June 15, 2012 Recent Legal News

Fraud & Criminal




Peer Review and Employment

Fraud & Criminal

US v Lahiji

Urologist Hossein Lahiji and his wife Attorney Najmeh Lahiji of McAllen, Texas, were indicted on Medicare and other insurers of fraud charges.  It is alleged they used unlicensed people to render care and billed for their services as well as billing for services never performed.  The allegations claim Dr. Lahiji treated over 100 patients a day as well as upcoding.  The couple have also been indicted in Oregon on separate charges and will appear there soon.

US v Al-Amin

Dr. Ihsaan Al-Amin (aka Robert O'Neil Robinson, Jr. ) from Chattanooga, Tennessee, has been indicted on federal drug distribution, money laundering, tax evasion and firearms charges.

US v Garrison

David James Garrison, a Southern California PA, was found guilty of illegally using Medicare numbers to obtain wheel chairs.  He would obtain the numbers and sell them to the shop that purchased wheel chairs at $900 and billed them at up to $5000.  Medicare was dumb enough to pay the inflated prices and is now attempting to recoup the payments.

United Kingdom v Garg

Mr. Sudhanshu Garg, a urological consultant at Bradford Royal Infirmary, was sentenced to two years in prison for gross negligence leading to the death of a patient.  The Indian trained physician failed to order an ultrasound on a woman with a kidney infection and then failed to transfer the patient to another facility per protocol.  He also falsified his medical notes regarding the case.

US v Gary Anusavice

Mr. Anusavice is an unlicensed dentist in Rhode Island.  It was found that he owned a chain of Medicaid dental clinics in Connecticut.  This scheme apparently defrauded Medicaid out of $20 million over two years. He had been previously arrested, convicted and excluded from the Medicaid program for fraud in Massachusetts and Rhode Island.   

US v University of Missouri

Two radiologists have resigned in the government probe of the University billing for reading X-rays not performed.  The Chief of the Department of Medicine also resigned.

US v Faulkner

Lance Faulkner of Tecumseh, Oklahoma was sentenced for Medicare fraud to repay $4.6 million as well as 51 months in prison and 100 hours of community service.  Mr. Faulkner was a prosthetic maker and spent most of misgotten money on cars and an outdoor music amphitheater.        Top


Keegan v Zukowski

Ms. Keegan had eight hours (yes, eight hours) of plastic surgery at an outpatient center.  The anesthesia was given by a nurse anesthetist.  She went into cardiac arrest several hours post op and was resuscitated by Dr. Zukowski, the plastic surgeon in Wilmette, Illinois.  The physician had left the center shortly after the surgery and was recalled when she was in arrest.  After the resuscitation she had brain damage and died two days later.  She had undergone a facelift, neck lift and breast implant all done at the same sitting.  The suit names the plastic surgeon, the nurse anesthetist, Geraldine Kacherian and her employer Windy City Anesthesia.  I don't understand the mental processes of a patient who wants to undergo all that at one time and the physician who would allow it.

Huddleston v US
6th Circuit

The Court has declared the suit against the VA by the patient for hepatitis B is too late.  The problem is that is was filed within months of being informed of the problem at the VA with sterilization of colonoscopy instruments.  The VA withheld the information until the statute of limitations had run within Tennessee where the case was filed.  The filing did not allege intentional concealment and so the three year statute held.

Fleming v Mountain States Health alliance

Fleming's estate sued for malpractice when he was assessed as a fall risk, fell in the bathroom with the sensor off and died of his injuries.  In discovery the plaintiff wanted all the internal policies and procedures regarding fall risks.  The court allowed this as (1) it is a federal court and (2) there is no rational reason why policies may not be discovered.  They also got the incident reports as they are not protected either.

Cleveland Clinic v Innovative Placements
ND Ohio

The hospital was sued for a wrongful death and paid $400,000.  The nurse who was at least partially responsible for the suit was at the hospital under contract with a placement agency.  The contract between the two entities stated that Cleveland Clinic would be indemnified for all actions, claims and demands whatsoever resulting from or claimed to have resulted from any intentional or negligent errors of Agency Personnel engaged in the fulfillment of the agreement.  Not only did Cleveland win on the contract but they also got attorney fees.

Cline v Kresa-Reahl
West Virginia Supreme Court

Cline entered the hospital with symptoms of a stroke.  He was seen by the neurologist who decided thrombolytic drugs were not indicated and treated him with bed rest.  He died and the widow sued for lack of informed consent. She did not do the things necessary for a med mal suit required in state law.  The courts all agreed that since thrombolytics were not indicated there was no claim for lack of informed consent but the claim would fall under med mal.  Since she did not do the required items for med mal the suit was dismissed.

