June 15, 2013 Recent Legal News




Peer Review and Employment




US v Goldman

Dr. Eugene Goldman of Philadelphia has been found guilty by a jury in federal court of illegal kickbacks.  He will be sentenced later but will be removed from the Medicare roster.  He was the Medical Director at Home Care Hospice and referred many patients there.  That's not a problem but when you get reimbursed for sending your patients to the Hospice that is a problem.  The payments were disguised as payment for his services as Medical Director.   

US v Sharma

The Sharmas, a husband and wife MD team, had previously been convicted of Medicare fraud and sentenced to prison plus payment of restitution of over $40 million.  They appealed the money.  The court of appeals changed the amount to $37 million.  They have already lost all their real property and accounts which totals about $27 million.  They will be personally liable for the total amount.  These Texas docs were really good and very efficient in their practice as the amount of patient rose to a high of 279 patients in a day.

US v Kelly

Dr. Paul Kelly was sentenced to 18 months in prison for his part in a $18 million fraud scheme.  He signed home health referrals without the patient being homebound.  He was also to pay $582,000 in restitution.

US v Patil

Dr. Sandesh Rajaram Patil of London, Kentucky, pled guilty of doing cardiac stents in people who did not need them.  St. Joseph Hospital has already paid $256,000 in restitution.  The physician apparently placed stents in arteries that were less than 70% occluded.

Clark v Beth Israel

Heiress Hugette Clark spent the last 20 years, yes years, of her life living in Beth Israel Hospital.  During this time she paid $800 dollars a day and stayed in several different rooms without any medical reason, according to the suit.  While alive she gave a $6 million Manet painting to the hospital and an additional $4 million in cash.  Her will left $28 million to her nurse, and $3 million to her physicians.  She also left an additional $1 million to the hospital in her will.  She paid the hospital with her daily payments over $5.8 million over the twenty years.  I wonder if they got Medicare payments as well.  The family is suing for coercion and duress with disgorgement of the money. 

US v Okereke

Dr. Edozie Okereke, a Podiatrist in Shreveport, Louisiana, was sentenced to 21 months in prison and supervised release for three years.  He was also ordered to pay $680,000 in restitution for upcoding from disallowed codes to allowed codes.

US v Siripurapu

 Dr. Padma Sirpurapu of Belle Mead, New Jersey pled guilty of receiving kickbacks for referring patients to an MRI unit.  She admitted receiving several cash payments for referrals.  She is the 12th person to plead guilty to this charge.

US v Werther

A federal jury found Dr. Norman Werther of Fort Washington, Pennsylvania, guilty of 300 counts of drug crimes including a charge of distributing resulting in death.  He faces a mandatory 20 year sentence and may get up to life.        Top


Dewey v Sutter Health
Class Action Dismissed

Two plaintiffs sued in a class action against Sutter for their alleged tactics of forcing insurers that do business with Sutter to have their insured use Sutter physicians and facilities even if there is a cheaper alternative.  The district judge did not see enough proof but left room to amend.  The plaintiffs will amend and if still denied will go to the 9th Circuit, the circuit with more cases tossed by the Supreme Court than any other circuit.

Patients v Sutter Health
To Be Filed

The Alameda County (California) Sheriff's Department raided a drug house and found the personal information of about 4500 Sutter patients from Alta Bates, Eden Medical Center and Sutter Delta.  It is probable that they were using the information to get drugs or for identity theft in general.

US v Prime

Prime agreed to pay without liability a fine of $275,000 for Shasta Hospital violating HIPAA by releasing the medical information on a patient who had previously released his information to California Watchdog in an investigation of the hospital's billing practices.

Brown v Rawson-Neal Psychiatry Facility

Brown in the lead plaintiff in a class action suit filed by the ACLU against the facility for dumping patients.  The facility had allegedly sent patients on buses throughout the country to get them out of the area.  Added to the suit was the state of Nevada, the head of the state Department of Health and CMS.        Top


Center for Reproductive Rights v HHS
2nd Circuit

The appellate court ruled against Sebelius and the Obama administration in their attempt to override the FDA's stance to allow Plan B over the counter for those 15 and older.  This had been the first time a HHS person had ever attempted to overrule the FDA.  The court got around the HHS by allowing the 2 pill Plan B to be sold over the counter while the appeal of the 1 pill option was underway.  The administration then decided not to appeal and to allow the Plan B to be sold over the counter to all.

