July 1 Recent Legal News








Peer Review and Employment


Michigan v Lyon

Michigan finally went after the pols in the Flint, Michigan, water problems.  They indicted on involuntary manslaughter charges Nick Lyon, the director of Michigan DHS, Dr. Eden Wells, the chief medical exec for the department for obstruction of justice and 13 others.  The main problem was the lead in the water leading to problems and Legionnaire's disease.  Lyon is charged with failing to alert the public about increases in Legionnaire's cases.

California v Gonzalez

Alberto Gonzalez plead guilty of impersonating a physician.  The plea deal comes with a two year prison sentence.  He did this prior and was convicted in 2012.  

US v Cadden

Barry Cadden, the former president of New England Compounding Center, was sentenced to nine years in prison after being found guilty of second degree murder by a jury for racketeering and fraud.  About 76 people died in the country from meningitis due to contaminated steroids compounded in his pharmacy.  

US v Diaz Hernandez

This is a story of stupidity.  A California woman, I.T., hired a beautician Ana Bertha Diaz Hernandez to inject lamb's fat into her buttocks.   She was told the injections were guaranteed safe and will stay in play until death.  The expected happened.  Soon after the stuff moved to her back, legs and hips.  She underwent surgery to reconstruct the buttocks and need several more.  She went to the police and to the Medical Board.  At that time the feds became interested.  I. T. finally, on her own, got a friend go to the home of Diaz Hernandez and recorded the event.  The feds finally got her on illegally importing merchandise as well as misbranding of prescription drugs.  She faces 26 years in jail.  

Oklahoma v Nichols

Dr. Regan Nichols was charged with five counts of second degree murder in connection with her prescribing opiods to patients.  This was also in combination with muscle relaxants and anti-anxiety drugs.         Top


US v University of Rochester

The school will pay $113,722.10 to settle allegations that it upcoded.  They used modifier 25 when they should not have.  

US v McGrath

Dr. Robert McGrath of Cherry Hill, New Jersey, and his son agreed to plead guilty to conspiracy to commit health care fraud.  They agreed to pay $1.78 million as part of the civil settlement.  They used unlicensed PT people to give PT to the patients.  They still face jail time.  This whistleblower suit was filed by a former billing manager for the practice.  She will get $338,000.

US v Gonzalez

Mildrey Gonzalez and her daughter Milka Alfara were each sentenced to over ten years in jail after pleading guilty to fraud.  They were caught coming into Miami from the Dominican Republic with over $2.5 million in cash in their suitcases.  They owned seven home health care agencies in the Miami area and paid recruiters to get business for them.  They also paid bribes to physicians.  

US v Genesis Healthcare

The company was accused of grossly substandard care along with fraud in submission of claims for medically unnecessary treatments.  They will pay $56.6 million for their poor doings.  The whistleblowers will get almost $10 million.  

US v Ashrafklan

Former doctor Sardar Ashrafklan of Ypsilanti, Michigan was found guilty of fraud and illegally distributing narcotics.  He is sentenced to 23 years and will be deported back to Pakistan upon his release.

US v Greenspan

Dr. Bernard Greenspan of River Edge, New Jersey, was found guilty of accepting bribes from the notorious Biodiagnostic Labs and has been sentenced to 41 months in prison.  He received about $200,000 plus non economic goodies.  

US v Five Physicians

Five physicians plead guilty to taking bribes in the Biodiagnostic case The are Geroge Roussis of Staten Island, Nicholas Roussis of Staten Island, Jorge Figeroa of Wayne, New Jersey, Basel Batarseh of Franklin Lakes, New Jersey and Yousef Zibdie of Wayne, New Jersey.

US v Chikvashvii
4th Circuit

Rafael Chikvashvii was the former CEO of Alpha Diagnostics, a radiology company,  He was convicted of fraud for changing codes and directing technicians to read the studies.  This resulted in at least two deaths for missing congestive heart failure.  He was sentenced to 120 month in prison.  He appealed the decision on three grounds and lost on all three.  

