July 15, 2013 Recent Legal News





Peer Review and Employment


US v Ayodele

Dr. Emmanuel Ayodele and Mr. Alejandro Maciel of SoCal pled guilty of Medicare fraud for a power wheelchair scheme.  The physician was fed patients for the scheme by recruiters.  The recruiters were hired by the DME providers.  They face 10 years in prison.  Others have already pled guilty and some still are to go on trial.

US v Univ. of Louisville

The University paid a fine of $2.8 million to get rid of charges of fraud.  They had their own PAs and NPs in the ER to see non urgent patients and the MD also billed for their services.  Double billing usually doesn't work.

US v Hospitals

Fifty five hospitals have agreed to settle charges with the feds over the performing of kyphoplasty procedures as inpatients when they could have been done as outpatients.  The hospitals in 27 states will pay a total of $34 million for their poor judgment.

US v McLeod Cancer Clinic

The clinic in Johnson City, Tennessee, and three physicians have agreed to pay $4.25 million for using unapproved chemotherapy drugs in the clinic.  The owner of the clinic Dr. Kincaid will go to prison for 24 months and be excluded from Medicare for 10 years.  The other two minor partners will not go to prison but will pay fines.  The clinic purchased foreign drugs for less money and charged the same price as if they were purchased in the country.

US v Sound Physicians

Sound Physicians, a Tacoma, Washington company that provides physicians to about 70 hospitals in 22 states, has agreed to pay in a whistleblower suit $14.5 million.  They submitted upcoded billing for its physicians.  The company paid the physicians based on the amount they billed setting up a conflict where physicians and the company would overbill.  The company admitted no liability but.

US v Toumey
Notice of Judgment

The Justice Department is playing hardball with the hospital.  The hospital lost a fraud case and was fined $237 million.  They would not settle and appealed the fines.  The feds have said they are willing to settle the case for less but the hospital wants a new trial.  

US v Jackson Cardiology

In a whistleblower case, Dr. Julie Kovach sued Jackson Cardiology Associates of Jackson, Michigan and the hospital Allegiance Health for unnecessary cardiac caths.  The hospital paid to the US who intervened $1.8 million and the physiciams paid $2.2 million.   

US v Infirmary Health System

The fed joined a whistleblower suit against the Infirmary and the Diagnostic Physician's Group of Mobile, Alabama.  They are going after over $400 million for unnecessary cardiac nuclear tests which were done for increased payments by the hospital.  The original suit claimed medical records were altered to justify the procedures.  The hospital paid extra money to the ordering physicians the year following the tests by lower rent and other subsidies.

US v Agarwal

Dr. Shashi Agarwal, a cardiologist in Edison, New Jersey, was sentenced to 30 months in prison for receiving kickbacks from an MRI/CT scanner for making referrals.  So far 12 of 15 arrested have pled guilty.  Several have also been sentenced to prison for various lengths of time and all ordered to give up their ill gotten gains.        Top


Health Clinics v California
9th Circuit

California lost again in the courts over cuts in Medicaid.  The state cut dental, optometry, podiatry and chiropractic care for Medicaid patients.  The court stated they can not do that and must pay for the care.

Liberty University v US
4th Circuit

In another case going to the Supreme Court over Obamacare the Christian university lost its case to stop Obamacare from imposing its rule over religious tenets. They also said it violated the Commerce Clause by forcing employers into providing health insurance.  The Supremes had ruled that Congress did overstep it's bounds by attempting to use the Commerce Clause to justify the law but could under the taxing powers which were overtly not considered by Congress.  This is what the University wanted when it initiated the suit.        Top


Patients v California
To Be Filed

Apparently, the state prisons have been sterilizing women without their full consent, or maybe not.  Some people have said several years after release they were sterilized without their consent.  The physicians state otherwise.  The problem is that the medical records are all under control of the feds and not the state so no one can see who is telling the truth.

Fielding v John Hopkins
Maryland Ct of App

The court of appeals reversed a trial verdict for the plaintiff in a bad baby case.  The reason for the reversal and a new trial was that Hopkins was not allowed to fully discover the role of a midwife who attempted delivery of the child at home prior to sending the patient to the hospital.  She was not named in the suit.        Top  


Faircloth v Adventist Health

The judge has dismissed the class action law suit due to insufficient evidence.  Of course, over 740,000 medical records were compromised and employees of the chain sold information to others.  Faircloth attempted to get around the inability of private lawsuits under HIPAA by filing state court claims in federal court.  It just didn't work.

US v Wellpoint

Wellpoint has agreed to pay $1.7 million fine for not providing good web security which left unprotected the data of over 600,000 people.

Kardashian v Cedar Sinai
To be Filed

When Kim Kardashian had her baby at Cedar Sinai Hospital in Los Angeles her record was illegally searched multiple times.  This resulted in six employees losing their job.  This is a common occurrence at this hospital to the stars.  They should receive a large fine.        Top

Peer Review and Employment

Granger v Christian Health Ctr
Louisiana Supreme Court

In another verdict of stupid hospital lawyering, the hospital did not give the summarily suspended physician his due process rights after the suspension and therefore are not entitled to HCQIA immunity.  The physician is just as stupid as he did not apply for readmission to the staff and now is not entitled to loss of wages, only general damages.

Rao v Washington Township Hosp
Ca Ct App

The physician had an investigation and a hearing on his proposed charges which did not include banishment.  The peer review committee voted on a punishment that did not include revocation of his privileges.  During the hearing Dr. Rao was interviewed by the media and made derogatory comments about the hospital and one member of the peer review committee.  That member was subsequently removed by the hearing officer.  The board sent the matter back to the peer review for reconsideration.  The peer review committee this second time recommended revocation but did not allow the physician to rebut the decision.  The board of directors then revoked the privileges.  While this was going on the MEC decided to now to recommend revocation of Rao's privileges due to the documentary.  A separate peer review panel was formed (Rao 2).  This panel did not render a decision since Rao had already been kicked off the staff.  They did reserve the right to render an opinion if and when they decide to do so or is told to do so by the MEC, Board or a court.  Rao then went for a writ of mandamus against the first decision and a dismissal of Rao 2.  The lower court ruled against him.  The appellate court stated that the physician had the right to defend himself before the new revocation charge but the peer review committee may limit the testimony or oral or written and the length.  This is only to rebut the revocation of privilege.  The appellate court also denied the argument that Rao 2 should be terminated due to this being an infringement of his First Amendment Right.  The court said it was premature to stop the hearings before it made a decision.

Hamdan v U of Indiana
DC Ind

Dr. Talal Hamdan is a US citizen of Palestinian descent.  He had privileges at the hospital and alleges that he was harassed because of his heritage.  He had two letters of Adverse Action against him by the MEC but all were withdrawn.  Dr. Hamdan then sued for racial defamation.  He showed that HCQIA could be tossed since the people had the knowledge of what they were doing.  He also claimed the bylaws were a contract.  Since this was a motion to dismiss the actions were not ripe for review but the case could be heard.

Chudacoff v University Medical Center
D Nev

In the case that has been going for years, Dr. Chaudacoff had been summarily suspended by the MEC and had that overturned by the peer review committee.  Eventually he got a formal letter of reprimand.  The physician sued and much litigation ensued as to whether or not the MEC and the individuals were state actors and given immunity.  It was found they were state actors by the 9th Circuit.  The present case was on remand and found that the defendants could not be sued.  The court did not rule on the claim of tortious interference.  Therefore the case continues.        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.