v Five Nursing Assistants
Five nursing assistants at Prairie View Residential Care in Fayette were arrested for having sex with patients. The women had sex with the court ordered patients. Top
US v Five Physicians
Drs. Gordon Freedman, Jeffrey Goldstein, Todd Schlifstein, Dialecti Voudouris and Alexander Burducea all of which practiced in Manhattan were arrested and charged with accepting bribes and kickbacks from Insys. They were part of a speakers bureau for the company and were paid stipends that he feds believe are too much and were really for prescribing the med.
US v Holmes
Elizabeth Holmes was charged with fraud for her company Theranos. She has agreed to be banned from serving as an officer of director of a public company for a decade and must return her almost 19 million shares of Theranos that she owns. If Theranos is purchased she can not profit until $ 750 million is returned to defrauded investors.
US v Banka
Dr. Vidya Banka, a cardiologist at Pennsylvania Hospital, agreed to pay the feds $126,617 to settle allegations that when he worked at the hospital he did procedures that were not medically necessary. He is also excluded from all fed med for five years. He no longer works at the hospital. The hospital had reported him to the feds.
US v Alere Inc.
Alere has agreed to pay the feds $33.2 million to settle allegations that it knowingly sold defective diagnostic devices to hospitals. Alere needed to settle this prior to being acquired by Abbott. The machines produced erroneous results and were sold after receiving multiple complaints about the tests results. This is a qui tam suit by a former senior quality control analyst at Alere. She will get about $5.6 million.
California v Sutter Health
California's AG has come up from his filing so many suits against President Trump and filed a California suit stating Sutter Health has run afoul of the antitrust laws and is driving up prices. The AG believe that Sutter is wrong in requiring insurers to contract with all of Sutter and not just parts of it. He continues by asserting Sutter prevents insurers from offering low cost options and it sets high out of network rates. The AG is temporary and wants to be elected.
US v Sightline Health
The radiation therapy company has agreed to pay $11.5 million to settle allegations that it knowingly submitted claims that violated the anti-kickback law. They paid physicians for referring patients to their radiation centers by allowing referrers to invest and be paid. This was a qui tam and the whistleblower will get $1.72 million.
US v Yrorita
Juan Yrorita of Sterling Heights, Michigan, was sentenced to three years in prison for healthcare fraud. He was the assistant director of nursing at Anointed Care Services, a home health agency. They paid for referrals and billed for services not provided.
US v Georgia Bone & Joint
Settling with the feds are Georgia Bone & Joint, Southern Crescent Anesthesiology, Sentry Anesthesiology and David LaGuardia. They agreed to pay $3.2 million to settle claims they provided a free medical director to Southern Bone to induce the used of their surgery center over the office. They also claim that Georgia Bone and LaGuardia did false claims by billing for meds purchased outside the US. The suit was started by a former administrator for Georgia Bone and she will get her share of the recovery.
Washington State v Providence
Providence Health and Swedish Health agreed to pay $1.4 million to settle allegations that they scammed the public by making patients use out of network labs without telling them the labs were out of network. The patients will get reimbursed $385,101 for their out of network charges.
New York v CenterLight Health
New York and the feds will get money from CenterLight. CenterLight will pay $10.36 million to settle state and fed allegations that its long term plan billed New York Medicaid for monthly premiums and did not repay for falsely obtained payments.
US v Genesis Medical Center
The Iowa hospital agreed to pay $1.88 million to settle allegations that it illegally retained overpayments for hospital admissions when the charges should have been either outpatient or observation status. Top
Patient v Michigan
A patient was the lead plaintiff in a class action law suit against the state. The state agreed to settle the suit over a policy of not paying for hepatitis C treatments unless a patient has severe liver damage.
California v Starbucks
California has Proposition 65 which requires companies to tell the public if they sell a product that causes cancer. Well California now says that coffee causes cancer. Not coffee per se but acrylamide which is in coffee. All coffee sellers will now have to post warnings in their stores.
AHA v CMS
The federal judge in this case is frustrated. The suit is about the backlog of cases by HHS on appeals by hospitals. Now the judge has asked the plaintiff to give ideas how HHS can work through the backlog. Since the RACs get a percentage of recovery it will be suggested that if they lose most of their appeals they should be penalized. Hospitals win 72% of their appeals. The AHA also hopes that RACS are removed entirely and the reviews are by QIOS. HHS says the RACs are already penalized and RAC reviews are only about 5% of the HHS reviews.