 US v Crumb

Dr. James Crumb and his PT group as well as Coastal Neurological Institute agreed to pay $1.4 million to settle claims they committed fraud to maximize payments.  They are accused of billing for medically necessary ultrasound guidance for blood draws and injections.  

US v Thomas

Michael Thomas, DPM, was sentenced to six months in prison and fined $20,000 for falsifying billing to Medicare for toe nail trimming, a non covered visit.  He also must pay over $40,000 in restitution.

US v Orthopedic and Sports Medicine Center-Norman, PC

The Oklahoma practice and its owners Drs. Mark Moses, David Bobb, William Harris, Vytautus Ringus, Steven Schultz and Brad Vogel agreed to pay $1,537,796 to settle allegations they billed false claims.  They self reported that they illegally billed for physician extenders where the documentation did not match, DME where there was no supporting documentation, EM hospital codes not supported by documentation and PT where documentation did not support.  They should be congratulated for stepping up and doing the right thing.

US v Burgos

Dr. Miguel Burgos of Gotha, Florida, was sentenced to 64 months in prison and restitution of $9.8 million for billing insurances for infusions of drugs never given.  They also billed for PT when there was no licensed PT person.  

US v AMI Monitoring (Spectocor)

The cardiac monitoring company and its owner Joseph Bogdan agreed to pay $13.45 million to resolve allegations that they billed for higher and more expensive levels of cardiac monitoring than ordered by the physician.  This qui tam case realator, a former sales manager, will get $2.4 million.

US v Lincare

The company agreed to pay $20 million to resolve allegations that it fraudulently billed for oxygen and respiratory equipment.  It was alleged that the company billed for equipment when people did not need them, lied on oxygen orders and improperly waived co-pays.  The also are alleged to pay kickbacks. 

US v Sen

Dr. Anindya Sen and his wife Patricia of Greenville, Tennessee, agreed to pay $1.2 million to the feds to settle allegations that they billed for anticancer and infusion drugs produced in foreign countries and illegally imported into the US.  

US v Landry

Dr. Charles Landry of Manchester, Maine, agreed to pay $133,464 to settle claims that he billed EM codes for services not eligible for reimbursement.  He is a chiropractor and billed for services connected with manipulation.  These are not reimbursable by Medicare.  The payment is twice the amount he got paid.

US v Pacific Alliance Medical Center

The acute care Los Angeles hospital agreed to pay $42 million to settle claims they paid physicians for referrals.  The hospital paid above market rates to rent spaces and did marketing for physicians.  The is a qui tam suit and the former manager will get over $9.2 million.        Top


New York v CoPilot

The company provides physicians with insurance coverage information has a data breach.  They waited over one year before notifying patients of the breach.  For that they will pay the state $130,000.  They also did not notify the feds about the breach and will soon be fined by them as well.

Patients v Washington State University
To Be Filed

The University had a break in and a hard drive was stolen.  The information of over 1 million people were on the drive.  There is no mention if the data was encrypted or not.  

Consumers v Anthem

A class action law suit against Anthem has been settled regarding a 2015 data breach affecting about 80 million people.  The insurer agreed to pay $115 million, a paltry sum, for their massive breach.  This will cover two years of credit monitoring and cover out of pocket expenses as the result of the breach.  This was a cyber attack that was successful due to Anthem's lax security.  

Patients v Ascension
To Be Filed

Tennessee's Ascension Saint Thomas Health had a breach affecting almost 3000 people.  Health records were found scattered on a rural road.         Top 


Empire Health Foundation v Community Health Systems

The foundation filed suit to force CHS to pay the $110 million they promised for indigent care when they were allowed to take over several hospitals in Eastern Washington.  CHS says it has fulfilled its requirement.  The suit states the CHS, as all hospitals, inflate the price for patient pay so they can seem like they give more charity care.  CHS is in the process of selling the hospitals.  

Patients v Mary Health of the Sick Convalescent Hospital

In a class action suit the hospital was accused to using powerful drugs without discussing the impact of the drugs to residents, family members or people with powers of attorney.  The hospital is alleged to have its staff fill out papers that confirm the doctor consented the patient when they knew it was not true.  In the usual settlement, of the total money paid $314,000, the attorneys receive $228,500 and $35,000 for costs.  The residents are left with $500 per person.

