Georgia v Funk
Dustin Funk went to Northside Cherokee Hospital in Canton, Georgia 29 times under multiple different names as a way to score drugs. He is now in jail.
New York v Choy
Dr. Lawrence Choy is under arrest for manslaughter. He fled to Wisconsin when he learned he was under investigation for the death of two patients after overprescribing a mix of oxy, Xanax and a muscle reliever.
US v Memorial Hermann Health
The feds have said why Memorial was fined $2 million when the hospital wouldn't. The fine was for billing for scheduled surgical services when the patients stayed under two days. They billed as inpatients instead of outpatients which they knew was the law.
US v Delgado
Dr. Julio Delgado pleaded guilty of aiding the fraudulent acquisition of controlled substances. In the past month Dr. Gilberto Sanchez, Elizabeth Cronier, RN and Stephanie Ott, RN all of Montgomery, Alabama, also plead guilty. They wrote prescriptions for patients that were not seen or did not have an examination.
US v Hurley
Five salesmen from the dreaded Biodiagnostic Labs have been sentenced. Doug Hurley and Kevin Kerekes of New Jersey were sentenced to 24 months. Like Chicco of New York was sentenced to 21 months. Kristina Hamdan of New Jersy was sentenced to 41 months in prison and David McCann of New Jersey was sentenced to three years probation. They had all plead guilty of violations of the anti-kickback laws.
US v Zamora-Quezada
The feds have indicted Dr. Jorge Zamora-Quezada of Mission, Texas, of health care fraud and money laundering. They say he falsely diagnosed people with diseases after running unneeded tests. He then treated them with unneeded chemotherapy for their non-existent diseases. The indictment wants forfeiture of his jet plane, Maserati, and multiple residential and commercial properties in both the US and Mexico.
US v Mercy Health
The Cincinnati organization has agreed to pay $14,250,000 to settle allegations that they paid six employed physicians over FMV for their services for referring patients.
New York v Demas
The state charged Keisha Demas RN of receiving money from Interfaith Medical Center for not showing up for work for four years. She did not pay income tax and did receive Medicaid during that time. She was contracted to the hospital via a outside nursing agency and had someone falsify her timesheets.
US v Koh
Dr. Vincent Koh and his wife and office manager were sentenced to pay fines of a total of $10,500 for a misdemeanor of receiving misbranded drugs. The oncologist and his wife ordered discount drugs from foreign areas which he prescribed to patients.
US v Effingham Health Services
The system agreed to pay $4.1 million to resolve allegations that it did not guard against theft of drugs that contributed to the opiod epidemic. They did not report the drug diversion to the DEA. They had many thousands of oxy not accounted for.
US v Barit
Dr. Manuel Barit of Mullins, West Virginia, was indicted on charges of unlawful distribution of opioods. He also was charged with billing for services when he was out of the country.
US v Mitta aka Reddy aka Suresh
Suresh Mitta aka Suresh Reddy or Mitta Suresh was convicted in Missouri of selling fake MRI equipment to a north Texas hospital. The following week he had what is described as a seizure in his cell and died. Mitta was the chief technology officer of several companies owned by Albert Davis who has already been sentenced to 12 years in prison and the restitution of over $19 million.
US v Amarrah
Atheir Amarrah, the owner of Prompt Care Home Health in Bloomfield Hills, Michigan, plead guilty to paying illegal kickbacks to recruiters for referrals.
US v Tanner
Gary Tanner, the former Valeant executive and Andrew Davenport, the past CEO of Philidor RX Services were found guilty by a jury of defrauding Valeant. They did a secret kickback where Tanner would kickback to Davenport for referrals. Tanner also killed deals with Philidor rivals.
US v Pfizer
The feds have alleged that Pfizer used a charity to raise the price of Tikosyn, a heart drug. They say that Pfizer worked with the charity to help defer costs of the drug at the same time they raised the price of the drug. They gave $10 million to the fund. Pfizer agreed to pay $23.85 million.
US v Rose, Sr.
