February 1, 2015 Recent Legal News




Peer Review and Employment




National Assn of Homecare v US

The association sued the Department of Labor after the administration stated that home health workers would be those who spend no more than 20% of their time providing actual care.  This would have vastly increased the workers covered under wage and overtime rules.  Common sense rules again but it will be appealed.  Soon after the ruling California stopped their implementation of home care workers overtime pay.

Teva v Sandoz
US Supreme Court

The high court ruled that Teva's patent on a medication was valid due to the decision by the trial court judge.  The court of appeal attempted to dismiss the trial court judge's interpretation which is not allowed.  The court again stated that the appeal court must in a patent case defer to the factual finding of the trial court unless they are "clearly erroneous".

Armstrong v Exceptional Child Center
US Supreme Court

The Court heard oral arguments in this case which pits providers against states.  Can they sue the states for not paying enough money to cover their costs?  Can federal judges balance a state budget?  No, but they can state the state must pay enough to cover costs.  The ruling will come in June.

Health Consumer Alliance v California
Ca Superior Court

The trial court ordered the state to comply with the law to process claims for Medicaid within the 45 day time limit.  They must also grant provisional benefits to those applicants who are likely eligible.  The state has a huge backlog of applicants stemming from the Obamacare process.        Top


US v Nason

Drs. Baron Nason and Robert Hamilton of Charleston, South Carolina settled for $1,021,778.  The were accused of submitting claims for procedures done by  physician assistants as if they were done by physicians as well as unnecessary lab and radiological exams.  They also agreed to remove all their radiological equipment and all signage stating they care for emergencies.

US v Williamson

Dr. Paula Williamson of Redford Township, Michigan, was sentenced to 15 months in federal prison for referring patients for home health services that were medically unnecessary.  She falsified documentation.  She also must pay $1,3 million in restitution.

US v Kuthuru

Dr. Mahesh Kuthuru of Las Vegas has pled guilty of lying and cheating Medicare due to his billing for services never performed.  He was having a office in New York state fill prescriptions for narcotics when he never saw the patients.  The staff would send the prescriptions to Las Vegas where the "doctor" would sign the scripts.

US v South Shore Physician Hospital Organization

The South Shore Hospital of Massachusetts and its physician arm agreed to pay $1.775 million to the state and feds for billing for physicians to whom the hospital paid kickbacks for referrals.  

US v Sabido

Dr. Benjamin Sabido of Passaic, New Jersey, pled guilty of defrauding Medicare by billing for physical therapy sessions that never occurred.  He will pay $700,500 plus interest plus potential jail and fines.

US v Guerrero

Dr. Jaime Guerrero of Kentuckiana, Kentucky, has been indicted by a federal grand jury for prescribing Oxy and other pain meds that resulted in the death of five patients.  He is accused of prescribing the pain meds without a legitimate medical purpose.  He is also been indicted on health fraud.  He faces life in prison.

US v Johnston

Dr. David Johnston of Ridgefield, Conn., pled guilty of billing for physical therapy sessions that never occurred.  He will pay $210,000 in restitution plus possible jail time and fines.

US v Dalicho Sankyo, Inc

The pharmaceutical company agreed to pay $39 million to the feds to settle contentions that it paid kickbacks to physicians to use their products.  They paid physicians to give talks to their own staffs and other such boondoggles for using their products.  

US v Harper

Dr. Dennis Harper of Georgia agreed to pay $305,000 to settle allegations that he submitted claims for doing urine drug samples under inappropriate codes to bypass the computer that would have disallowed the billings as well as billing for high complexity tests when he did low or medium complexity testing.        Top


Blevin v Coastal Surgical Institute
Ca Ct App

Blevin's knee became infected after surgery at the institute.  The institute paid for  the cost to treat his infection but did not tell him about the time of the state statute of limitations, one year.  Fifteen months later he filed suit and the institute said too late.  The trial court said that the statute was tolled and affirmed the plaintiff judgment.  The court of appeals affirmed stating the California Insurance Code 11583 applies to the malpractice actions.  The Code states that any person making an advance payment as an accommodation to an injured patient not represented by counsel and who did not sign a release must tell the patient about the applicable statue of limitation.  The toll will be the time from the accommodation to when any such notice is actually given.

Thorton v Maryland General Hospital
D Maryland

In a case that goes against common sense, the court deciphered that a patient could think that a physician seeing her when she was admitted via the ED was a hospital employee and therefore the hospital had vicarious liability for the actions of the independent contractor physician.  The physician was wearing a hospital identification badge and did not say he was not a hospital employee.

