May 15, 2012 Recent Legal News






Peer Review and Employment



Minnesota v Accretive 

The state Attorney General has sued Accretive Health, the collection agency, for fraud.  Accretive has gone to court to have the suit dismissed.  They state no consumers have been harmed and the fraud claims are baseless.  Accretive has also been under the gun for aggressive debt collection measures.  It has temporarily halted all debt collection in the state. (See Recent News)  

California v Prime Healthcare

California has accused Prime's Shasta Regional Medical Center of HIPAA violations for defending itself in the press and with its employees about a story that stated Prime over billed a patient.  The fine could be as high as $250,000.   Top


Buckwalter v Nevada Med Bd
9th Circ

Dr. Buckwalter was investigated for illegal prescribing and had a summary suspension of his ability to prescribe.  he tried to settle the case but was unsuccessful and sued.  He lost since the Board was deemed by the liberal 9th Circuit to have full immunity under state and federal law.

Cundiff v California Med Bd
CA Ct App

Cundiff, a Board Certified Oncologist and Hematologist lost his hospital privileges and then his license for withdrawing anti coagulants from a patient with DVT.  The patient developed another clot and died.  He did research and firmly believed what he did what not sub-standard.  He had a hearing before an ALJ who agreed with the Board because the physician believed what he did was correct.  Nine years later he again applied for his license and again was rejected by the Board and an ALJ for still believing what he did was correct.  He then sued and lost in both the trial and appellate courts for the same reason, his continued belief that he was right and the medical literature was wrong.  He had not been rehabilitated.        Top


US v Villa

The Villa brothers of Miami, Florida, are the alleged biggest thieves of prescription drugs in the country.  They were said to drill into the roof of an Eli Lily warehouse in Connecticut and make off with $70 million of prescription drugs.  The heist happened in March, 2010.  One of the brothers was also charged with the theft of 3500 cases of cigarettes from a warehouse in Peoria, Illinois.  

Virginia v Beshah
Va Ct App

Netsanah Beshah, a LPN, was convicted of forgery of charting she administered meds when she did not.  A patient's family complained and the FBI put a camera in the room showing that she did not do what she wrote she did.  The convictions was upheld.

Nevada v Desai
Nevada State Court

 Dr. Dijak Desai was found by a grand jury and then by the court able to stand trial for his operation of a clinic in which Hepatitis C was transmitted to patients due to faulty cleaning of colonoscopy instruments in 2007 and 2008.


Doctors v St. Joseph Med Ctr
Trial Ct

Physician OB/Gyns at the New Jersey hospital sued the hospital and Dr. Roger Kierce, the chief of the department for harassment.  The chief was accused of using harassing comments to control the physicians.  The hospital was sued for failing to act on the complaints against the OB chief.  After an hour the jury came out with a verdict of $1.5 million.  The judge ordered a reduction of the money and the jury verdict was $1.270 million shared equally by the three defendants Kierce, the hospital and the CEO.  This story from the North came to me from a reader.

Veterans v VA
9th Circuit

The entire court reversed the panel and said that the court can not force the VA system into becoming a good hospital system that cares about it's patients.  Only the President and Congress can fix the problem and they are both incompetent to do so.  Therefore the country's vets have to wait four years to see a physician for mental health problems.  This continues the joke on the Vets that the VA has become.  Let the Vets come to private physicians and pay their bills and meds.  This will save lives and costs.        Top


Engelhardt v St. John Health
Mich Ct. App

A patient sued a physician for malpractice and the hospital for negligent credentialing.  The physician nicked a nerve in the surgery.  He had 17 med mal cases filed against him from 1984 and 2002 which the plaintiff alleges should have put the hospital on notice.  The court ruled that the past actions did not mean that the current injury would have been avoided.  Therefore due to lack of causation the hospital should have been given summary judgment.

Robinson v Spectrum Health
Michigan Trial Court

Ms. Robinson went to the ED for a sore throat.  She was seen and sent home.  She returned several hours later with increasing pain.  She again was sent home with pain meds.  The next day she again returned where she was diagnosed with Group B Strep.  She went on to a full blown cellulitis with many surgeries.  The hospital lost the case and the jury awarded $755,000.  The hospital will appeal.  It should be pointed out that the patient was not seen originally by a physician but a physician assistant. 

Medical Protective Co. v Duma
6th Circuit

The circuit court agreed that the med mal company did not have to indemnify a physician who delivered a baby while intoxicated. There was an explicit clause in his Kentucky contract stating same.    