Jeffery Rose, Sr., the former CEO of Team Work Ready was sentenced to 233 month in federal prison and was ordered to repay $14,537,548 in restitution. He and his wife were found guilty in October, 2016 for submitting false claims for PT therapy. They billed for never received one on one therapy.
US v Solvay Pharmaceuticals
The high court did not take the case from the 5th Circuit allowing summary judgment to Solvay. Two relators who worked for Solvay alleged the company engaged in off label marketing and kickbacks. All courts in the case agreed the whistleblowers were not the original sources.
Nevada v We Care Behavioral Health
The agency was found guilty of a gross misdemeanor charge of intentional failure to maintain adequate records of their billings to Medicaid. They were fined $1million and put on three years probation.
US v Traylor
Dr. Millicent Traylor of West Bloomfield , Michigan, was convicted of health care fraud. She was unlicensed but acted as a physician for home health care. She falsified papers showing services provided were necessary when they were not. She also forged other physician names on prescriptions for oxy.
US v Mallory
The feds sued LaTonya Mallory, Floyd Dent III and Robert Johnson and won a judgment of $111,109,655 against the three and an additional $3 million against Dent and Johnson. This after a jury verdict against them where they were guilty of paying kickbacks for referrals for laboratory tests which were not necessary. These are triple damages. The original suit was a qui tam filed by Dr. Michael Mayes et al. their share remains to be determined.
US v Frey
Dr. Michael Frey of Fort Meyers agreed to pay $2.8 million for receiving kickbacks from medical equipment and pharmaceutical companies for referrals from A&G Spinal Solutions. He also faces up to 10 years in prison.
Anthem v Sonoma West Medical
This suit is for fraud in billing for toxicology specimens. The health district was not named in the suit.
US v Signature Healthcare
The skilled- nursing provider agreed to pay $30 million to resolve allegations that it upcoded for rehab services.
US v Nicoll
The president of the infamous Biodiagnostic Lab and his brother were sentenced. The president David Nicoll was sentenced to 72 months and his brother was sentenced to 43 months in prison. Should have been longer.
US v Hess
Jennifer Hess, the owner of Redirections Treatment Advocates with offices in Pennsylvania and West Virginia has been indicted for unlawfully dispensing controlled substances and fraud. She apparantly aide five physicians with unlawfully prescribing Suboxone not for the treatment of addiction.
US v Tarabein
Dr. Rassan Taravein of Alabama was sentenced to five years in prison and to repay just over $15 million to six different health care programs. He operated a private pain clinic and induced patients to visit to illegally bill insurance programs for unneeded tests and procedures. He still is to be sentenced in state court for other offenses.
Life Legal Defense Foundation v
A California trial judge ruled that the state's law allowing terminally ill to end their life was unconstitutional. It was not the law but the way it was passed that was wrong. There was a special session of the legislature devoted to medical care and passed this law. They need to do it again and do it right this time. The state has appealed and in the meantime the legal decision continues, no more physician assisted suicide.
Avera v Meadowvale Dairy Employee
Juan Marquez was employed by the dairy when he developed Guillain-Barre Syndrome. He was treated at Avera McKennan and ran up expenses of over $760,000. He was eligible for participation in the dairy medical plan and the plan submitted some of the expenses for payment. That is when they found out Marquez was an illegal alien who used a false name and SSN. The plan administrator then sent Marquez a letter stating his coverage was retroactively denied. Avera appealed to the plan and it was rejected. The court found that the plaintiff hospital complied with all relevant administrative processes and had standing to sue.
Maczuga v Michael
Boguslaw Macuga was injured in an auto accident and treated by Dr. Ronald Michael. Following surgery he received a surgical bill for $244,267.01. When he did not pay he received a notice to pay based on a contract that said the patient would pay all reasonable fees. At trial the plaintiff had an expert that said the reasonable amount would be $41,294. The trial court awarded that amount and the surgeon appealed. The upper court found where there is a contract where no there is no provision regarding price the law implies a reasonable price. The court also found there is no reason why the lower court should not have believed the plaintiff's expert regarding the locale's reasonable price.
