December 1, 2012 Recent Legal News


Peer Review and Employment





US v Reinstein

Dr. Michael Reinstein of Skokie, Illinois, has been alleged to have committed health fraud by doing 140,000 false claims to Medicare for antipsychotic meds prescribed and 50,000 false claims that he did "pharmacological management for nursing home patients.  He used almost exclusively Clozaril by Novitis and received received payments from Novitis for prescribing (medical directorship).  When the drug when generic he got a medical directorship from the generic manufacturer IVAX, now a subsidiary of Teva.  This paid him $50,000 per year plus many perks.

US v Kachare

Dr. Dilip Kachare of Utica, New York, has been accused of multiple counts of healthcare fraud by the government.  He is accused of submitting codes for treatment of patients on a daily basis which may have exceeded 24 hours a day.  If convicted the potential sentence is 20 year in prison and hundreds of thousands of dollars in fines.  The alleged fraud amounts to about $12 million and the government wants to also recuperate that amount from the internist.

US v Coventry Health

Coventry Health has agreed to pay the feds $3 million to avoid criminal charges for allowing its employees to access a database and use it for illegal purposes. 

Surgery Centers v Hospitals

Four Colorado surgery centers are filing antitrust charges against HCA, Centura Health and Kaiser for their anti-competitive actions and restraint of trade.  The suit charges that the hospitals conspired to not allow Kaiser to sign an agreement with one of the ASCs. The hospitals denied doing anything wrong.

US v New Jersey

The feds have ordered the state to return $50 million that it paid psychiatric hospitals that did not treat enough low income patients to qualify for the payments.  The feds state the that New Jersey actually overpaid $100 million but only has to pay half that.  The state has offered about $3.5 million, a sizeable difference.  This eventually could go into the courts.

US ex rel Ferraro v Morton Plant Mease Health Care

In a whistleblower case the helath system agreed to pay over $10 million to settle the allegations that they billed for inpatient care when the care should have been observation or outpatient.  The whistleblower got $1.8 million.

US v Van Putten

Dr. Juan Tomas Van Putten of Ladera Heights, California, pled guilty of health care fraud.  He used shills to bring in patients to get high price wheel chairs and other DME that was not needed.  He would then get kickbacks from the DME operators.  He and the DME operators put in claims for over $11 million and received almost $6 million.  He faces a huge fine and 10 years in prison.

US v Baylor University

Baylor has agreed to pay a fine of $907,000 for radiation oncology misbillings.  They billed for IMRT for patients that did not need it.        Top

Peer Review and Employment

Adem v Jefferson Memorial Hosp
ED Miss

Dr. Adem is a cardiologist that was accused of unethical behavior and doing unnecessary procedures.  He was summarily suspended and in the hearing won on the issue of unnecessary procedures but lost on the ethics.  His privileges were terminated and he sued under racial discrimination and state claims.  He lost the discrimination claims since he was not employed and the bylaws were not a contract.

Woodford v CVS Pharmacy

The Florida pharmacist refused to fill a prescription for oxycontin due to his belief that the prescription was illegal.  Florida has a law that requires pharmacists make sure a prescription for a controlled substance is legitimate prior to filling the prescription.  Woodford was ordered to fill the prescription by his supervisor and refused.  He was terminated and sued.  The court agreed with Woodford in summary judgment.  He was fired for refusing to participate in an illegal act and the case can go to trial.

Adam v Jefferson Memorial Hosp

Another discrimination claim bites the dust.  The winners here are few and far between.  Adam, a cardiologist, had his privileges terminated for quality reasons and he sued for racial discrimination.  He of course lost since he was not an employee of the hospital and the bylaws in Missouri are not a contract between the hospital and the physician.

Brintley v St. Mary's Mercy Hosp
ED Mich

In another loss for discrimination suits that cost physicians thousands of dollars and are for the most part losers, the physician sued for racial and gender bias after she was terminated for quality issues.  She also was not an employee and could not make herself one.  Also in Michigan the bylaws are not a contract.  The state claims were dismissed under HCQIA.

Safari v Kaiser
Ca Ct App

The physician perinatologist had a problem with twins when he pulled too hard on a vacuum extractor.  He also had other conduct issues as well as other quality issues.  He was very well liked and respected by his peers in the hospital but the peer review committee members were from outside the hospital.  The fascinating part for me of this case was the attorney for the physician is an attorney that usually is a medical staff attorney and the hearing officer was also a medical staff attorney from the same city who did no physician defense.  The court found no bias of the hearing officer for financial reasons and that the unilateral selection of the panel and hearing officer did not deprive the physician of a "fair hearing".        Top     


Watts v St. Mary's Med Ctr

Watts presented to the hospital's ED after hitting his head on the bottom of a pool.  He was seen by the triage nurse and ruled non-urgent.  He sustained an injury and sued.  He wanted the cap of $500,000 for serious injury removed due to his being classified as non-urgent even though he was urgent.  The court stated that the hospital could not have it both ways.  They classified him and they are stuck with their own classification.  The cap is removed.

Smith v Christus St. Michaels Health
5th Circ

Smith was admitted to the hospital for an underlying condition which required the insertion of a jugular catheter.  Smith died after the catheter was removed and he fell in the bathroom.  The problem was he was at high risk for falls and no bed alarm was activated.  The hospital argued and won in the lower court that the underlying condition would have killed him in any case.  The 5th circuit said that may be but he died due to the direct negligence of the hospital in not having an alarm nor other fall protections in place.  Retry the case.        Top


Liberty University v Geithner
US Supreme Court

The high court has ordered the court of appeals to re-hear the challenge to Obamacare's individual mandate.  They are suing on the grounds of religious freedom as they may be required to pay for abortion and family planning which is against their religion.  The 4th Circuit will now re-hear the case.

Liese v Indian River County Hosp
11th Circuit

A hearing impaired person was admitted and had gallbladder surgery.  She continually requested and was denied an interpreter.  The hospital and physician communicated by reading lips and sign language.  She sued for violation of the Rehabilitation Act.  The court overturned the lower court's summary judgment for the hospital on the Rehabilitation Act but kept it on the claim for emotional distress since the Act did not create a negligence duty.

Alina Health v Sebelius

Sebelius took it on the chin for her unilaterally altering a formula for payments to DSH.  She was sued and lost.  She now has to do it all over and do it correctly again costing the taxpayers money due to her inefficiencies and short cuts.

Ragland v Blue Cross Blue Shield of ND

Neurologist, Dr. Ragland, was scrutinized by the insurer and claims not paid to the physician or the clinics for which he worked.  Dr. Ragland sued for multiple claims including slander.  There was no publication of any statements regarding Dr. Ragland so there could be no slander.  The court allowed two claims to go forward, intentional interference with contractual relations and intentional interference with business relationships.  Should make for interesting discovery.        Top


California v Prime Health Care

California had fined Prime Health $95,000 for a major breech of privacy.  California has been after Prime for a long time due to it's close association between the Democratic leaders and the California Nurses Assn. who pays big bucks to the pols.  The state says that Prime's Shasta Hospital shared a woman's medical files with journalists and sending an email about her treatment to 785 hospital employees.  Prime said the disclosures were permitted under both state and federal law.  It has appealed all fines and penalties.        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.