February 15, 2016 Recent Legal News





Peer Review and Employment



US v Burton

Dr. Fredrick Burton of Wynnewood, Pennsylvania, was indicted for Social Security fraud.  He has been accused of sending letters to the Agency falsely stating that people were unable to work and should get benefits.  The person he attested to was a personal friend and another physician, Dr. Dennis Gluck Von Kiel.

Wexford Hotel v UPMC

The small hotel and other small businesses sued UPMC and Highmark six years ago for conspiring to keep insurance companies out of Western Pennsylvania.  The settlement would pay small group health insurance subscribers who got insurance from Highmark between July 2010 and march 2012.  The parties are now in negotiations.

US v Lora

Dr. Henry Lora of Miami pled guilty of health care fraud.  He said he and others wrote false prescriptions for home health for kickbacks..  He also admitted to falsifying medical records.

US v Porro

Drs. Yamile Porro, Henry Lora, and Kansky Delisma all of Miami area have been arrested on charged of healthcare fraud.  They have been accused of falsely signing prescriptions for unneeded care for home health.  Porro is from Cuba.  Lora is from the Dominican Republic.  Delisma is from Howard University. 

US v WELLHealth

The feds have settled fraud charges against Florida WELLHealth, Topical Specialists and Drs. Manish Bansai, Mehul Parekh, Marisol Arcila and Syed Asad.  they have agreed to pay the feds $10 million.  The physicians allegedly wrote unnecessary prescriptions to the pharmacies they had an interest in.  The pharmacies allegedly billed the feds for the unnecessary prescriptions.  

US v Destasio

Dr. Vincent Destasio of Toms River, New Jersey, was arrested for accepting bribes to refer patients for lab tests.  He is accused of referring patients to PROMED and DNA.  He received a kickback of about $25,000.  He faces a prison sentence of five years.  Not a good trade.          Top


Patients v Titus Regional Medical Center
To Be Filed

The medical center is sick.  It got a virus in its computer system which took down the system.  They could not leave orders nor get information.  They have gone back in time to the era of paper records and runners.

Univ. of Virginia v Jordan
Va Ct App

An employee accessed her ex husband's medical records at his request and she was fired for this.  the University was dumb enough not to take into consideration the multiple authority she had been given to access the records.  All who heard the case ruled for the nurse.  

OCR v Lincare

The respiratory company was fined $239,800 for a violation of HIPAA.  They had the gall to appeal the fine and were rebuffed.  The company allowed employees to take records out of the office.

Patients v Washington
To Be Filed

The state of Washington fired two employees for one forwarding information on 91,000 people to another to seek technical help.  

Patients v Jackson Health
To Be Filed

An employee of the health system accessed up to 24,000 patient records illegally over five years and the system never caught on.  Bad employee.  Worse system.

Patients v Seim Johnson
To Be Filed

The compliance company lost a laptop to theft which they do not know if it was encrypted.  They have notified about 4900 patients.


California v Tseng

Dr. Hsiu-Ying "Lisa" Tseng, a GP in LA, was found guilty last month of second degree murder for her role in the deaths of three patients who overdoseds.  She was sentenced to 30 years to life.  This is the first murder conviction of a physician for over- prescribing drugs. She had surrendered her license in 2012.  The case is telling other primary care physicians to refer their pain patients out so they do not have the potential for this result.   

Kentucky v Jefferson

Dr. Ted Jefferson of Mayfield was arrested after he started swearing in surgery.  He was pulled out and allowed to cool off for 30 minutes before being allowed to return to surgery.  When he returned to the case he went after the administration verbally.  He was again confronted by the administration and was soon escorted from the premises and suspended for three days.  He was found the next day on hospital grounds and arrested on Terroristic and Disorderly Conduct Charges.

Georgia v Gower

Mike Gower, the CEO of Union General Hospital in Georgia was arrested for prescription drug charges.  Along with Gower Dr. James Healton was also arrested.  He was accused of writing thousands of fraudulent prescriptions for painkillers.          Top


Russo v The Brattleboro Retreat
D Vt

The patient committed suicide at the facility.  As part of the discovery the plaintiff sought the records of TJC review of the incident.  The court said the records are protected under the state peer review statute.  