Patient v Univ. of Ontego Dental Hosp.
To Be Filed

The dental lab at this New Zealand University dropped two specimens on the floor and when picked up they went into the wrong containers.  As a result of this a woman had a misdiagnosis of cancer and had her jaw removed.  She has hired an attorney.

Fee v Piedmont Medical Center
South Carolina Supreme Court

In a weird decision the high court said that an expert in a medical malpractice case only need to show that there was a breach of the standard of care and not causation.  Of course, if there is not causation there is no case.  Apparently the legislature only used the word "breach" in their law and not causation. This will be taken up again at the next session of the legislature.

Nice (executor of Harlem) v Temple University
Jury Verdict

Mr. Harlem was 38 years old when he was transported to Temple Hospital ED with chest and arm pain.  He had a past history of atrial fib and began experience the pain during a basketball game.  He was not worked up for heart disease and was released later that day with a diagnosis of pneumonia.  Three months later after a basketball game he had anoxic brain injury due to cardiac problems.  He was ventilator dependant and required many surgeries prior to his death.  The jury awarded $6.4 million and allotted 2% to the hospital, 10% to the resident physician who examined him and the remainder to the attending physician.        Top


Aetna v Bay Area Surgical Management

Aetna has sued the management company of seven California Bay Area surgical centers for $20 million to cover up their own negligence.  They claim that the surgical centers cherry picked their out of network clients and charged astronomical prices for procedures which Aetna paid without a second thought.  The charges were astronomical but were never challenged by the insurer.  They were the negligent party and should be sued by their insureds for their negligence being responsible for raising premiums.  Aetna claims the centers did not charge their patients out of pocket co-pays for going to an out of network provider.  Illegal?  Aetna claims the physicians did not tell their patients they were owners in the centers.  Illegal?  Aetna claims it is illegal for physicians to be paid for referring patients.  The physicians were paid for their ownership in the centers and not on the number of referrals.  Aetna claims physicians are only to bill the fair market value for their work.  The physicians billed their services legally.  The surgical centers are being sued, not the physicians.  Aetna was not scammed they were fools.  The only potential problem for the surgical centers was in not collecting the co-pays.  Since they had no contract with the insurer they had no duty to tell them they did not pay co-pays.        Top


Patients v Our Lady of the Lake 
To Be Filed

The Baton Rouge, Louisiana hospital had a lap top computer stolen with 17,000 names and PHI.  Another example of the wonders of electronic medical information.        Top

Peer Review and Employment

Melman v Montefiore Med Ctr
NY App Div

Dr. Melman was Chief of Urology at the med center.  He complained to the center that he was being paid less than one of his subordinates.  He then complained that he was being bypassed for committee meetings and being retaliated against for complaining about the pay differential. He sued and lost since the pay differential had nothing to do with age but with the subordinate's ability to do robotic surgery and threatening to leave if he wasn't paid more.  The court also believed that once one files a law suit or threatens one the medical center may see this as a potential problem and not want the individual to be a part of the center.  The court ended with it "saw no justification for allowing this meritless lawsuit to continue to divert the medical center's limited resources" from its true mission.

Akl v Virginia Medical Center

Dr. Akl was terminated from the medical center and sued for 12 separate actions.  They were all dismissed on summary judgment.  The hospital then sued Akl for sanctions.  Akl filed for bankruptcy to avoid the payment of sanctions.  The hospital withdrew its sanction suit and Akl sued the hospital for suing for sanctions just for harassment.  The hospital won again on summary judgment and Akl appealed.  Guess what?  He lost again. He never proved the hospital acted in bad faith in any of the suits.

Gowski v Peake
11th Circuit

The 11th Circuit confirmed that a single issue is not a cause for harassment complaints but a retaliation of internal complaints using multiple disciplines is.  The doctors worked at the Bay Pines VA and complained about a litany of retaliations the hospital made if anyone complained.  Dr. Gowski received $16,000 in lost wages and an additional $250,000 for emotional distress.  Dr. Zachariah received $90,000 in lost wages and $1 million for emotional distress.

Meyle v San Diego Ambulatory Surgical Center

Two former employees of the surgical center have filed a claim in Los Angeles that the center used potentially contaminated instruments on patients during bariatric procedures. The Centers in Beverly Hills and San Diego were accused of not sterilizing  instruments properly.  The centers are owned by the Omidi brothers who also own the infamous 1-800- GET- THIN advertising gimmick.  It is interesting that one of the plaintiffs is a dietary worker and one wonders how she knows anything about surgery.  The other plaintiff is a surgical assistant, who may have some knowledge. 

OhioHealth Cardiology v Physicians

The cardiologists that ran OhioHealth left and went to work for the U. of Ohio.  They were sued for non compete and the settlement said they are not to practice in the county they were practicing until fall 2013.  They also need to pay OhioHealth $125,000.  The University will help pay the physician's monetary fine.  The University was not a party to the suit.        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.