April 1, 2017 Recent Legal News






Peer Review and Employment


US v Cadden
Jury Trial

Barry Cadden, the co-owner of New England Compounding Center in Framingham, Massachusetts, was found innocent of of causing the deaths of many for his compounding errors.  He was found guilty of fraud and racketeering.

San Francisco v Litz

Chad Litz was arrested for identity theft and practicing medicine without a license.  He was volunteering as a nurse practitioner at a City clinic for four months.

Pennsylvania v Grossman

Dr. Peter Grossman was a physician at Thomas Jefferson Hospital and is accused of hacking into cell phone, email accounts and social media accounts of former classmates from high school.         Top 


US v Nursing Homes

A Florida federal judge presided over the case and a jury decided that the nursing home companies DMCII, Salus Rehab, 2017MarshallDrive Opetations and 803 Oak Street Operations defrauded the feds and should pay $347 million.  The judge just nullified that stating the nursing homes do not have the money and would force them to default on loans causing a massive collapse of nursing homes in 17 states.  This stay is in effect while the homes appeal.  

US v Pavlic

Dr. Romeo Pavlic of Spokane has agreed to pay the fed $300,000 to resolve allegations he billed for tests not performed.  He acknowledged that he did wrong.  He ran "cardiac clinics" and billed for complete EKG when he only did a limited EKG.

US v Paulus

 In an unusual case Dr. Paulus was granted acquittal by a judge in the DC of Eastern Kentucky.  He was accused of performing unnecessary cardiac stents.  He was convicted of same and asked for an appeal stating there was insufficient evidence.  The court ruled that the government used insufficient evidence to prove its case and a new trial was indicated.

US v Insurers

The feds have filed fraud charges against Health Net, Aetna, Cigna and Humana for billing fed med for conditions patients were treated for conditions they did not have or received no treatment for.  This qui tam suit was initially filed against United Health by an executive in 2011.  

US v Esechie
SD Texas

Charles Esechie, RN, of Houston plead guilty of health care fraud.  He was a nurse at Baptist Home Health he knew they paid kickbacks for Medicare patients.  He also knew that Baptist billed for unnecessary treatments.  He admitted attesting patients for care while working another job.

US v Pon

Dr. David Pon an ophthalmologist in Jacksonville, was sentenced to ten years in prison for lying to patients telling them they had wet macular degeneration when they did not and billing $10 million illegally for sham procedures on those 600 patients. The prosecution wanted 40 years.   

US v Tull-Abreu

Dr. Juan Jose Tull-Abreu of Puerto Rico was sentenced to 7 years in prison for fraud.  He billed for services never done.

US v Ezukanma

Dr. Noble Ezukanma of Ft. Worth was convicted of healthcare fraud.  His co-defendants all plead guilty and one has been sentenced to 24 months and payment of over $4 million in restitution.  The total scam was in the neighborhood of $40 million.  They billed as separate healthcare companies when in reality they were one.  

US v Leinweber,Jr.

Dr. Clinton Leinwerber Jr. of Greenville was charged with drug trafficking prescription meds.  He is a radiation oncologist at East Carolina University.  He is no longer with them as he was removed from the workplace upon his arrest.  

US v Fernandez

Dr. Roberto  Fernandez of Miami was charged with conspiracy to commit healthcare fraud and healthcare fraud.  He is alleged to receive bribes from others for referring patients for Medicare and Medicaid services.  He is accused of also billing for procedures never done.

US v Conrardy and McCutchen, III

Dr. Anthony Conrardy and Dr. William McCutchen, III of Ann Arbor, Michigan, were found guilty of illegally distributing oxy.  Sentencing is later.

US v Posada

Henry Posada, a Chicago chiropractor, was indicted on health care fraud.  He allegedly billed for services never provided.  This was a $10 million scam.  

US v Vitreo Retinal Consultants of the Palm Beaches
US Supreme Court

The high court refused to hear an appeal from the Eleventh Circuit that found HHS properly recouped $8.9 million for improper billing.  The issue was Medicare says they pay for a single 0.5 mg dose of a medicine.  The physicians used multiple doses from each vial but Medicare only pays for one dose per vial with the rest thrown away.  The issue before the Supreme Court and the one they did not address was whether the Secretary could ignore the statutory payment rate and instead cap payments at a physician's costs to acquire the drug.

US v Bergman
11th Circuit

Roger Bergman, PA, and another were found guilty by a lower court of fraud for billing for PHP services not provided or not reimbursable.  The Circuit Court agreed with the convictions.

US v Morad

Mark Morad, the ringleader of a Medicare fraud scam was sentenced to 15 years in jail for his part.  This leaves only one left in the group in the New Orleans area that scammed the feds.

US v MedStar
ND Ill

The federal court allowed MedStar to stand trial along with others for conspiracy to submit false admission certifications for Medicare patients.  This was to get more inpatients than observation as they paid better.  If a physician said the patient only need observation the information would be faxed to non-medical people at Accretive who would override the physician's order.        Top


Patients v Denton Heart Group
To Be Filed

 The Dallas cardiology group had a hard drive stolen from a locked closet.  There was information on over 21,000 patients on the drive.  There is no mention if the information was encrypted or not.  Patients will get one year of fraud protection.

New Jersey v Horizon Healthcare Services

Horizon has agreed to pay a fine of $1.1 million for not only having had two laptops stolen with information on 690,000 people but they did not encrypt the information.  The fine was too little.