Consumer Watchdog v UnitedHealthcare

The action was filed because United has stated their subscribers must use the mail pharmacy and not local pharmacies for serious diseases such as HIV/AIDS.  The lead plaintiff in the proposed state class action suit is named Doe who is suing over the privacy of HIV meds.  This is basically the same suit that settled a month ago with Blue Cross.  The settlement allowed an opt-out of the mail in pharmacy.        Top

Peer Review and Employment

El-Attar v Hollywood Presbyterian Med Ctr.
California Supreme Court

The California high court has unanimously ruled that the delegation of authority to the hospital board by the medical staff to appoint a peer review committee is not a loss of due process to the practitioner being reviewed.  Dr. El-Attar was denied re-appointment and requested per the bylaws a peer review hearing.  The MEC was mad at the board since the MEC had given El-Attar the re-appointment but the Board overruled them.  The MEC then said let the board appoint the peer committee.  They did and El-Attar was denied re-appointment.  The peer review body said the re-appointment was justified but they would have not done that if they had been asked initially.  The lower court in a mandamus decision stated all was OK.  The Court of Appeals stated the hospital overstepped it's authority since there was nothing in the bylaws to allow the board to convene a peer review hearing.  The high court said that may be so but the physician's due process rights to a fair hearing were still not affected materially. The lower court now needed to decide whether there was actual bias or other problems with the now declared legal proceedings.

Villare v Beebe Med Ctr
De. Superior Ct.

The hospital had taken the physician off the Trauma roll and the physician sued and lost.  He is now suing the hospital for failure to renew his privileges.  The hospital argued that the issue had been decided in the earlier case. The court disagreed with the hospital as there were two separate events three years apart and allowed the case to go forward.  However the physician could not claim that his termination of the trauma led to the failure of reappointment and he could not ask for damages.

Hepner v Thomas Jefferson Hospital 

Hepner sued the hospital after he was terminated.  In the summary judgment motion the hospital lost since there was an on the job injury, hostile treatment, medical leave and termination of his job all in close proximity to the date of injury.

Ramos v Kawanee Hospital
Ill App Ct.

Ramos was summarily suspended from the hospital and sued.  The jury found against him and he appealed.  The appellate court ruled that the hospital did the best it could when it missed the deadlines for a hearing by several days.  They did order a new trial since the judge refused to allow Ramos to depose an outside reviewer who was instrumental in getting him removed.        Top


Calloway v Ohio State Med Board
Ohio Ct. App.

In a follow-up to a case presented here several months ago, Calloway was finally out of trouble.  Dr. Calloway initially had his license revoked for vouching for a fellow physician who he really knew very little about.  However, the courts felt like Dr. Calloway did nothing wrong.  He left out the time he knew the other physician who had his license revoked in another state.  The Board screwed up by not sending the unfinished paper back to Dr. Calloway.  All is right in the world again.

N. Carolina Bd. Dentistry v FTC
4th Circuit

The FTC filed an antitrust action against the Board when they attempted to stop non-dentists from providing teeth whitening in the state.  The Board answered by stating they were exempt from antitrust due being a state agency.  The courts disagreed with the Board.  They found that since the Board was mostly practicing dentists elected by other dentists they were not a state agency but a private actor and therefore are not immune from scrutiny.  The Board was told by the FTC to stop issuing cease and desist orders to non dentists doing teeth whitening as this is against the Sherman Act.        Top


Dickoff v Tollefsrud
Minnesota Supreme Court

Dickoff was an infant when she developed a lump that was later found to be a rhabdomyosarcoma and had spread to other parts of the body.  The parents sued the pediatrician and his employer and lost in the courts since the theory of the case was loss of chance of survival.  The Supreme Court reversed and the state has now joined 22 other states that allow this claim. The case now goes back to the lower court for trial to determine if the physician really cost her a chance at survival.        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.