Methodist Hospital v St. Francis Hospital
7th Circuit

The two Peoria, Illinois, hospitals are squabblers.  Here Methodist sued the dominant St. Francis for antitrust because they had an exclusive contract with insurers that if they used their physician networks they could not use others.  St. Francis has a wider array of services than Methodist so is a "must have" hospital.  The 7th said Methodist is just another unsuccessful competitor.  

Raymond v Avectus
6th Circuit

Plaintiff was injured twice and treated both times by defendant Mercy.  He was insured at all times and the insurer had an agreement with Mercy.  Mercy Health, in order to get more money, billed the plaintiff instead of the insurance company.  The plaintiff refused to pay and asked that the insurance company be billed.  The scum at Mercy then sent him to collection to get money from any settlement.  The plaintiff sued and lost in district court but the 6th reversed.  The 6th ssays that any money to plaintiff from the tortfeasor belongs to the plaintiff and the hospital has no right to presume that any settlement would include medical expense reimbursement.  Now they lost money since they, hopefully, had to pay not only their fees but the fees of the plaintiff as well.

Graves v Elmhurst Hospital

In what is certain to become a late night joke Judy Graves is suing the hospital for an attack by a bird.  She claims the hospital knew the birds were there and failed to post signs warning about them, as that would have make a difference.  She wants over $50,000 and legal expenses.  Hopefully this case will be dropped soon before she become more of a laughing stock.          Top


Covenant Medical Center v State Farm
Michigan Supreme Court

The state high court overturned many years of appellate law and ruled that providers that care for patients in the no fault insurance state may have to go after the patient for the money not the insurance companies.  In this case a patient injured in a MVA ran up $43,000 in medical bills.  The hospital billed the insurance company who refused to pay and denied coverage.  The patient individually sued the insurer for benefits and settled the case for $59,000.  The patient as part of the suit released the insurer of all expenses including medical.  The hospital sued the insurer and lost in the lower court due to the release.  The high court said there is nothing in the law to allow providers to sued insurers.  They said to sue the patient for the reasonable charges.        Top


Paylan v Department of health
Fla Ct App.


Christina Paylan was convicted after a trial of one count of obtaining a controlled substance by fraud.  Florida state law required that after a conviction such as this the person requesting reinstatement of their license must either enroll in a substance abuse program where there is a certificate at the end of the time or wait ten years to apply for a license.  Paylan did neither and tried to say the penalty was too harsh.  The courts ruled against her.        Top


Kalitan v North Broward Hospital District
Florida Supreme Court

Kalitan had carpal tunnel repair and developed a perforated esophagus due to intubation.  The jury awarded $4 million in non-economic damages but that was essentially cut in half by the Florida law limiting caps on non-economic damages.  The court of appeals ruled the caps were illegal and the Supreme Court agreed.  The majority found an equal rights argument to get rid of the caps and the dissents said the majority were flat wrong.  The legislature will try again.

Avila-Hernandez v Children's Dental Clinic 
To Be Filed

The 3 year old died after having teeth pulled under anesthesia.  The question will be why any 3 year old needs dental surgery to have teeth extracted.

Patients v J&J

Patients were suing for Ovarian cancer due to talcum powder, a tenuous theory at best.  The mistrial was called by the St. Louis judge since the US Supreme Court in an 8-1 decision decided in a similar case that defendants could only be sued where they have close ties, not just sell product.  This over ruled the liberal California Supreme court who said Bristol Meyers could be sued in California because they sold their product there.  This should kill forum shopping.

Kralkin v New York

Yaugeni Kralkin was drunk and strapped on a gurney in an ambulance.  He decided he did not like that so he unbuckled the straps and jumped out of the moving ambulance.  He was injured in the fall.  He is now suing with the help of some shyster for damages for his own actions.  The case rests with the ability of the plaintiff to know what he was doing as he was drunk as a skunk and the workers failed to protect him against himself.  Does the EMT have a duty to fight with a drunk and possibly be injured themselves?  