Patients v Metropolitan Urology
To Be Filed

The Wauwatosa, Wisconsin, urology group found ransomware on their servers which may have accessed patient data.  This occurred with almost 18,000 patients.  It has since put in the appropriate firewall protection and is finally doing a risk assessment.

Patients v St. Charles Health 
To Be Filed

The Bend, Oregon, health system had a caregiver breach 2500 patient records without authorization.  She has filed an affidavit stating she did not disclose the information nor use it illegally.

Patients v UNC Health Care
To Be Filed

The state owned system had prenatal forms that Medicaid women were to fill out and send to local county health departments.  The women who filled out the forms were not Medicaid people and so had their information including HIV status exposed.

Patients v Med Center Health
To Be Filed

An employee of the Bowling Green system stole information on 160,000 patients for an outside business interest.  He apparently lied to obtain the information and there was no system to check whether he told the truth.  Another hospital system that failed its people.

Patients v Lane Community College
To Be Filed

The health clinic did not have good security and an infected computer may have relayed information.  The virus was on the computer for one year without being detected.  They are not offering protection.        Top


Temple University v Amtrak

A patient at the hospital was injured in a railway accident.  Temple treated 14 patients from the accident but this one AL was insured by Medicare.  Temple was negligent in not billing Medicare for this passenger.  The other 13 were covered under Amtrak.  Medicare would have paid $269,469 for the patient but greedy Temple wanted $1.63 million for the care.  They did not bill Amtrak for the care.  They got what they deserve, nothing.  

UPMC v O'Day

The Pittsburgh health system sued a local lawyer Michael O'Day for allegedly pressuring patients with Chiari brain malformations to sue. He is a sole practitioner.  He is in the process of filing a suit against the surgeon and the organization and is in the process of attempting to reach a settlement. 

Carle Clinic v Illinois
Illinois Supreme Court

 The high court said the lower court which ruled that not for rofit hospitals had to pay property taxes did not have the authority to do so.  They did not say whether the law exempting not for profits from paying the tax was constitutional or not.  The case now goes back to the state court to determine whether Carle should be considered tax exempt.  Carle filed the original suit after the city of Urbana stated they needed to pay tax.  

Sacred Heart Hospital v Marshfield Clinic

Sacred Heart does not want Marshfield next to them in Eau Clare, Wisconsin, and filed a TRO to stop their construction.  Another hospital that can not compete so goes to the courts.  Sacred Heart actually sold the lots to Marshfield with the stipulation they would not build a hospital on it.  They are not.  They plan to use the land for parking lots for a new hospital which would be in direct competition with Sacred Heart.            Top  


Michaud v Calais Regional Hospital
D Me

The Maine District Court denied a hospital's plea for summary judgment under EMTALA.  He had a syncopal episode while undergoing outpatient dialysis and was transferred to the hospital where he was suspected of having a significant cardiac problem by the attending.  He needed to be transferred as the hospital did not have dialysis available.   After four hours the attending changed his mind and discharged the patient.  He died at home soon after discharge.  The EMTALA was allowed as there was a dispute as to whether or not he was stabilized prior to leaving the hospital. 

Fuller v Insys

Fuller is a young woman who died after using prescription fentanyl.  The family is suing the physician, pharmacy and drug manufacturer.  The lawyer contends that Insys lied to the medical community to give Subsys for off-label usage.  It is FDA approved for cancer.  She had chronic pain from an auto accident. The attorney thinks that since she did not have cancer she should not have been prescribed the narcotic. The physician has agreed to the suspension of her license while the case is being investigated.

In re: Fosomax
3rd Circuit

The court in a 3-0 vote revived patient claims against Merck for not warning about the risk of thigh bone fractures with the use of Fosomax.  The lower court had not allowed the claims due to pre-emption by federal law.          Top

Peer Review and Employment

McGee v St. Luke's Health Network
Pa Superior Ct

A jury awarded damages to a physician in a defamation suit.  The physician was terminated from the hospital and sued the hospital for defamation which settled and the hospital agreed to a letter to to be sent to all reference requests.  The hospital did not do what it promised and was sued again.  This time damages were awarded to the physician by the jury but it was a lot less than he thought he deserved according to his expert.  The trial judge reduced the award more due to faulty trial instructions that he gave.  McGee appealed and lost.  His own attorney on examining his own expert challenged the experts assumptions of the amount owed.  Therefore the jury was allowed to reduce the amount found by the expert even though he was unopposed.  The judge could gut the damages as there was no evidence supporting actual damages.  Sounds like the attorney did him wrong.

Doe v Mercy Catholic Medical Center
3rd Circuit

The medical center certainly did not live up to its name. A resident in diagnostic radiology was sexually harassed and eventually dismissed after many complaints against the director.  She sued and won the summary judgment issue of the residency being a Title IX institution.  To trial on retaliation but not on hostile environment as it was time barred.

Stevens v Rite Aid
2nd Circuit

He was a pharmacist at Rite Aid when they introduced a program to give immunization shots to customers.  Pharmacists were to give the shots but Stevens has fear of needles and could not give the shots.  He had a medical note stating this but was terminated.  He sued and won in the lower court.  The 2nd Circuit said that since giving injections was an essential part of the job and he could not do that even with accommodation he was not covered under the ADA.        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.