Florida v Marrero
Yoandi Marrero was accused of stealing the information of a New Jersey physician to submit false claims for services such as ultrasounds and x-rays.
US v Mencia
Dr. Andres Mencia of Fort Lauderdale was convicted of distributing controlled substances. He prescribed pain meds not medically necessary. He prescribed over 1.2 million doses of opioids in two years. Dr, Mencia no longer has a Florida license nor a DEA license. He will be sentenced later.
US v Burkhart
James Burkhart, the former CEO of American Senior Communities was sentenced to almost 10 years in jail for fraud. His legitimate salary was about $1 million per year but he wanted more. He would have his vendors bill inflated bills which the corporation would pay and then kick the overages back to him. He also caused vendors to submit phony bills for no merchandise and get the money kicked back.
US v FWC Urogynecology,LLC
The Florida group agreed to pay the feds $1,700,000 to resolve the allegations that they submitted false claims. They us modifier 25 for services not billable or it did not provide. The former employee will get $300,000 for starting the case.
US v Thomas
The former CEO of Tennessee's United Benefits of America was sentenced to 66 months in prison and to forfeit $1.5 million and pay restitution to the victims of over $2.5 million. He sold fake medical insurance to people stating it was just as good s major medical. He also stole money from the company and deposited it into a friend's bank account.
New Jersey v Faustino
Dr. Alan Faustino has plead guilty of distribution of controlled substances. He was arrested selling to patients he had never met nor treated. He was known for treating celebrities in the Atlantic City area.
UnitedHealtcare v American Renal
The dialysis company agreed to pay $32 million to settle allegations that it manipulated the Ocare and employer markets to make more money. They will also enter into a three year agreement for national networks at specified payment ratios.
US v Health Quest Systems
The system agreed to pay $14.7 million to settle allegations that it knew and submitted wrong claims. They submitted claims for home health that lacked substantiation of those claims. They also submitted claims for tow orthos who received kickbacks from the hospital. This was a qui tam suit and the blowers will get monies ranging from $56,000 to $1,893,000.
US v Heibron
Dr. Roy Heilbron of Santa Fe was sentenced to 51 months in prison for fraud and obstruction. The fraud was fro submitting false and inflated claims with false diagnosis. He also obstructed by faking medical information on himself saying he had cancer in an effort to avoid his sentencing for fraud.
Coming Attractions Bridal &
Formal v Texas Health
The Ohio florist is suing the owner of the hospital in Texas where the Ebola patient was treated and the two nurses were infected. One nurse who did not know she had the disease flew to Ohio and shopped at the floral store. the Ohio state health department ordered the store closed until it was cleaned. After it re-opened it never regained business and eventually shuttered. In their suit they believe there was no medical malpractice but the District Court and the 5th Circuit both said it was and it needed expert witnesses. The florist is now asking the Texas Supreme Court to re-open the case. Not likely.
Hospitals v HHS
The court said that the three year limit on reconsidering Medicare reimbursement claims does not count for appeals.
US v Kalina
Linda Kalina of Butler, Pennsylvania, was indicted for stealing and disclosing health information of another. She was employed as a patient information coordinator at the University of Pennsylvania Medical Center and later by Allegheny Health Network. She got information on 11 patients and disclosed information on three to cause malicious harm, according to the indictment.
Hassell v Yelp
Attorney Dawn Hassell states that a client defamed her by falsely claiming the firm did not communicate whit the client. A Superior Court judge agreed and ordered the client and Yelp to remove the post. The client failed to comply so she asked Yelp to do it. Yelp refused so a second judge and a court of appeal agreed with the first judge. All were overturned by the California Supreme Court who said that the federal law that protects internet companies from liability for posts by third party users ruled. Yelp won and the disgruntled attorney is considering an appeal to the US Supreme Court.
Patients v Children's Mercy
The Missouri hospital was phished and the data from about 60,000 patients were compromised. They are now and only now doing multi factor authentication. They have had several other HIPAA problems in the last few years. They really deserve a huge government fine.