US v Anthem
Anthem will pay $1.63 million to settle allegations that it placed illegal caps on therapy treatments for children with severe autism. It will also stop using guidelines that base coverage of applied behavior therapy for autism solely on age. The attorneys suing will get about half of the settlement leaving the needy scraps.
GlaxoSmithKline v Teva
The judge reversed a jury determination that Teva needed to pay over $235 million for infringing on the patent for Coreg. Teva did a generic. Top
Patients v Clinical Pathology
The pathology company had a laptop stolen. The problem was it was unencrypted. About 500 patients had some information compromised. The company deserves a nice fine by the OIG.
Patients v CVS
CVS unintentionally revealed the HIV status of 6000 Ohioans. The health status was revealed in the envelope window. Top
Saint Anthony Hospital v Leapfrog
The Chicago Hospital sued Leapfrog for defamation saying the group used knowingly wrong information to give the hospital low ratings. Leapfrog has responded saying there can be no defamation since the information was never published and even if published was based on the hospitals own information given to them.
Trinity Health v Markham Group
The hospital in Minot, North Dakota, is suing the Arkansas based Group for defamation. They allege that Markham published false statements online to lead the public to believe they were responsible for a hepatitis outbreak in 2011. The state investigated and found no clear cause for the outbreak. About 11 victims and relatives have settled claims against Trinity.
New Hampshire v LRGH Healthcare
The hospital agreed to pay the state $40,000 to settle allegations that it hired a CNO who was not a nurse. Medicare requires the postion be a registered licensed nurse. Patricia Strohla will pay $1500 for allowing herself to be hired without the necessary credentials. Top
Rafferty v Merck
Rafferty sued Merck stating he was injured by a generic med made by another company. He said Merck's label did not provide adequate information regarding side effects. The US Supreme Court had prior ruled that generic drug makers must use the drug labels of the original maker of the medicine. In this case he used Proscar and got sexual dysfunction, a known complication. The lower court dismissed the negligence claim but the state high court allowed the suit to continue to sue but for recklessness instead requiring a higher standard of proof that Merck did not update its label despite knowing the risks.
CMS v University of Maryland
CMS say the ED wrongfully would not allow a mental health patient into the hospital on a frigid Baltimore night and escorted her to a bus stop in just a hospital gown and socks. The hospital kept the entrance door to the ED waiting room locked and security guards would not let her enter. The woman had been discharged two hours prior by the ED. Let us hope they also lose a law suit by the woman.
Bright v VA
In a get out your checkbook case, the woman had a baby at the VA at Jacksonville with an epidural. She has complained of chronic pain since. It turns out their is a need in her back from the epidural 14 years ago. She states they knew this for the past 14 years and did not tell her or put it in the medical record.
Seibert v Okun
A local judge nullified the state cap on med mal damages by ruling the legislature exceeded its constitutional authority. It is now up to the defense to appeal or not. To keep the decision local or if upheld to the state. Top
OFCCP v Humana
The Office of Federal Contract Compliance Programs did a routine compliance audit on Humana which resulted in Humana paying $2.5 million in back pay and interest to 753 women which resolved allegations of pay discrimination. They paid the women less than the men for the same jobs which is against federal law for federal contractors.
Nwaokocha v Illinois Department of
Dr. Emmanuel Nwaokocha had plead guilty of Medicare fraud and the state suspended his license for no less than three years. He countersued saying he should be given probations and the penalty was too harsh. the courts sided with the state saying the physician gave no authority for his arguments. That is on the attorney.
Maxfield v UMass Memorial
Kirstin Maxfield, RN, filed for sexual harassment. She claims when she moved from the ER to the OR she saw medical staff and surgeons were verbally abusive, used foul language (heavens forbid) and made violent gestures that she ways was intentional but the physician says was not. The hospital says it investigated and found the claims invalid.
Erdle v California Medical Board
Dr. Erdele was arrested on suspicion of possessing cocaine. He says he was arrested for a minor offense and had the bags to drop off in a medical disposal unit. The case was dismissed and never went to trial. Erdle went to drug treatment program but the Medical Board issued a public reprimand and placed him on probation. He sued and lost in the lower courts and the state Supreme Court refused to hear the case so it stands. All professionals can now be disciplined if they go through pretrial diversion. 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.