June 15, 2011 Recent Legal News



Peer Review & Employment

False Claims




Aetna v Physicians

Aetna has sued nine physicians in New Jersey for "unconscionable" fees for out of network services.  Four of the physicians are countersuing for fraudulent insurance practices.  There is no limit in law on what is considered reasonable and customary.  The suit is supposed to help determine what that amount is. 

Florida v Dept. of Health
11th Circ

 In the latest case to be heard by a federal appellate court, the administration has done a pre filing to bolster its argument.  The newspaper articles do not state any legal principles for the overturning of the decision that Obamacare is unconstitutional but only talk about the social and political ideals. 

San Francisco v Insurers

San Francisco has sued multiple insurers for underpaying San Francisco General Hospital and other public hospitals in the state for emergency services.      Top


Chandna v Citizens Medical Center

In a really ugly fight, three Indian cardiologists were ousted from practicing at the hospital.  The department was closed and therefore they lost their privileges without benefit of due process.  The problem is one of discrimination and retaliation.  There are emails that talk about getting the Indians off the reservation and like remarks.  The three Indian physicians have their own practice and did not get along with the rest of the cardiologists on staff. This led to strife with the administration and lack of trust on both sides.  The cardiologists state that they are all citizens, they were removed from committees, removed from laboratory posts and overlooked in favor of new less qualified cardiologists.  The three cardiologists would not refer to the cardiac surgeon due to questions about his skill and they were threatened regarding their privileges.  The hospital stated that this was a mistake on their part and referral patterns were not a reason for privileges.  When the physicians were no longer allowed to practice at the hospital due to the closure of the department they sued and won an injunction to allow them to continue to treat patients at the hospital.  The appellate court overturned that decision but they are still practicing at the hospital while the appeal to the Supreme Court is pending.  The discrimination suit against the hospital is on hold until the issue of potential qualified immunity is concluded. However, the cardiologists are not being told by the ED when their patients come to the ED.  The hospital states that the three cardiologists started a smear campaign against the cardiac surgeon who threatened to leave the hospital.  The hospital also states they have many ethnicities on staff and they do not discriminate.  

Juweid v U of Iowa

In an equally ugly fight Dr. Juweid, a tenured professor at the University of Iowa, believes the University is promoting unneeded and dangerous PET/CT scans on normal patients.  He turned the University in to the state for doing one on a 8 year old child.  The University is attempting to get rid of Dr. Juweid and accuses him of a HIPAA violation in turning the information into the state.  Dr. Juweid is now suing the University for multiple state complaints.  The fight is now in the news and will probably continue to play out in the papers.  

Record v Healthone of Denver
D Colorado

 A physician sued another physician for sexual harassment and for his suit wanted peer review records which the Medical Board refused to hand over.  The court stated that there is no federal peer review law and ordered the records handed over. 

Papudesu v Med Mal Jt. Underwriting of Rhode Island
Rhode Island Supreme Court

This is a case that all physicians should take to heart and change med mal carriers if the carriers have a provision that they may settle a case without the consent of the physician.  The high court said the carrier could settle in the middle of a trial without the consent of the physician.  This will potentially screw the physician for a insurance business decision since all payments made on behalf of a physician are reported to the NPDB and the physician must report it on all future forms.        Top

  Peer Review & Employment

Mercy Hospital of NW Arkansas v Bicak
Ark Ct. App

The hospital sued Dr. Bicak for having the audacity of terminating his employment and going to work elsewhere.  The court blasted the hospital stating they had no evidence of the physician stealing patient information and that all they were doing was attempting to eliminate competition.  That is what hospitals do the best.  Summary judgment for the physician.

Sisters of Charity v Farrago
Maine Supreme Ct.

The Sisters of Charity did not live up to their name when they sued three employed physicians who left to work for a competitor and took 1300 patients with them.  The physicians had a restrictive covenant and liquidated damages provision in their contracts.  The court upheld the contract and ordered each physician to pay $100,000 to the Sisters of Charity as liquidated damages.  

Bissada v Arkansas Children's Hosp
8th Circ

The physician had his privileges revoked and sued for discrimination.  The physician agreed to no hearing rights as part of a settlement and then sued for not getting a hearing.  Duh!  What attorney would allow this case to go forward?  Obviously, the hospital won summary judgment.

Kiblitsky v Lutheran Medical Ctr
NY Sup Ct.

In a novel action Dr. Kiblitsky sued the hospital for terminating her for cause and then reporting her to the Medical Board. Her contract stated that there was a no cause termination for 60 days.  the hospital paid her the 60 days.  She was reported for a for cause termination but never received a hearing as provided by the bylaws.  She is suing the hospital for the tort of self-defamation.  She states that she has to put down on all future applications the hospital's defamatory statements.  The problem is there is no such thing as the tort of self-defamation.  Summary judgment for the hospital on this count.

Executive Risk Indemnity v Charleston Hosp

In the underlying case Dr. Hamrick was terminated from the hospital for not having what they deemed adequate med mal coverage.  He sued for reinstatement and punitive damages.  He was promptly reinstated and eventually won his suit for false light and defamation against the hospital.  The hospital notified its carrier when it was sued by Dr. Hamrick.  Dr. Hamrick won $2 million in compensatory damages and another $8 million in punitive damages.  The insurance company declined to pay since it should not pay for the hospital's fraudulent acts and the hospital sued.  Since the physician did not sue for fraud the insurance company had to pay the full amount under its D&O insurance.   