Patients v Nashville Public Health
The agency accidentally placed the HIV results of thousands of people where all could see the names. It was available for about 9 months.
Doe v Aetna
John Doe of Orange County filed suit against Aetna fro negligence and invasion of privacy. He alleges that Aetna sent a letter about a change of pharmacy benefits but that information regarding HIV meds was seeable via the large window.
Kalkaska County Hospital Authority
The Michigan hospital has filed defamation charges against three relatives of a patient. They were prohibited from visiting the patient relative after being accused of verbally abusing the patient, ignoring dietary restrictions of the patient, told her not to take meds and withheld meals from her. They are also accused of abusive behavior toward staff. The family members then took to Facebook with lengthily posts and began picketing the hospital.
Re: Testosterone Replacement
The judge overturned a jury decision to award $140.1 million to a man who claimed AbbVie's testosterone was misrepresented causing a heart attack. A new trial was ordered. The problem was the jury also found AbbVie not guilty on another claim creating an inconsistent verdict. This is the second time the judge has done this and in the first case the verdict was still guilty but the damages went from $150 million to $3 million.
Griffey v Adams
Griffey sued her podiatrist after he began to operate on the wrong foot. Pre-op he marked the correct foot but did not follow the time out steps. The court stated that the podiatrist can not get summary judgment on the claim of willful and wonton injury and may face punis for his actions.
22 Women v J&J
The women claimed the J&J talcum powder gave them ovarian cancer and the court ordered the payment of $4.7 Billion to those women. The trial lasted six weeks and the deliberation of damages lasted eight hours and for the punis 45 minutes. The women will see a very small percentage of that verdict if anything at all.
Vaughn v Round Rock Medical Center
The father of a 24 year old woman in a head on auto collision has sued the hospital for giving false information to the police. The daughter was driving on the wrong side of the road and injured four others in another car. Her BA was 0.28 (over three times the legal limit). The father says that the hospital staff "mischaracterized" her as a "22 year old female drunk driver" and "misinterpreted" her lab tests.
Waldbaum v Slodzinski
Benjamin Waldbaum RN is suing Dr. Martin Slodzinski for what he says is taking a syringe of fluid from a patient IV and squirting at him where it landed on his face and torso. This is after the nurse chastised the physician for remarks to the patient, a drug addict. Of course the employer was also named Johns Hopkins.
Johnson v Memorial Hermann Helath
The fired physician peer review coordinator has filed suit for retaliation after she says she refused to reveal confidential information. She says she was asked to reveal surgeon "grades" in open meetings of the administration. The hospital says her position was eliminated.
Frazier v Houston Chronicle
Dr. O.H. Frazier has filed suit against the paper and ProPublica for defamation. The story said that the transplant surgeon at Baylor St. Luke's was accused of "violating research rules and skirting ethical guidelines". They implanted heart pumps in patients who did not meet medical criteria for clinical trials. This prompted the hospital to refund money to Medicare.
Causey v North Arkansas Regional Medical Center
Dr. Robert Causey had filed a suit against the hospital an the CEO Vince Leist regarding his suspension and remarks made by Leist at a civic club. Causey had his privileges suspended in 2017 for 14 days. He had a "sentinel case" reviewed by a peer review committee and nothing recommended. that case was again taken before the Credentials Committee and again he was allowed to continue but the committee asked to be notified of any further cases. All of a sudden there were three other cases one of which the peer review committee rejected, and the other two had no risk to patient care. The credentialing committee terminated his privileges. There is always more. Dr. Causey had signed an employment agreement between the two credential committee meetings with a competitor of the hospital. Causey then requested and received a hearing committee and received his privileges back with a one year probationary period with review of his cases. The Board imposed stricter conditions on the reinstated privileges. These included the dreaded mental health evaluation. The CEO was asked in regard to the publicity surrounding the credential committee hearing, "What you're saying is the hospital doctors designate that this doctor is not fit to be a doctor? Is that right?" Leist supposedly said "That's what the credentials committee has decided."
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.