PW v Children's Hospital Colorado
Colorado Supreme court

The high court ruled that the hospital cannot assert comparative negligence and assumption of the risk defenses when the hospital knew that suicide was a possibility.  That this issue reached the high court was remarkable.

Patients v Swedish Medical Center
To Be Filed

A former employee surgical tech may have stolen narcotics and about 2900 patients of the Colorado hospital are now at risk for HIV and Hepatitis.  The problems is potential reuse of needles.  The feds have taken over the investigation.

Patient v University Medical center
To Be Filed

A new born was inadvertently taken to surgery at the Tennessee hospital and had a frenulectomy.  The physician who did it asked for the wrong baby. 

Summer v Summerlin Hospital 
D Nevada

 Attorneys never learn and waste money and resources.  A elderly patient went to the ER with chest pain.  She had a CT Scan and was assured and discharged.  The next day she died from gallbladder torsion.  The attorney sued for not only med mal but for EMTALA.  The court dismissed the EMTALA claim and remanded it to state court for the med mal claim.  New filing needed.  

Hammer v Barth
Ill App Ct.

A wife sued for wrongful death against the hospital.  The hospital asked for summary judgment but was denied since the treating physician wore a name tag identifying her as a hospital employee and a lab coat with the hospital logo.  The admitting form did state that some of the physicians were not employees but did not name the physician.  The hospital website discussed its team of physicians.  A good example of a hospital program gone awry.        Top

Peer Review and Employment

Searls v Johns Hopkins
D Md

A deaf nurse completed two rotations in the hospital with an ASL person.  She then applied and was accepted for a position in coordinating care.  The position required listening and communication skills so she requested another ASL person.  The hospital turned her down and rescinded the offer.  She found another job at a different hospital with an ASL person.  She sued Johns Hopkins and the idiots attempted to defend the indefensible.  Of course the hospital lost all at Summary Judgment.

Monarch Healthcare v Orr
Ca Ct App

A physician sold her practice to the company for hard assets plus good will.  She worked for the company until the end of her contact and then went to work for herself.  There was a covenant not to compete and the company sued the physician.  Aside from losing any good will with all physicians they also lost the case.  The covenant was not enforceable since there was no consideration for the non compete clause.

Klaine v Southern Illinois Sers.
Illinois Supreme Court

The plaintiff sued Dr. Dressen and SI Medical for malpractice and also the hospitals for negligent credentialing.  They requested the physician's applications for staff privilege.  The hospital refused to turn them over claiming they were privileged.  The court did an en camera review and found them not privileged.  The hospital appealed and the hospital lost again.  They again appealed. and lost a third time. The documents were directly relevant to the legal action. The application included information sent to the NPDB.  

Epic Management v Paquette
Ca App Ct

Dr. Paquette had a contract with Epic to do non medical management services for 120% of the aggregate monthly costs Epic incurred.  For three years Epic charged and was paid 50% of office medical services, 25% of surgical service charges and 75% of pharmaceutical charges.  The contract was quit early and Epic sued for unpaid fees.  Arbitration said the contract had been modified by action.  Paquette argued that the approach violated the corporate practice of medicine.  The court agreed that the contract was valid as modified.        Top


Hospitals v HHS
DC Ct App

The hospitals have won an important round in their fight with the HHS.  The agency has been delaying for years the appeals process required under law.  The court said the appeals process may have been illegal and sent the case back to the district court.

Unilab v Angeles IPA
Ca Ct App

Although not a hospital case it is interesting regarding payments.  A physician had a Quest lab drop box in his office.  He dropped a patient specimen in the box and Quest ran the specimen before finding that it was not an approved provider for the patient's IPA.  Angeles IPA refused to pay and Quest sued and lost.  The court ruled that Angeles could not prevent the physician from sending patients labs out of network and they had never agreed to pay for unauthorized tests.  The court went on to stte the the Knox Keene law did not hold Angeles liable here.        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.