US v Mantoura
Amira Mantoura, a podiatrist in Greenwich, Connecticut, was sentenced to 200 hours of community service for falsifying the billing to private insurers as well as Medicare and Medicaid. She billed for nail avulsion when she performed clipping toenails. She must also pay three times the amount she illegally billed. This comes to a total of $618,000. It is to be paid within seven days. She is also banished from the Medicare and Medicaid programs.
US v Olympus
The company will pay $646 million to settle civil and criminal claims that it made illegal payments to physicians and hospitals to use its products. They also must upgrade its compliance training and maintain an effective compliance program, must have a confidential hotline for complaints, the execs must annually certify that the program is effective and they must set up a recoupment program for execs who engage in misconduct to forfeit up to three years of performance pay.
US v 21st Century Oncology
For the second time in a few months 21st Century has settled a fraud case with the feds. This time the amount is about $35 million and has to do with their radiation therapy clinical training and testing on something called GAMMA. Neither the company not the feds would comment on the settlement.
US v Azmat
In a fascinating case, the feds have said that the hospital has submitted false claims for services rendered by Dr. Najam Azmat. They say he should not have been given privileges to do endovascular procedures at Satillla Regional Medical Center. Dr. Azmat was found to be immediately upon joining the staff incompetent to perform the procedures by the staff who immediately reported it to the administration who did nothing except fire the nurse who did the reporting. She filed the qui tam suit and will get the money. The hospital will pay $840,000 for the settlement. There is still a claim against the physician for his false claims. Very stupid hospital and legal staff.
US v Toussaint, Jr.
Dr. Richard Toussaint, Jr., an anesthesiologist at Forest Park Medical Center in Dallas, was convicted of seven counts healthcare fraud. He can be sentenced to 10 years in prison and a $250,000 fine for each count plus restitution. He submitted billings for doing the anesthesia when it was done by nurse anesthetists. He also pre-signed medical records and inflated the anesthesia time. The amount falsely billed is about $10 million.
US v Kuchipudi
Dr. Venkateswara Kuchipudi of Oak Brook, Illinois, was convicted of receiving kickbacks from Sacred Heart Hospital on Chicago's West Side. He received free physician assistants and nurse practitioners both at the hospital and also in nursing homes. The hospital allowed Kuchipudi to bill for the services.
US v Eladema
Pharmacist Mohammad Eladema of Staten Island was arrested for allegedly billing for HIV meds never dispensed. He is said to have convinced and paid Medicaid patients not to fill their prescriptions and billing for them.
US v Greenspan
Dr. Bernard Greenspan of Bergen, New Jersey, was indicted on multiple causes of soliciting bribes from the ill fated Biodiagnostic Laboratory. He is alleged to have received over $200,000 in sham rental and other agreements.
US v Alzate
Oscar Alzate and Alba Garcia of Kissimmee, Florida were arrested for running a scam where they would phony up mammogram physician signatures and do poor quality work at their Digital Radiology Center. Neither are physicians.
US v Ades
Dr. Albert Ades, a GP in Englewood, New Jersey, was sentenced to 37 months in prison, 3 years supervised release and restitution payments of $280,000. He pled guilty of health care fraud for visits that never occurred. He also altered patient charts to back up his false claims. Top
Students v UC Berkeley
The university was hacked affecting about 80,000 present and former students and employees. The financial information was taken.
Employees v Main Line Health
The organization found out about spear phishing when an employee opened up an email requesting employee info. The employee gave the info thinking the request was real. No patient info was compromised.
Patients v Premier Healthcare
In yet another example of the problems with e-records, a laptop computer was stolen that had 200,000 patients personal health information. Let us hope they get big time fines.
Patients v 21st Century Oncology
This has been a bad fortnight for the cancer organization. First they were fined millions for fraud (see above) and now they report a data breach affecting 2.2 million patients. They say there is an ongoing federal investigation into what happened.
Patients v Geauga Medical Center
A former employee of the Ohio hospital illegally accessed the medical records of 677 patients for an unknown use. It continues to be a shame on hospitals that they wait for a problem before becomes active in preventing this type of crime. Top
Pipitone v Williams
The court ruled that a physician has no duty to report domestic abuse when they do not reasonably suspicion of the abuse. A person was killed by her husband. Several months prior she was treated when the husband ran over her foot with his truck. She did not reveal the true nature of her injuries at the time. Her mother did make a report to the police which was investigated. After the death the mother sued the physicians involved initially for not making the report. Common sense and the courts agreed that one can not report something which they do not know. The court also said causation was lacking since the police did investigate the mother's report.
Patients v Genesis Health System
The Iowa health system reported that four surgeries had wrong side problems. This occurred within a 40 day period. They were with different surgeons and at different hospitals.
Patients v Trinity Health
Both the affected patients and Manor Nursing Home in Minot, North Dakota, are suing the hospital for 52 cases of hepatitis C. Top
Gobeille v Liberty Mutual
The high court ruled for the insurer in an ERISA suit. Vermont wanted information for its healthcare reform efforts and Liberty did not want to provide the information. It is an old question with the same answer. Fed law supercedes state law.
FDA v Amarin
In a case of David beating Goliath, Amarin, a small company, was allowed to promote a drug for a non approved use as long as they do it truthfully. This settlement comes after the FDA lost in trial court. Top
Wheeler v Georgetown
Patricia Wheeler is a black nurse who was terminated by the hospital after colleagues reported multiple errors after one shift and a subsequent investigation. She sued for racial discrimination and lost in the District court. The DC Circuit said that she had presented enough information to overturn the lower court and allow the case to continue. She showed that non black nurses were not fired for the same errors.
Green v Calhoun Liberty
The CFO of the hospital filed suit against it for not trying to stop the harassment by the former CEO Phillip Hill. She accused Hill of stealing funds from the hospital and threatening her if she did not go along. She eventually resigned when the threats did not stop. He is now also gone and under investigation. 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.