Missouri v Rivera
Samantha Rivera spent three months as a nurse in the ICU at St. Alexis Hospital in St. Louis. The problem was she has never been a nurse anywhere. She worked for the hospital for several months but her contract was not extended. She had previous been employed as a nurse instructor in Brown Mackie College of Albuquerque. She had lied on her application stating she had a Masters of Nursing. The college is no longer accepting new students. The hospital refused to comment. They should be ashamed.
Virginia v Love-Robinson
Malachi Love-Robinson was sentenced to ten years in prison for forgery and providing a false statement to obtain credit. In reality he will only serve one year as the judge suspended nine years of the sentence. He will still have to face a trial on charges of impersonation and treating patients. He repeatedly portrayed himself as a physician and did treat patients in his own clinic in West Palm Beach.
Texas v Jones
Genene Jones, a former nurse now in prison for the murder of a toddler by injection of a muscle relaxant and the attempted murder of another baby with an anticoagulant, has been accused of the murder of many others who died from seizures while he was working at the hospitals. She is due for release next year but will now face additional trials. Top
US v Omnicare
Omnicare has agreed to pay $8 million to settle whistleblower allegations that it billed for generic drugs different than actually supplied to patients. They did this by using their own less specific codes. The whistleblowers and their attorneys will get about $2 million.
US v UnitedHealth
The feds have formally intervened in a whistleblower suit alleging the insurer knowingly inflated risk adjustment in their HMO clients. They did chart reviews to find diagnosis not carted by the physicians. They would use this to increase the risk adjustment payments to them. The case was originally filed by a former finance director for United. The feds claim $1 Billion in overpayments due to the boondoggle.
US v Merck
Merck and Upsher-Smith Labs have agreed to pay just over $60 million to settle claims that they conspired to delay the availability of a generic of K-Dur.
US v Mercy Hospital Springfield
The Missouri hospital and its affiliate Mercy Clinic Springfield Communities have agreed to pay $34 million to settle allegations that they illegally billed Medicare for chemotherapy services referred by oncologists who were paid by the value of their referrals to the system. This whistleblower case was filed originally by a physician who was employed by the defendant.
US v Gardner
In the final of the case of Medical Necessities, a medical practice in Springfield , Tennessee, the CEO Pam Gardner pled guilty of receiving kickbacks from Air Affiliates, a Nashville equipment provider for referring patients to Air Affiliates. Up to date three people and three physicians have been convicted. They all face years in prison and fines.
US v Sayegh
Yet another physician Dr. Rcky Sayegh, of Scarsdale has said he was guilty of accepting bribes from the notorious Biodiagnostic Laboratory Services. He received about $400,000 for referring patients to the lab. To date a total of 45 people have been convicted, 31 of them physicians.
US v Montano
Dr. Carlos Montao of Newport Beach, California and Dr. Suzie Schuder of corona del Mar were accused of writing unnecessary urine drug tests in order to commit fraud. They along with the owners of Compass Rose Recovery are accused of running a scam of billing for urine tests daily. The docs got allegedly $200 per patient and a percentage of the net insurance proceeds.
US v UHS
The feds are looking into whether UHS, the nation's largest psychiatric chain, is holding patients longer than needed in order to maximize profits. It is alleged that they are directing their hospitals to keep patients as long as their insurance allows no matter the medical necessity. Those investigating are the FBI, DOD, and HHS as well as the private insurers.
US v Esposito
Dr. Michael Esposito, an endocrinologist in Albany, was accused of billing federal programs when he was barred from same. In 2016 he agreed not to bill fed med due to his forging prescriptions. He also had his license revoked in New York. He has agreed not to bill any more and pay $100,000.
US v Betts
Kyle Betts, a medical resident in St. Louis obtained prescriptions for narcotics by wring false names on prescription pads.
US v Pamatmat
The Farmington Hills, Michigan, physician was sentenced to 19 years in jail for fraud and illegally distributing prescriptions. The "patients" would get the narcotics and peddle them on the street. He is 71 years of age and will not see the outside of prison again.
US v Ma
Dr. Sherry Ma and Aima Neurology agreed to pay almost $300,000 to settle allegations that she double used Botox and billed for a full usage. She received them for no charge to use on private pay patients and then used the remainder on Medicare patients and billed as if she purchased the vials.