The Community Oncology Alliance v
The 5000 independent oncology association filed suit against HHS to halt a 2% Medicare sequester cut for Part B drugs especially cancer drugs. This Obama era law was extended recently. The suit says the law is illegal under the separations of powers doctrine.
Planned Parenthood v Arkansas
The court turned away a case without comment from the 8th Circuit who said the lower court invalidation of the law was premature. The law requires those physicians that prescribe medication abortions either have or contract with a physician who has hospital privileges. This will close two of the three abortion clinics in the state as they offer only medication abortions.
King County v HHS
King County sued the feds after their $15 million grant for teen pregnancy prevention was terminated two years early. All grants were terminated in all states in 2017 because the HHS did not believe the program was working. The judge ruled for the county.
Doe v HHS
The court punted the case with no dissents since it was now moot. The case was that an illegal teenage female alien who requested an abortion. The feds said no even though no fed funds were to pay for the abortion. She sued via the ACLU and won the right to have an abortion which she did. The court said the lower court's decision was overturned and therefore is not allowed as precedent. The court did not rule on the underlying cause of action regarding the legality of making the feds allow abortion for illegal aliens. There needs to be a case before the court before an abortion.
Doster v Pomona Valley Hospital
Plaintiff Teri Doster went to the hospital ED for emergency services and was billed for same. She then sued and wanted a class action invalidating ED billing for reasonable amounts. The court ruled that there could be no effective relief as each persons bill would need to be analyzed for reasonableness, therefore a class action would not be a superior way to resolving the issue. Another shyster shot down.
Texas v US
Several years ago Texas and other states filed suit against the feds stating that Obamacare was illegal. The feds have now agreed and will not defend the case. The feds say the part of the act that mandates insurance companies cannot deny coverage or charge higher rates for pre-existing conditions are unconstitutional. The Blue states have filed to defend the law.
Moda Health v US
Moda Health and Land of Lincoln health insurers had sued in the lower courts to get money they say they were owed from the risk corridor program. A divided 3 judge panel rejected their argument stating Congress had taken action requiring the program to be budget neutral each year. Next to the full court nad then the Supreme Court.
Patients v LifeBridge Health
LifeBridge Health of Baltimore notified over 500,000 people of a compromised health information malware server. They found this almost two years after information was accessed illegally. Gross negligence.
Patients v Terros Health
Terros Health reported a phising scam that got data on 16000 patients with mental illness and drug addiction.
Patients v Tenet
Tenet was the prior owner of MacNeal Hospital in western Chicago. During their ownership an employee Erik Albavera broke into homes of patients while they were in the hospital. They are seeking a class action by the attorney who wants fame and money for HIPAA violations.
Stewart Health v Blue Cross
A federal judge refused to allow Blue Cross immediately appeal a motion for summary judgment against it. Therefore the trial will occur. A hospital went bankrupt and Stewart was going to buy it but could not reach an agreement with Blue Cross. Stewart then filed suit stating Blue Cross obstructed the sale for antitrust reasons. Blue Cross filed a motion for summary judgment which was denied and the judge refused an appeal to the 1st Circuit.
Rhode Island v Rohde Island
The hospital agreed to consent agreement to do a bunch of system improvement measures after four recent patient errors. They had a wrong patient get a CT angiogram, a second patient get an angiogram meant for another, a wrong part spine procedure an a wrong patient getting a mammogram.
Patients v USC
It took the shysters of LA about two days to find plaintiffs to sue USC for the acts of disgraced OBGYN Dr. George Tyndall. There were articles in the LA Times regarding his acts during his long term as the GYN for the student health. He is accused of groping as the charges of making lew comments would not get much money. The suit also alleges that the school did a settlement with Tyndall in which they agreed to not speak about the alleged details.
Anderson v J&J
J&J lost another baby powder suit to a woman who claims she developed mesothelioma from the asbestos in the baby powder. There is none but the plaintiff says asbestos is intermingled in the mining of talc and it is impossible to remove. She won $21.7 million in compensatory damages in LA. This is the second loss for J&J in asbestos. They lost a case of $117 million in New Jersey. J&J won a asbestos case in California.