Sanders v Ahmed
Missouri Supreme Court

The state Supreme Court affirmed the cap on economic damages which started at $350,000 but is now $600,000 due to inflation.  The case was one of alleged malpractice of the physician not recognizing medication side effects.  This ruling only applies to pre 2005 claims.  There is a second case before the court regarding later claims.  That has not been decided.   Top

 Peer Review and Employment

Conn. Dept. Public Health v Freedom of Information Committee
Conn. Superior Ct.

A newspaper sued for information regarding a physician that were obtained by the Public Health Department of Connecticut from the NPDB.  The Health Department refused to give the information after the FOIC had ordered it to release the information.  The suit protected the information in the HIPDB from the paper's intruding eyes.  It allowed the release of the NPDB records since the State Supreme Court had allowed the disclosure in a previous case.  I do not understand how the State Supreme Court can overrule a federal law, HCQIA.

DeKalb Med Ctr v Obekpa
Ga Ct App

The physician was alleged to have quality issues.  He went through peer review hearing which agreed and the Board terminated his privileges.  He sued to have the lesser severe peer review recommendations put in in place of the Board's and to have the hospital not report his termination to the NPDB while the case was in progress.  The trial court agreed and the court of appeals overturned the trial court.  The appellate court said since there was no malice the hospital was entitled to immunity from suit.

Nigro v St. Joseph Med Ctr
Mo Ct App

The physician did not show up in the ED when called for a patient.  He was suspended and investigated.  He disputed the findings of the investigation but he waived his right to a hearing if the suspension was lifted.  Two years later Blue Cross asked the hospital about the physician with a release signed by the physician.  The hospital complied and sent the verbatim report of the investigation.  The physician sued for defamation.  The trial court and the appeals court both gave summary judgment to the hospital.  Truth is an absolute defense.  The report was true even if the physician disagreed with the conclusion.  Also the physician had released the hospital from liability for reporting in good faith.

Jajeh v County of Cook
7th Circ

This is another dumb physician and attorney combing to clog the courts.  He was employed as a physician at the hospital when the hospital did a cut back of positions.  His was one such position.  He sued for discrimination and of course lost.  

Vertkin v Cal Physicians Serv.
Cal Ct App

The physician had a contract with the insurance company as a preferred provider and participation in a managed care network.  She was terminated from a physician group, the only group associated with the insurer in the county.  She was told that she still belonged to the network but she balanced billed patients anyway since she believed she had been terminated. The contract with the insurance company was terminated because of the balanced billing. The trial court gave summary judgment to the insurance company. The court of appeals agreed to give the physician a new trial as it was reasonable to believe that managed care only meant HMO and not PPO as well.  This was a contractual ambiguity which meant a trial.        Top


US v Apex Medical Grp

Apex Medical Group aka Nephrology Consultants of Knoxville, Tennessee, has agreed to pay $4.36 million for submitting false claims by upcoding.  

US v 107 Individuals

The feds raided seven cities and charged 107 people including physicians and other medical people of fraud.  The fraud was $452 million in false billing.  This included suspension of payments to 52 providers.  The arrests were made in Miami, Detroit, Los Angeles, Houston, Chicago, Tampa and Baton Rouge.

US n Day

Brian Day of Richton Park, Illinois, owned and operated Charms Development , LLC. in Chicago Heights.  He is charged with $1 million in fraud for false claims for psychotherapy services.  Day has no medical credentials.   

California v Guiamelon
Ca Ct App

The court of appeals upheld the criminal conviction of Dr. Guiamelon for paying for recruitment of patients.  The court said the she was put on notice that the action was illegal.

US v Abbott Labs

Abbot Labs agreed top pay $1.6 Billion to fed and state governments for illegal marketing of Depakote for seizures.  The company marketed the drug for conditions for which it had not been approved.

US v Parkland Hospital

The hospital and some of the physicians practicing in the hospital were charged with fraud.  The issue is that rehab appointments were made and treatment carried out without the order of the primary physician.  This is a whistleblower suit filed by a former resident at the hospital.   

US v Agbebiyi

Dr. Jonathon Agbebiyi of Detroit has been convicted of fraud.  The OB did unnecessary neurologic tests on patients.  The tests were done by his clinic employees who had no knowledge or ability to do the tests.  The patients had been recruited to the clinics with prescriptions or money.  The physician is the 9th individual to be convicted in this matter.       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.