NY v Health Care Workers
New York has indicted 14 healthcare workers for fraud and laundering. The charges are about a clinic in Queens whose owner was alleged to tell an attorney to bribe hospital officials for patient information. This was an insurance scam to have patients go to the clinic after being seen in the hospital.
US v LSU Shreveport
The hospital paid just over $700,000 to settle charges of Medicare fraud. They were accused of billing for medical services not provided by teaching physicians. This whistleblower case was for two Orthopods who billed for assisting residents in surgery but were not present. The two whistleblowers, one an Orthopod and the other the head OR nurse, were then fired by the hospital and are presently suing the hospital for illegal retaliation.
US v Perez
The government have indicted two Miami men for Medicare fraud. They are accused of having 21 DME offices in Miami and billing for $179 million in services not provided. They also face identity theft charges for the unauthorized use of physician identification numbers. Again, this is a problem with government payors. Top
Hospital of Valdosta v Meeks
The claim was negligent credentialing and the plaintiff wanted peer review information. The high court stated that they could get peer review information as long as the information does not contain any information regarding the evaluation of any actual medical services provided by the subject physician. The case therefore says nothing.
Arunasalam v St. Mary Hosp
The physician was summarily suspended for disruption and quality concerns. He requested a judicial hearing and after one year and approximately 10 sessions the hospital had still not finished presenting their case. The bylaws stated the panel was to consist of five people but one quit after the year. The medical staff then picked a new panel to restart the case. The physician sued to enjoin the action for lack of moving forward. The court found that the physician had not used his administrative remedies and the medical staff was not responsible for the delay in the proceedings. I wonder who was? Top
Drug Miners v Vermont
Vermont passed a law prohibiting mining of prescription drug information by third parties without physician consent. This was found to be OK by the court. A similar law in New Hampshire was given the same treatment by the 1st Circuit and denied review by the US Supreme Court.
Brzica v Minnesota
The Brzicas and others have filed a law suit in Minnesota against the practice of the state obtaining blood samples from newborns for future genetic testing without consent from the parents. This is done in other states and Michigan is attempting to be a national repository for the blood samples.
Medical Board of Vermont v Welch
Dr. Joshua Welch of Fletcher John Health Care was reprimanded by the state medical board for accessing the medical records of eight women illegally since none were his patients. The physician is not practicing currently and is taking courses in physician patient boundaries. Top
Independent Living v California
The ninth circuit directed California that it may not decrease the Medicaid payments to providers by 10% as it had planned to do. The decision was unanimous. Top
Pinnacle Anesth. v Fisher
Fisher had sued his group for various contract breaches and the trial court gave him $8.5 million. The court of appeal agreed with the trial court. Fisher was told to come to a meeting and then blindsided by the group regarding clinical and administrative incidents. Fisher claimed this was done in retaliation by the management for his questioning the decision to do as many out of network cases as possible to increase income. At the end of the meeting he was given five things he must do and he refused. He was terminated for cause. Fisher proved in court that none of the employment contract for cause reasons pertained to him. This group needs to get its head on and a new attorney.
LaFaro v NY Cardiothoracic Grp
A hospital went with an exclusive contract for their cardiac surgery. Two other physicians were grandfathered into the exclusive group. The two sued the hospital and the other exclusive physicians for antitrust. The court ruled the hospital was entitled to state action immunity and the case was remanded to determine the relationship between the hospital and the exclusive physicians. If the hospital had active supervision over the private physicians they also would be entitled to state immunity, otherwise they could be sued. Top
Colorado Heart Institute v Johnson
In this case a group of cardiologists were providing services to local hospitals but at physician owned labs. The hospitals would bill Medicare and pay a set fee to the labs. CMS had a rule change that would make this an illegal self referral. The labs challenged since they believed it met an exception to the Stark rules. The court bailed by stating the parties first had to go through administrative procedures prior to suing. This makes it impossible for the physicians. Since the rule makes it impossible for the physicians to bill directly, they have no standing to challenge the ruling administratively. The hospitals could have standing to bring the administrative challenge for the physicians but would be not likely to do so since the incentives are not aligned. This means the physicians will have to go into direct competition with the hospitals by the use of separate outpatient cath labs. Top
Phelps v St. Joseph Hosp
In a blow for common sense the Wisconsin Supreme Court threw out a $200,000 award by a trial court for bystander emotional damages. The plaintiff was the father who was present when one of his twin sons died. The first year resident allowed the mother to go to the bathroom where the first twins toes were felt coming out of the vagina. The baby died and the second son was delivered and is normal. The family did get an award of $500,000 which was not contested. The court would not allow the additional $200,000 for emotional damages to a bystander since the med mal law of the state did not allow these.
Van Buren v Evans
The California Appellate Court upheld the $250,000 limit on non-economic damages in the state. The case revolved around an award of $2.5 million for non-economic damages for a women who had fecal incontinence after a peri-anal cyst was excised. The award was reduced to $250,000. The court stated the legislature has a right to expand or limit damages as long as it is related to a legitimate state interest. The plaintiff's attorney will ask the California Supreme Court to hear the case. The decision is unpublished. 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.