Shahimian v Cedars Sinai
Ca Ct App

Dr. Hrayr Shalimian, a surgeon, won a $4.7 million judgment against Cedar Sinai Hospital for endangering the lives of his patients.  The Ct. of Appeals upheld the judgment.  He claimed and proved the hospital failed to sterilize his instruments using routine flash sterilization and leaving brain matter on "sterilized" instruments and put multiple road blocks in his way. He had resigned from the staff.  The hospital is considering further appeals.  

Williams v University Medical Center
D Nev

Dr. Charles Williams, an anesthesiologist, was accused of being a drug addict and removed from the staff of the hospital in 2005.  He then lost his family, professional reputation and his home.  He was given no due process or investigation into the charges.  He sued and won $8.8 million.  The problems stemmed from a renal transplant and the blame was placed on Dr. Williams to protect the program.  Dr. Williams had multiple drug screens which were all negative.  The judge had made a determination in advance of the trial that Dr. Williams rights were trampled and the only thing for the jury was the amount.  The parties had previously agreed to void the data bank report and pay Dr. Williams $6.5 million and not to seek appeal.  He was sued for the transplant patient and had a forced settlement of $775,000 by the insurance company.  In 2008 the hospital's renal transplant ability was stripped and reinstated a year later.

Pena v Meeker

Pena was fired from his position at Sonoma Development Center after he complained to the inner powers and finally to the DHS about the Center's removal of patient photographs.  The Center was chastised by the DHS for its photo policy and then Pena was fired.  The lower court ruled for the Center in summary judgment but the 9th said the jury had a right to hear the case.    

W Va Imaging Tech Bd. v Harrison
W. Va Supreme Ct. of Appeals

The court upheld the Board's decission to suspend Harrison for two years for working outside of his license.  The hospital in which he worked had a quasi policy of allowing techs to administer not only contrast material but also Benadryl for allergic complications without calling a physician.  This is what happened and the hospital failed to recognize it's own problem, fired Harrison and then turned him over to the state.  

Lurie v Mid Atlantic Permanente

Dr. Lurie was accused of being disruptive.  The Group moved him to various hospitals but the conduct was the same.  He was fired by Permanente and sued.  Guess what?  He lost in court.     

Suleman v Shinseki
D N Ca

Dr. Suleman worked at the VA hospital.  The hospital settled a med mal case and reported the settlement and Dr. Suleman to the NPDB.  Dr. Suleman sued to stop the report but to no avail.  The court stated that he did not go through all the administrative procedures since he did not ask the Bank to delete the report.  If that challenge is unsuccessful the Bank could be challenged in court.          Top

False Claims

US v Santos

A federal jury found nurse Armando Santos guilty of filing false claims and making false statements regarding his giving insulin shots to homebound diabetics who were not able to give themselves injections.   

US v Azeem

The government has added Muhammed Azeem to their Most Wanted List of health care fraud.  There are now 170 people on the list.  Most are foreign who have fled the country after being initially questioned by the government.

US v Gonzalez 

Rudy Gonzalez of Newark, New Jersey was sentenced to 24 months in prison for conspiracy to illegally sell prescription drugs.

US v Gonzalez

Miami residents Angel Gonzalez and Adrian Chalarca pled guilty of one count of conspiracy to commit Medicare fraud.  

According to court documents, from fall 2009 to summer 2010, Gonzalez and Chalarca submitted and caused the submission of $757,654 in fraudulent claims by Dynamic to the Medicare program. Gonzalez and Chalarca admitted that they paid and caused the payment of kickbacks and bribes to Medicare beneficiaries in order to obtain their Medicare billing information and used it to submit claims to Medicare for physical therapy services that were never provided. According to court documents, Gonzalez and others also stole the identities of a physical therapist and Medicare beneficiaries in order to submit additional false claims to Medicare. Gonzalez and Chalarca admitted that they knew the Medicare beneficiaries, on whose behalf claims were submitted to Medicare, never received the services billed to Medicare.


Another vice president of Dynamic, Andres Cespedes, pleaded guilty in May 2011 for his participation in the fraud scheme.            Top


D'Attilo v Viscarello
Conn Superior Ct.

In another ridiculous decision the jury in a med mal case against an OB for waiting too long to perform a C-Section and getting a bad baby with CP awarded the parents $8.6 million in compensatory damages and another $50 million in non economic damages.  The judge may reduce the award and should.  If not then an appeal will ensue.  The patients will not receive any money for many years.  The patient will never receive this amount of money since it is way over the insurance amount and the physician will either go bankrupt or never make enough money to pay the judgment.         Top 


Mercatus Grp v Lake Forest Hosp
7th Circ

Mercatus, a company that was to build a physician center to compete with the hospital, sued the hospital on antitrust after the deal fell apart.  The hospital did a public campaign lying to the public according to the complaint in order to get a community board to deny the competitor any ability to compete.  They also bought off two medical groups so they would not join the competition.  The court stated that it was all protected speech and as such did  not fall under antitrust.  It is obvious to all that if the plaintiff and defendant were reversed so would the verdict.        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.