US v Abington Memorial Hospital
The hospital has agreed to pay the feds almost $500,000 to settle allegations that it forged physician signatures on forms submitted to Medicare for home health. The hospital had discovered the problem on its own and self reported it. Top
Goel v Regal Medical Group
Dr. Sanjiv Goel did emergency work on four patients of the medical group and billed for $275,000. For some reason they paid him only 150% of Medicare or $9600. He sued for the difference and to no one's surprise he lost. Expert testimony showed the price paid was reasonable and he rate was greatly excessive. The appellate court affirmed saying the coourt was correct in applying the rates charged or paid by others.
McCullough Orthopedic Surgical
Service v Aetna
The Ortho group alleged the insurer promised and then reneged on paying higher out of network services for their members. McCullough, after being promised payment of 70% of usual and customary fees operated on an Aetna patient. The insurer moved the case to federal court under ERISA and the court refused a remand. The appellate court ruled that Aetna reneged on an oral promise and there was no valid assignment of the claim. Remand is proper.
House of Representatives v HHS
Sixteen attorneys general, all
Democrats, filed to intervene in the case to try to preserve insurance
subsidies. The case is currently on hold and if the executive branch
withholds payment they want to push the case forward even if the House does
Hipps v Virginia Mason
One month ago Mr. Hipps was awarded $8.5 million in a malpractice action against Virginia Mason. Now he and the Mrs. are filing suit again after being notified that the he and his wife had their records illegally breached by an unknown number of unauthorized viewers. Now it is breach of privacy.
US v St. Luke's -Roosevelt Hospital
The hospital agreed to pay $387,000 to the feds for stupidly disclosing a patient's HIV status to the patient's employer without permission. Faxes that were supposed to go to the patient went to the employer instead.
Patients v Molina Healthcare
Molina Healthcare exposed an unknown amount of patient records for an unknown amount of time on its website. This is a major error and will have a major fine from the feds for their lax oversight. Top
Doe v University of
A teenage girl was sexually assaulted twice while in the ED of the Fairview hospital. She had psychiatric problems and another psychiatric patient in the same ED sexually assaulted her twice in a short time. The parents are suing for damaged for the daughter's suffering and additional needed treatment costs.
Mandelman v Los Robles
The wife of an elderly man sued for elderly abuse after the man was hospitalized for pneumonia and remained so for one month until his death. He fell three days prior to his death and became unconscious. The hospital did not notify the wife of the fall and staff found no evidence of pneumonia 10 days prior to death. The suit says that on admission he was judged to be at high risk for fall but when he did fall he was unsupervised. Top
Egge v Santa Clara County
Dr. Melissa Egge was fired by the county for allegedly failing to report abuse in a toddler who eventually died. She states that she complained about systemic failures and mistakes of her supervisors and that she had told her supervisor about the possible abuse and was told he would report it to Child Services. The toddler died after it is alleged that he mother's boyfriend raped beat and suffocated him. He now faces the non-existent California death penalty. Egge was originally notified about the possible abuse by an intern and after being given not the full story said she did not suspect abuse. However, later when learning the full story she recommenced reporting. The supervisor, according to Egge, stated he forgot to make the report but would do so. Egge did not follow state law which states that if you are not sure someone else reported it you must.
Holsapple v University
Dr. James Holsapple, the current chair of neurosurgery at MGH objected loudly to the practice of concurrent surgeries and was removed from University Hospital in upstate New York. The physician sued and won a bench trial in state court. He was retaliated against by the hospital and the hospital owes him $88,000 in lost wages and this could reach $155,000. Not much money but it does set a precedent.
Biondo v Kootenai Hospital
The PA Natale Biondo applied for medical staff privileges which the credential committee approved but the board denied. He sued under antitrust and lost on the anticompetitive violation but won on the due process violation in summary judgment. He did not get a hearing to which he was entitled.
Kime v Adventist Health
In a strange case that should never have been filed, Dr. Ryan Kime, a ED physician at the Adventist Clearlake hospital, complained many times to the hospital about the amount and quality of the nurses in the ED. He then sued the hospital for EMTALA violations. The court threw the case out quickly as there were no violations and the law does not allow a private right to sue. Hope he leaves before he is tossed. 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.