Be Filed
Bay Area company Theranos is being investigated by the feds for civil and criminal matters. The lab testing company is being discredited by multiple sources for its products. The investigation is for potential lying to the feds and the SEC.
NY v Gould
Arrested
Dr. Jeffery Gould admitted hiding two spy pens in a unisex bathroom in Crouse Hospital (Syracuse, NY) ICU bathroom. Crouse was fired from his position as a resident from Upstate university Hospital doing a rotation at Crouse. He did it to try to find the person who had stolen his prescriptions and a camera. The cameras were not pointed toward the toilet. 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.