US v Neisler
Dr. Justin Neisler of Denver plead guilty of producing child porn. He had secretly taped exams of minors using a Spy Pen camera.
Virginia v Goldstein
Dr. Stuart Goldstein was on his way to work as the on call surgeon when his car hit a pedestrian. He has been charged with intoxicated driving and may have been on his phone when the accident took place.
US v Shawl
Dr. Timothy Shawl of Garnet Valley, Pennsylvania, plead guilty to unlawful distribution of narcotics. He wrote prescriptions for patients without a medical reason.
Illinois v Kink
Dr. Shaun Kink of Bloomington was arrested for forcing oral sex on a women with a disability. He has been temporarily suspended from is position as an ankle and foot specialist at OSF St. Joseph Hospital.
Texas v Jones
Genene Jones plead guilty of killing newborns decades ago and was sentenced to life in prison. The RN is suspected of killing over 50 children.
US v Salerno
Dr. Egisto Salerno of El Cajon, California, ws arrested for conspiracy to possess and distribute narcotics. He and seven others were arrested. It is alleged that they rounded up fake patients to see Dr. Salerno for which he received an office visit fee and prescribed narcotics. The patients were then paid to turn over the narcotics to the rest of the gang so they could be sold.
US v Neilson
Elet Neilson RN worked in two Utah hospital. She admitted to injecting herself with narcotics and bringing the syringes back to the ED where they were accidentally mixed up with other syringes. She has a rare strain of hepatitis C so the problems was discovered. She was sentenced to five years in prison.
US v Kapoor
In the first ever sentencing of an exec for illegally boosting sales of fentanyl, Dr. John Kapoor, the CEO of Insys was sentenced to 5 1/2 years in prison. The conviction is up on appeal.
Eisenrich v CarePoint
The owner of Alaris Health is sing CarePoint for embezzlement. This is in retaliation for a suit against Alaris by CarePoint earlier alleging interference with the sale of Bayonne Hospital.
US v Halley
Dr. Randall Halley of Nixa, Mo. was indicted for his role in prescribing fentanyl spray. He was one of the top prescribers of the drug in the country and was being paid by the company to promote the drug. He is accused of falsifying pre authorization requests stating patients had cancer when they did not. He is also being accused of signing blank prescriptions for use by patients when he was out of the office.
Doe v Kaiser Permanente (Kempiak)
In a second suit filed against Dr. Stephen Kempiak and his employer Kaiser Permanente Jane Doe alleges that he wanted to do a vaginal exam when she went to him for sores in her mouth and feet. He had her strip and examined her breasts and buttocks but she refused the vaginal exam. He pushed and she still said no. He then prescribed a steroid cream for her to put in her mouth and tongue and then blow drying it. This is the last we will hear of this suit as it will go to arbitration and will possibly be settled.
US v Lowry
Dr. Roswell Lowry of north Carolina plead guilty of interstate travel to aid racketeering. He had no experience in pain management but after being recruited he went to West Virginia to work for HOPE Clinic where people came from all over to get opioids with no exams.
US v Manzanera
Dr. Edgar Manzanera of Oceanside, California, was sentenced to three years probation, loss of his medical license and register as a sex offender. He worked for the VA and plead guilty of one count of sexual exploitation. The prosecutor got buy-in from his victims for this sentence.
US v Burducea
Dr. Alexandru Burducea, of Manhattan, ws sentenced to 57 months in prison for his part in accepting bribes from Insys to prescribe Subsys. He was part of the now disgraced Insys Speakers Bureau. Top
US v Zamora-Quezada
Dr. Jorge Zamora-Quezada, a rheumatologist in Mission, Texas, was convicted by a jury of conspiracy to commit health care fraud. He was said to have falsely diagnosed people with rheumatoid arthritis and treated them with meds that were medically unnecessary.
US v ResMed
The San Diego company that sells sleep apnea devices agreed to pay $37.5 million to resolve allegations that it gave unlawful kickbacks to customers as an inducement to purchase its equipment. This was a whistleblower suit.
US v May
Dr. Joe David May, of Alexander, Arkansas, and a sales rep were indicted for a scheme to pay and receive kickbacks to purchase compounded drugs. May is accused of rubberstamping prescriptions for which TRICARE paid.
US v TMJ & Orofacial Pain
Treatment Centers of Wisconsin
The company agreed to pay $1 million to settle allegations that it billed for fabricating oral appliances that they actually purchased from an outside lab.
US v Smith
Paul Smith, a psychologist with multiple clinics in the Detroit area was sentenced to 51 months in prison for health fraud and money laundering. He submitted claims for services not provided. he was also ordered to pay $3,163,172.92 and to forfeit interests in things purchased with the illegal funds.
US v Crabb
Dr. James Crabb of Loretto, Tennessee, was indicted for heath fraud. He is accused of signing prescriptions based on only a brief tele meeting or no meeting at all. The patients were in states where he was not licensed. He also prescribed DME where not needed it is alleged.
US v Bhayani
Dr. Rajendra Bhayani or Brooklyn and his practice new York Otolaryngology & Aesthetic Surgery agreed to pay $1.1 million to settle allegations that they paid kickbacks and submitted false claims. He is alleged to have done allergy testing in elderly care facilities that were not needed and paid kickbacks to the management of these facilities for exclusive use.
US v Morrow
Dr. David Morrow of Rancho Mirage, California, had plead guilty of fraud and then fled the country to Israel before sentencing. He was sentenced to twenty years in prison in abstentia. He was extradited and began to serve his sentence as soon as he re-entered the county.