Boyd-Bostic v Johnson &
The judge declared a mistrial in the case of a plaintiff suing for mesothelioma after the jury could not reach a unaanimous decision.
Patients v Imerys SA
The company agreed to settle claims by 22 women that the talc it supplied to J&J was tainted with asbestos and caused their cancer. The secret deal gets the French company out of the J&J cases. This settlement allows a trial in St. Louis to proceed with J&J as the only defendant.
Doe v Good Samaritan Hospital
Doe is a 12 year old voluntary psych patient in a room with a 10 year old patient admitted under a psych hold. There was an order to observe every 15 minutes and this was apparently done. Doe was discharged after 9 days and told his parents he was sodomized in the bathroom by his roommate. The hospital was sued and a nurse did a declaratory that said the hospital met the standard of care. The plaintiff did not file an opposing expert declaration and summary judgment was granted. the appeals court overturned since a declaration without what the standard is and what the conduct required to meet the standard of care in no testimony.
Davis v Ingalls Health
The representative of the child who died sued the hospital and Dr. Atul Joshi for failing to diagnose and treat strept which let to other disorders that resulted in the death. Joshi was an independent contractor and the hospital moved and was granted summary judgment by the lower court. The court of appeals reversed stating that the hospital held out that Joshi was an agent of the hospital because the badge he was wearing had "Ingalls" on it rather than MEA his actual employer. He also had a coat on with the hospital name. These showed potential reasonableness that the patient believed Joshi was an agent of the hospital.
Jones v Bard
In a bellwether case a woman had a Bard vena cava umbrella move and it left a broken wire permanently stuck in the vena cava. She sued and lost. This is the second tried case and Bard lost the first one.
US v Delta Pharmacy
The USDC order Delta not to distribute adulterated drugs into interstate commerce. The FDA wanted this as they believed the compounding pharmacy was unsterile.
Patients v W W
A nurse in this Cherokee Nation hospital reused syringes to administer meds. Now 186 people are being tested for HIV and hepatitis.
Doe v University of Virginia
Jane Doe is suing the hospital for doing medical tests without consent. She was taken to the ED after a suicide attempt and had blood tests and a catheter inserted after she could or would not give a urine specimen. She apparently refused all the tests but got them anyway. The suit involves physicians, nurses and even the hospital CEO.
Henderson v Steward Health
Claudia Henderson the former senior vice president of human resources sued the company and the CEO and general counsel for harassment and discrimination for sexual and racial comments. She states that when she complained she was replaced with a white male.
Behnke v Aetna
Sarah Behnke, the chief Medicare actuary for Aetna filed a whistleblower law suit and was placed on paid administrative leave as soon as Aetna found out. She accused Aetna of not paying attention after she reported that Aetna's partner CVS Caremark was billing the feds more than appropriate for Medicare drugs. Caremark is an intermediary or PBM who sets prices for insurance companies and pharmacies. The suit says that CVS was charging Aetna up to 40% more than it charged Aetna's competitors. Apparently Aetna confirmed Benhke's analysis but still did nothing as they are being purchased by CVS. Aetna threatened to look for a better deal and then CVS offered a better deal and even better when they stopped shopping.
Aljaberi v Neurocare
Dr. Mohammed Aljaberi was employed by Neurocare until he was fired for misconduct due to physically assaulting another as well as having porn on his computer. He admitted to the problems but said he should have been disciplined not fired. He wanted for trial all documents relating to any communications sent to the state medical borad of Ohio. The court ordered the documents disclosed and Neurocare appealed. The upper court said the report was not filed with malice and the law states all reports to the board are confidential. Aljaberi gets no report.
Toussaint v Brigham and Women's
The Haitian American nurse Gessy Toussaint sued for discrimination and retaliation after she states she stood up for another Haitian nurse who she believed was suffering from verbal abuse. She lost the case for racial discrimination but won on retaliation and was awarded over $3 million in compensatory damages and $25 million in punis. This will be reduced. The retaliation claim was against her supervisor who put her on leave and made her take a test for new nurses on which she scored 100%. The other nurse's case comes next.
