California v Wilson
Mr. Wilson worked in the billing department of Cedar Sinai. He stole the identity of about 1000 people and used the information of about 12 to obtain money from their insurer for medical treatments never delivered. He originally pled not guilty but after hearing the evidence against him in the prelim hearing he decided to plead guilty and received a sentence of four years and eight months in prison plus the restitution of $354,000 to the insurance company and $60,000 in back taxes.
US v Jones
Two women, Tabitha Jones and Glenesha Bowling-Moye pled guilty to defrauding the government of about $1 million. They billed for services never rendered or done by unlicensed people. They operated EBC Healthcare in Tennessee and mostly scammed TennCare. They will be sentenced in November. Middle Tennessee is becoming a hotbed of fraud.
Georgandellis v Holzer Clinic
Dr. Georgandellis sued the hospital, clinic and physicians for violation of the non retaliation provision of the False Claims Act. The court allowed the claim to go to trial along with the antitrust claim against the hospital and clinic. They also allowed the defamation claim and the claim for tortious interference. These were all against the hospital. The claims against the physicians were all dismissed due to lack of sufficient facts. The facts were the physician who was on the peer review committee believed a surgeon was a danger and reported this continually within the hospital hierarchy. The physician was harassed and then reported fraudulent billing practices to outside agencies and was terminated following this. This hospital needs to get a new attorney.
US v Multiple People
South Florida continues as the hotbed for Medicare fraud. The government has accused eight Miami residents of $100 million in fraud. There are two claims. The first is fraudulent infusion therapy and the other is money laundering. The shame is that the government is so far behind in getting the people scamming the taxpayers. The Detroit News says that the feds are using sophisticated analysis of Medicare data to find fraud hot spots. They need to do this early and not late. Now Detroit is the new place for fraud. The feds arrested many from this area as well as South Florida and some in Denver. There were a total of 40 arrests and 13 are still being sought.
US v Patel
Dr. Mehmood Patel of Lafayette, Louisiana, was sentenced to ten years in prison for doing interventional implantation of heart stents on people who did not need them. He was convicted on 51 counts. Our Lady of Lourdes Hospital in Lafayette had removed Patel in 2003 and paid the government $3.8 million to settle false claims due to Patel. He was the highest earning cardiologist in the state with a earning of $500,000. Top
Spiegelman v Victory Mem Hosp
The court agree with the jury that the hospital was vicariously liable for the actions of its unemployed physician. The hospital consent form did not say who were independent contractors and who were employees. Therefore the patient could have reasonable believed the ED physician was a hospital employee. The court took into consideration the hospital advertising about their ED care.
Bennett v Kent County Hosp
The hospital was sued under EMTALA and under the federal rules wanted the hospital's peer review files on a physician. The court said that the case was one of negligence and that the files were protected.
Patients v VA
The Philadelphia Veterans Hospital really screwed up. They were implanting radioactive seeds for the treatment of prostate cancer and got the dosage wrong in 94 of 114 cases. Most men received too little dosage but some got too much. The brachytherapy treatment is now suspended at the hospital. The monitoring equipment for the procedure was broken but they treated anyway. Top
Egan v St. Anthony's
Dr. Egan was terminated from the staff after he operated to remove a tumor that the GI physician had already removed. He then did not tell the patient of the error and put in misleading statements in the chart. He received a fair hearing. He wanted an injunction and a new hearing due to failing to follow the bylaws. The courts routinely state that technical deviations from the bylaws do not constitute not following them. The deviations have to materially prejudice the physician or undermine the result. The hospital "forgot" to tell the surgeon that he would be up on charges of not telling the patient about the error. The court said that this is a minor error.
Bode v Los Angeles Metro Hosp
The hospital gave Dr. Bode temporary and renewable anesthesia privileges. She had her privileges suspended and then not renewed. The hospital argued during the hearing and later during the trial that since the physician had an application in place she had the burden of proof. The court rightly said the hospital had the burden of proof since they had granted her temporary privileges she was no longer an "initial applicant". The court went on to state that when the burden was switched to the hospital they could not prove their case.
Johnson v Christus Spohn
Tone Johnson, a black physician, was suspended from the hospital and sued for the usual suspects. The court and the 5th Circuit gave summary judgment to the hospital under HCQIA for all but the discrimination. They then stated Johnson did not prove his case for discrimination and gave the hospital summary judgment on that as well. They did a good job in laying out the four aspects of HCQIA.
Thayer v E. Maine Hosp
Dr. Thayer sued for discrimination. She is entitled to the peer review records of both herself and male physicians in the same or similar professional practice area. She wanted to prove that the male physician received "significantly better working condition, privileges and treatment in general" from the hospital. The court is federal so allowed the discovery.
Westmoreland v Pleasant Valley
Hosp. & Physicians
The physician and plaintiff sued the hospital and the physicians that suspended his privileges in federal court for all state issues. The physician was suspended and then reinstated on the staff retroactive to his date of suspension. He claimed the hospital continued to go against him by telling patients that he had been suspended so patients would not come to his outside practice. The court ruled that since all his claims were state and they were a federal court they had no jurisdiction and the case was dismissed.
Turner v Memorial Hosp
This is really an employment case but put here since it has some peer review type features. Turner is a respiratory therapist who told a Joint Commission inspector about the hospital's going against a standard and jeopardizing patient care. The hospital fired Turner. The case of retaliation turned on the role of The Joint Commission. It was ruled that the entity was not a state actor so there could be no protection from retaliation under state law. The issue of the truth of the matter asserted was not considered. Top
Minn. v Hauser
Daniel Hauser, the 13 year old with Hodgkins Lymphoma who fled the state with his mother, is doing better on chemotherapy. The kid thinks its the ionized water that is helping but who cares as long as he is getting better. The lung mass has shrunk after one course of chemo and he is starting the next one but reluctantly. The judge is happy and allowing him to remain at home for support. 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.