US v Multiple People
The feds in a three state bust arrested 32 people for healthcare fraud. They arrested people in Miami, Brooklyn and Detroit. One physician and one nurse were arrested in Miami. Dr. Fred Dweck was accused of referring over 1000 people for unneeded home health and therapy services, bribing owners of clinics to join him in the scam and faking medical certifications.
US v Johnson-Hunter
Dr. Janet Johnson-Hunter of Jacksonville, North Carolina, pled guilty of conspiring to conceal material facts connected to the delivery of healthcare. She owned a private ambulance company and told her employees to rewrite medical charts to show patients needed an ambulance because they could not ambulate themselves.
US v Smith
Wayne Smith, Baskaran Thangrasan and Sandeep Aggraval pled guilty in Detroit of health care fraud. The charges include falsifying medical records, money laundering and paying Medicare beneficiaries to go to a medical infusion clinic where they signed false statements that they received infusions.
US v Lourdes Medical
Our Lady of Lourdes Health Care Services agreed to pay the feds $7.95 million for settle charges of fraud against Our Lady of Lourdes Hospital and Lourdes Medical Center both of New Jersey. This was a whistleblower suit by a consultant who sued for the hospitals inflating charges to get higher reimbursement. He got about $400,000 for filing the suit.
US v Genesys Health
Genesys Health System will pay the government $669,413 for billing for higher EM codes than were actually done for patients. The whistleblower will receive 20% of the settlement.
US v St. Joseph Mercy Hosp
Trinity Health paid $205,000 to settle claims against its Michigan affiliate. The feds claim the hospital improperly billed Medicare for medical services by affiliated practitioners as though they were performed by a physician. This is another whistleblower suit and the original suer received $33,000 from the suit and an additional $30,000 for other claims against Trinity. Trinity also paid $30,000 for the attorney fees for the suer.
US v St. Johns
St. John's Health of Oklahoma self reported kickback violations and paid $13.2 million for its effort. They paid physicians incentives for referrals. Top
Patients v UCSF
The San Francisco Business Times reports that UCSF medical center had its medical records hacked. This was found in October and occurred in late September when a physician was successfully phished. The public was not notified until mid December although the affected people were notified earlier. UCSF is providing re-education to its staff to protect private information. Ain't electronics wonderful. Top
John Doe, MD v Community Medical
Dr. Doe was investigated by the hospital for ordering lab tests for his family. The investigating committee did not like the way Dr. Doe comported himself during the investigation so he was summarily suspended. The Supreme Court stated that the medical staff had not shown that he was an imminent danger to patients and upheld an injunction against the hospital from reporting him to the Data Bank. The Court also stated that the HCQIA did not preempt state law regarding injunction and breach of contract.
Jolley v BlueShield
Dr. Jolley, a pediatrician, since 2003 had been accused of having sexual trysts with the mothers of his patients. He had conditions placed on his license due to this. His association with BlueShield was an "at-will" arrangement. He was terminated from the panel and sued and lost on appeals and arbitration. He argued since he was given a reason for his dismissal it could not be a "at-will" termination but a for cause termination. This did not fly since he still could be terminated for no reason.
Fazaldin V Englewood Hosp
The estate of a deceased patient sued Englewood Hospital for not disclosing to the state medical board or the Data Bank information about a surgeon. The surgeon went to hospital B and operated on Fazaldin who died allegedly due to malpractice. The estate stated that if Englewood had made the appropriate reporting the surgeon would not have been on staff and the patient would not have been operated by the surgeon. The trial court stated that Englewood should have reported the case to New York medical board and they would have automatically forwarded the information to the Data Bank. The appellate court agreed and sent it back to the trial court. The trial court found that NY would not have automatically sent the information to the Data Bank but would have investigated independently. The case therefore had no causation and was dismissed.
Marlin v Robertson
Two pediatric neurosurgeons sued for antitrust. They had been on and off the hospital staff several times, resigning when they got a better deal. They wanted to get back on the staff but the hospital had hired their own physicians. This caused the suit. The court stated there was no antitrust since one needs to look at the consumer and not the physician. This was deemed competition and not antitrust. The court also stated that since the bylaws do not define or limit the power of the hospital as it acts via the board the bylaws do not have contractual rights. The physicians had also sued for breach of contract but since there was no viable contract between the hospital and the physicians there could be no breach. This is a lesson to all medical staffs to place in the bylaws a clause stating that this is a contract. Remember the next person wanting to claim this may be you. Top
CMA v Blue Cross
The California Medical Association had sued Blue Cross of California for illegally canceling health care coverage to patients. The court ruled in favor of the Medical Association. Therefore the suit by the Los Angeles city attorney asking for an injunction against all carriers doing rescissions can proceed. The main ruling stated that not only the state but also patients have the authority to enforce the laws of the state.
Amer. College of Cardiol. v
The American College of Cardiology has filed suit against the CMS in the Southern District of Florida to stop the fee cuts for office based procedures that cardiologists perform. The article did state that the basis for the suit is the use of flawed data for the payments and how it will affect access. Top
Sheridan v Rite Aid
The family of the plaintiff filed a wrongful death suit against Rite Aid pharmacy for filling a prescription that was a lethal dose of a chemotherapy drug. The patient had metastatic melanoma and was given a prescription for 14 capsules of Temodar a day (ten times the normal dose). The family claims the excessive dose allowed the cancer to grow more rapidly and kill the patient. The physician who wrote the script has already settled with the family. To me the error is obvious but the question is causation. The patient already had cancer in his brain and did the cancer or the drug kill him and was it any sooner that it would have been if he would have gotten the normal dose of the medication? Top
Delaware v Bradley
Dr. Earl Bradley, a pediatrician in Georgetown, Delaware has been arrested for alleged sexually abusing about 100 of his patients. The pediatrician had an office with a ferris wheel and merry go round. He is being held in prison on a $2.9 million bond. Dr. Bradley's hospital privileges at Beebe Medical Center were summarily suspended upon his arrest. The hospital also has arranged for counseling of his patients and their parents. His very large practice is being absorbed by other physicians in the area. The DA states that he videotaped some of his attacks. Top
Little Rock Cardiology v Baptist
Almost a year after the state judge forbid Baptist from enforcing their economic credentialing policy, the 8th Circuit affirmed the lower court decision on a suit for antitrust violation. Both courts stated that the cardiologists could not define product or geographic markets for their claims. 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.