Brown v St. Mary's Hospital
D Conn.

It is hard to be set up for a legitimate EMTALA complaint but this hospital did it.  They admitted a person with diabetes ketoacidosis and discharged him without stabilizing his disease.  He died soon.  Bad hospital, BAD.  Hospital denied the requested dismissal.

US v Tristar Summit Medical Center

 The Tennessee medical center agreed to pay a fine of $40,000 for an EMTALA violation.  They transferred a patient who has swallowed antifreeze without stabilizing him.  He was transferred because the hospital did not accept the patient's insurance.

Patients v Silverton Hospital
To Be Filed

Several patients undergoing surgery at the hospital received burns from a OR light.  It was a halogen light and the required filters were not replaced when the bulb was changed.  The hospital said no one was fired over the incident since it was a systems error.  They have since removed all halogen lights.

Hard v City of Bakersfield
Ca Ct App

Hard had a stroke and drove his car into a sidewalk.  Police responded and thought he was drunk so did not get immediate medical attention.  He had brain damage and sued.  The question was does the patient who is negligent in caring for himself (not taking his BP pills) have a contributory cause.  The trial court said yes and the court of appeals overturned.  It happened prior to the incident so doesn't count.  City may be liable.

Patients v Virginia Mason
To Be Filed

Virginia Mason announced that 32 patients had become infected after undergoing ERCP due to Carbapenem-resistant enterobacteria.  Their solution was to purchase additional scopes to quarantine those used in procedures.  This was at a cost of about $1 million.

Rivers v Yorkville Endoscopy

Joan Rivers' daughter has filed suit against the clinic and Dr. Gwen Korovin, Rivers' personal physician.  She charges they did not do a tracheotomy while trying to revive her, allowed cell phone pics to be taken.  She also states Dr. Korovin should not have been there in the first place and then she left during the emergency.        Top

Peer Review and Employment

Parungao v Piper
Ill App Ct

A surgeon sued the chief of staff of a hospital after the surgeon applied for privileges at another hospital and that hospital sent a signed release to the first hospital.  On receipt of the release the chief sent a note to the asking hospital stating the surgeon is on active staff, there was a peer review action opened due to clinical concerns but the surgeon has unrestricted privileges.  The chief had put this in the "other actions" portion of the request so it could be construed as if the surgeon was in an impaired program.  The courts ruled that the surgeon has sent a release of liability and also there was no defamation as no one had said he was in an impaired program.  Money spent for nothing.

Fatemi v Rahn
ED Ark

A resident, Dr. Nasrin Fatemi sued after she was dismissed from the residency program.  She was found to have thousands of surgical schedules, a HIPAA violation.  She said it was for retaliation.  Hospital won summary judgment as they did in her first suit for discrimination.

Miller v Imaging on Call
D Conn

This case is a warning to physicians under contract to companies.  Miller was under contract to Imaging on Call to provide radiology services to a hospital.  The hospital ws unhappy with her performance and told the company over the years but never the radiologist.  Finally, the company asked her to resign from the hospital which she did not knowing she was under investigation.  She was reported to the NPDB for resigning while under investigation.  She took back her resignation and had her privileges revoked.  She sued the company for the usual and lost on all.  She lost legally but the company was scum for not telling her about the problems.  Physicians check your contracts.    

Murphy v Goss
D Ore

After the Oregon Medical Board reported Dr. Murphy to the NPDB, he sued members of the board claiming they reported incorrect information.  The Board rightly claimed immunity from suit since they had no knowledge of the falsity of the information.  The plaintiff's attorney did not allege that particular fact so the client lost the case.   Top


US v Taclett
US Supreme Court

The high court unanimously threw out the biased 6th Circuit opinion that retirees has vested lifetime health benefits when that was not spelled out in the contracts.  The court wants the Circuit to rehear the case.  The liberal four want the lower court to look at the pension vesting as a factor to try to get the retirees the lifetime benefits without them paying any money.  The conservative five just want it basically overturned.        Top


Hospitals v Partners 
Mass. Trial Ct.

The trial court stopped the merger of Partners with three other hospitals.  It also stopped the state's attempt to create a "compromise" on the issue.  The state wanted to allow Partners to merge the three hospitals but the agreement would also cap the prices Partners could charge and stop further expansion.  The judge said the merger would just give Partners too much clout.          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.