US v Shetty
Dr. Udaya Shetty of Virginia Beach, Va., was sentenced to 27 months in prison for health care fraud. he billed for hour sessions when he actually saw the patient for 5-20 minutes. He also agreed to $1,078,000 payment to the feds and Virginia.
US v Ahmed
Ali Ahmed, Hector Alvarez and Mauren Morel all of southern Florida had plead guilty of health care fraud and were sentenced to various times in prison and ordered to pay restitution. Ahmed got 120 months and over $4 million , Alvarez 32 months and almost $4 million and Morel 32 months and $320,000.
US v Patient Services, Inc.
The foundation in Midlothian, Va., agreed to pay $3 million to settle allegations that the enabled pharmaceutical companies to pay kickbacks to patients taking the drug companies drugs. This is the fourth foundations to fall into this trap.
US v Sheridan
Ryan Sheridan, the owner of Breaking Point recovery Center in Youngstown and Columbus, was sentenced to 7 1/2 years in prison. He was also order to pay $24 million in restitution. He billed for drug and alcohol recovery services either not medically necessary or not performed.
US v Chen
Dr. Chang-Wen Chen paid $285,000 to settle allegations that he billed improperly for NP services. He allegedly billed as if the services were under direct supervision when they were not. This was a qui tam by a former nurse practitioner in the practice.
US v Practice Fusion
The San Francisco based health information company will pay $145 million to settle criminal and civil charges that it facilitated physicians to prescribe opioids to patients. It is alleged that Fusion was paid $1 million by Purdue Pharma in exchange for using its software to push pain meds.
Cameron v Brewster Ambulance
The former exec at the the ambulance company filed suit after being fired. He alleges that the company of defrauding Medicare by charging for rides to dialysis appointments. He alleges he was fired after complaining about the problem.
US v Schabert
Dr. Erik Schabert of Gainesville and his former wife Mika Harris were sentenced to prison pay fines and restitution of over $4.4 million. They committed fraud by filing claims for surgery and other procedures never performed. They also must forfeit their residence and other properties.
California v J&J
A California judge stated the company should pay the state $344 million because they deceptively marked transvaginal pelvic mesh implants to women in the state. The judgment will be appealed. This is about 1/3 the amount the state asked for.
US v Arch Health
The medical group that contracts care via Palomar Health agreed to pay $3 million to settle allegation that it committed fraud by false billing. It was alleged that they billed EM codes without adequate documentation. This was a qui tam by a former employee who will get almost $200,000. Top
Patients v Spectrum Health
The Maine organization notified over 11,000 people that their PMI may have been compromised due to their not having good enough internal controls to prevent it.
Rogers v Hillcrest Regional
Rogers was treated for a hand injury at the ED of the hospital and when she left the hospital called the police with all her particulars because she was driving and they suspected she was intoxicated. She sued and lost in the trial court and again in the court of appeal. The court said the disclosure was otherwise authorized by law and therefore did not violate either HIPAA nor the California Confidentially of Information Act. Yea for the courts.
Wallace v Health Quest
An attorney found a person whose medical information was compromised along with 28,000 others in a phishing incident involving Health Quest and Nuvance and filed a class action suit.
Patients v Beaumont Health
An employee had given the names and other information of over 12oo people to a PI attorney. The employee was fired. I would love to see the attorney lose his license.
Ciox Health v US
The DC District Court ruled that HIPAA does not say that medical records going to third parties do not have to follow the standards of payment under the rule. Fee limitations will only apply to a patient's request and not a request to transmit the records to a third party. Top
California v US
The Supremes rebuffed a Democratic attempt to manipulate it into taking up the issue of Ocare's individual mandate. They allowed the lower court's decision to stand which sent it back to the District for further findings. The Dems wanted to use any decision in the November elections.
The Supremes agreed with the administration stating that immigrants could be denied access to the country if they were too dependent on government benefit programs such as Medicaid. This came after a judge imposed illegally a nationwide injunction against the feds. Top
Patients v Greenville Health
Two patients successfully sued Dr. Byron Brown for med mal. He had no med mal insurance so they sued to collect from his hospital where he was on staff. They lost. The hospital had no contractual or tort duty to ensue Brown had med mal insurance. The court also did not allow a claim of corporate negligence. Top
Nani v King City Public District
Dr. Ali Nani sued the hospital for suspending him after he refused to go to PACE for competency stating it was imposed for retaliation and the court reversed the suspension. While back working at the hospital he had a patient with TBI and treated the patient for the first 28 hours. the patient subsequently died and his privileges were again suspended and he was to be reported to the NPDB. He sued for a TRO against the reporting and lost. The court said he was unlikely to win the suit.
Gruessner v SUNY Downstate
Drs. Rainer Guessner and John Renz filed suit against the hospital for retaliation after they allegedly voiced patient care concerns. They contend they were removed from their leadership positions after they alleged of misreported patient deaths and patient who died from medication problems.
Madarazo v Baptist Health
Over 10 years ago three RNs filed suit against Baptist Health System, Methodist Healthcare and Christus Santa Rosa for conspiracy to depress salaries of nurses. The suit was finally settled for an undisclosed sum after mediation.
Daouk v Orlando Health
In an interesting case Dr. Ayman Daouk, an ortho, filed a suit against Orlando for firing him after he refused to only do surgery at Orlando Health facilities and only refer to Orlando Health physicians. He states that this is against the Stark Law of self referral and kickbacks. He was originally employed by Physician Associates and this was acquired by Orlando Health. He, at first, was not required to refer in network. He was then told to refer or be fired according to the complaint. 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.