Taswell v Regents of University of
Dr. Carl Taswell is a nuclear medicine physician at UCLA. He complained to his chair regarding potential safety and compliance problems and got nowhere. He then went to the safety committee , the radiation safety officer and eventually to the California Department of public Health. He was put on paid leave and then he contract was not renewed due to a multitude of "issues". He filed a grievance which UCLA won and he sued under the whistleblower suit. The trial court ruled for UCLA on summary judgment for not exhausting remedies. The appellate court ruled for Taswell. He was not required to exhaust his remedies and was not barred by res judicata. The case resumes.
McGary v UMPC Susquehanna
Dr. Suzan McGary is a CV surgeon who wanted privileges at the hospital. She was denied because she did not meet the qualifications of doing 100 heart surgeries and 100 lung surgeries in the preceding year. She was on the staff prior but left for another position in another state. She returned after one year and applied for the position but the hospital had been purchased in the interim and the criteria had changed. She lost the antitrust suit on summary judgment.
Zappala v Steward Health Care
Dr. Stephen Zappala, a urologist who lost his privileges, has filed a whistleblowing suit against Steward for pressuring physicians and patients to keep referrals in network. He claims Steward called patients and told them they must have their surgery at Steward hospitals even if the urologist another hospital or cancel appointments Zappala's office made for patients at other out of network facilities. He states that after he refused to to comply with Steward's policies he was disciplined and then lost his privileges at Holy family Hospital. He was won in the summary judgment phase. Another physician also under order testified that Steward shamed physicians who disagreed with the policy and agreed that Steward cancelled out of network referrals. Sound's like Steward is going to get a ton of bad publicity costing them big bucks even if they win the suit.
Conard v Heartland Regional
Medical Center DBA Mosaic Life Care
Debra Conard was a medical coder for the company for about 40 years. She states that in April 2017 she was to start allowing charges for billing even if there was no documentation. She states she processed the charges but included notations about the potential for fraud. The following month she was moved to a coding position in another department and replaced by a younger person. She was also then disciplined and this led to a meeting after which she was accused of HIPAA violations and then fired. She is suing for age discrimination and retaliation along with the hospital doing billing fraud.
Nemickas v Linn County
Dr. Rimas Nemickas was employed by the group who entered into exclusive contracts with two hospitals. After he was terminated he suit for antitrust since he could not work at the hospitals. The court tossed the antitrust claim since he did not allege a true antitrust violation.
Theriault v Genesis Healthcare
A certified nursing assistant sued alleging she was fired in retaliation for whistleblowing activities. The lower and appellate courts both agreed that the facility was due summary judgment. She reported a fellow employee who was texting while dispensing meds. She failed to show that her report was the but-for cause of her termination.
White v North Carolina Medical
A judge paced a restraining order on the Board not allowing them to suspend Dr. Anne White's license. This allows her to immediately return to practice. The Board tried a summary suspension, a little used action, to suspend the license. This type suspension can be indefinite instead of only two years as with a revocation. She was accused of reusing syringes and dermatology products. She had been reprimanded at least four times in the past by the Board. She now goes before the Board in mid June to defend herself, if she can.
Gray v Medical Licensing Board of
Dr. Gerald Gray hired an unlicensed physician to treat his patients and allowed that person access to prescribe controlled substances. He then gave up his DEA license and plead guilty to one charge of Medicaid fraud. His license was on indefinite probations with a list of terms and conditions. The next year he applied for and received a new DEA number. He then wrote controlled substance prescriptions for his girlfriend. The board after an investigation issued a indefinite suspension of his license. He appealed and lost.
Song v Levine
Dr. Joon Song sued Michelle Levine for defamation after she posted about "very poor and crooked" business practices on Yelp, Healthgrades and Zocdoc. After getting sued she took down all the posts but the suit is still in play. She has spend over $20,000 fighting it to date. The suit is for $1 million plus legal fees.
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.