US v Visiting Physicians Assn
The Visiting Physicians Association of Michigan has agreed to pay the feds and the state $9.5 million for billing for non necessary home health visits and overuse of high codes where not warranted. This was a whistleblower suit and four plaintiffs will split $1.7 million. The Association also has services in Ohio, Georgia and Wisconsin.
US v Texas Health Arlington
Texas Health Arlington Memorial Hospital has agreed to pay the fed about $1 million for payments for blood tests that do not need interpretation. The hospital paid pulmonologists for uncompensated charity care and running a blood gas lab. The physicians had to interpret the blood gas studies as their only job. The tests required no interpretation.
US v Wheaton Community Hospital
The Minnesota hospital and Dr. Stanley Gallagher agreed to pay the feds $846,461 for doing unnecessary hospital admissions. The whistleblower in this case was the former associate of Dr. Gallagher, Dr. Steven Radjenovich who will receive just over $200,000.
OIG v CMS
The federal OIG office has reviewed Medicare claims from the first half of 2007. They picked 375 claims at random and found 20% did not fulfill the requirements for a wheelchair. This translated to a total of $112 million for the year that should not have been paid for by CMS. There was a 40% error rate in documentation which was not appreciated by the CMS. The OIG recommended that the CMS conduct additional reviews of wheelchair claims, recover overpayments and consider other action against suppliers that did not document correctly and educate suppliers and physicians about documentation requirements.
US v Berkowitz
Dr. Wallace Berkowitz, an ENT in St. Louis, has been indicted on fraud charges. He allegedly billed for services never performed in nursing homes. He billed for 25-45 minute exams and allegedly spent five to ten minutes with the patient. Top
Savicki v Bayside Medical Center
Ms. Savicki, the single mother of nine children on MassCare, was to have a C-Section and temporary sterilization. She states she gave an IUD to the nurse when she was rolled into surgery. She came out of surgery with a tubal ligation. The hospital can not find the consent form for the tubal. It sounds like the only issue is how much the hospital and the physicians are going to pay.
Watkins v Affiliated Internists
Watkins died 11 days after getting a prescription for a narcotic from an allied health professional. The Tennessee law is that the covering physician must review and countersign the prescription within 10 days. The State Board admonished the physician for not following the rules and the family of the patient then switched from regular malpractice to negligence per se witch does not require an expert. The Court agreed that it was negligence per se since the physician did not follow the statute but on remand said proximate causation still must be proven. Top
California v Dr. Michael Kamrava
Dr. Kamrava is the fertility physician for Octomom Nadya Suleman. He has been accused of gross negligence in stockpiling unused frozen embryos which serve "no clinical purpose." The physician was also accused in the 13 page accusation of transferring too may embryos and not referring Ms. Suleman for psychiatric evaluation, provided high doses of fertility drugs and keeping shoddy records. The attorney for the physician states that the guidelines for transferring embryos are just that, guidelines and not law. The physician had been expelled earlier in 2009 from the American Society of Reproductive Medicine. I wonder if Dr. Kamrava can find any physician to testify in his behalf before the Medical Board.
Arkansas v Mann
Arkansas has indicted Dr. Randeep Singh Mann of London Arkansas of planting a bomb that injured the chair of the Medical Board that had taken away his ability to practice.
Schaaf v Iowa Board of Medicine
Who said the medical boards are not vindictive? Dr. Jerry Schaaf was accused in 1998 of sexual abuse of a patient. The incident allegedly occurred in 1973. An investigation by the Board was performed and determined nothing happened but the case remained open. A new investigator reviewed the case in 2003 and gave the physician the first notice that a complaint was filed in 1998. In 2005 the complainant wrote a letter stating the original complaint was not true. In 2006 the Board filed formal charges. The physician defended on laches. The Board refused the laches defense even after the court said it was a valid defense. The Board then imposed sanctions on the physician from almost 40 years prior. The physician challenged the decision in Court and the lower court found for the Board but rightfully the decision was overturned in its entirety. Top
Haw v Seton Medical Center
Nurse Laurie Haw worked in the surgical recovery area of the hospital. The hospital required all employees to be vaccinated against seasonal flu and H1N1 or wear a mask. Haw refused, was suspended and when she still refused was fired. She would not wear a mask since she felt the last thing someone coming out of anesthesia would want to see was a masked person. She did not wish for personal reasons to have the vaccines. The hospital required the mask until May. Physicians with special contracts were required to be vaccinated and those with privileges were strongly encouraged. St. David HealthCare required seasonal vaccination or a mask. There is no cases of swine flu currently in Austin. Top
Howell v Hamilton Meats
The California Court of Appeal stated that the plaintiff hurt in an automobile accident was entitled to the usual and customary fees charged by her treating physicians and not just the negotiated discounted rate paid by the health insurer. The court stated that the plaintiff had the foresight to insure herself and paid insurance premiums to do that. She should be entitled to the full amount charged her for her care and the defendant should not pay less just because the plaintiff had the good foresight to get insurance. Top
Physicians v Memorial Hermann
The physicians that opened a hospital, Town and Country, have settled their antitrust claims against the Memorial Hospital that drove them out of business. Some of the claims will go to trial next week. Memorial paid significant money to settle the claims and may pay more depending on the trial. Memorial had threatened to raise prices to insurers if they recognized the physician's hospital. This is the second settlement over the same issue. The earlier one was with the Texas AG for $700,000. Top
Patients v Kaiser
In December a computer was stolen from an employee's car. The laptop had no financial information about the 15,000 members states Kaiser. They are notifying the affected members. The employee was not authorized to the use of the "storage device" and was fired. The medical information of the members was on the device.
Connecticut v HealthNet
The Connecticut AG Blumenthal, who just may be the Democratic nominee for the Senate seat in 2010, filed a law suit against HealthNet for privacy breaches that occurred and failure to notify patients of the problems. The AG states that this is a violation of HIPAA. Top
American College of Cardiology v
The College sued for an injunction prohibiting the reduction of the payments for cardiology testing. The Court refused the injunction. The judge stated that the federal courts do not have jurisdiction over Medicare payment determinations. The head of the College said Cardiologists will do the tests in the hospital and will cost Medicare more money. This may not be true if the practice is already making money and this is extra. 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.