Polanco v Elmhurst Hospital

Polonco entered the New York hospital for pneumonia and after developed sepsis which required amputation of his right hand.  It is alleged that a BP line was the cause and was not monitored properly.

Jarvi v University of Minnesota Medical Center 

Cindy Jarvi ways she was assaulted in her bed by another patient at the hospital is suing the hospital for not protecting her.  The hospital continues to have security lapses including another sexual assault.  Jarvi says she was attacked by a patient in heroin withdrawal and having hallucinations.  She was unsupervised.  She wanted to report it to the police but was told that was against hospital policy.   

Shinal v Toms
Penn Ct App

 Mrs. Shinal saw Dr. Toms, a neurosurgeon at Geisinger Clinic, for a symptomatic parotid tumor.  Another surgeon had removed part of it years ago.  Toms explained to Shinal the procedure.  Afterwards she spoke to the physician assistant who answered her questions regarding a craniotomy incision and scarring as well as other and also performed a history and physical and obtained Shinal's consent.  Toms did a craniotomy but ran into trouble and nicked the carotid artery leading to partial blindness, brain injury and stroke.  She sued.  She lost the case but appealed because the judge allowed jurors who had relatives with ties to another defendant, Geisinger Clinic as well as jury instructions regarding informed consent.  The court of appeal allowed a new trial but not for the reason of juror problems but for informed consent.  The duty to get informed consent in non-delegable and must be done by the physician.  Here it was not given by the physician so is not informed consent.       

Hurley v Kirk
Oklahoma Supreme Court

Hurley went to Dr. Kirk, a gynecologist, for treatment.  She determined Hurley needed a laproscopic total hysterectomy and after getting consent this was performed.  During the procedure with a non-physician assisting her either Dr. Kirk or the assistant injured the ureter casing future problems.  Hurley sued. The Supreme Court ruled that in order to have informed consent all material information must be given to the patient.  Here the information that the assistant was not a physician was deemed material and a new trial ordered.      Top

Peer Review and Employment

Hlatky v Steward Health Care
Jury Trial

Lynn Hlatky, Phd, sued and won in trial court.  She is seeking $35 million for destruction of her cancer lab.  Her lab was at St. Elizabeth in Brighton, Mass., when Steward took over the hospital and sent her lab to the financially troubled Genesys Institute.  They closed the lab and filed bankruptcy.  The lab was liquidated with the equipment sold at auction and the specimens incinerated.  She sued Steward and Genesys and won a breach of contract cause.  The jury awarded her $22 million.

Goldfarb v NY Presbyterian 

Hadas Goldfarb is a Orthodox Jewish paramedic in New York.  She began working for the hospital in 2015 but was terminated for refusing to wear slacks instead of a dress as required by her religion.  She has worked for other paramedic companies with no problems.  The hospital will lose this case.

Reid v KentuckyOne Health
Kentucky Supreme Court

Dr. Benjamin Reid sued the hospital and the hospital won the summary judgment motion in court.  the Court of Appeals stated that there was a professional review action against Reid.  the Supreme Court reversed both.  Reid had his privileges revoked summarily and could no longer perform any surgery without a board certified surgeon with him.  He was also told he would have all his cases reviewed.  The investigation ended without charges.  He was reappointed to the staff with conditions of meeting criteria for six months.  He performed no surgery for the six months and his membership expired.  He sued for damages for the usual things.  The hospital claimed HCQIA immunity.  Reid said no professional review action was held since there was no notice or hearing.  The high court said nobody was entitled to summary judgment and remanded the case.  

Talone v American Osteopathic Board

Dr. Talone and others sued the AOA for antitrust to make them become members of the AOA in order to retain their board certification.  They were told when they took their boards and again in 2013 that theirs were a lifetime Board.  The AOA then changed the playing field and required a tying between membership and certification.  The Court ruled for the plaintiffs in summary judgment.  They believe there may be an antitrust violation.

Manion v North Carolina Medical Board
4th Circuit 

In a quick case the lower court as well as the appeals court ruled the physician filed suit past the statute of limitations and therefore loses.  He had notice to file earlier but did not.        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.