NJ v Costino
In one of the stupidest trials ever, New Jersey is trying a physician for billing too much on seven occasions. They sent in an undercover agent and claim that the physician billed too much each time. The physician claims through his expert that he billed correctly three times, too much twice and too little twice. The total difference according to the expert was $35.93. The trial will go for several days and hopefully will leave egg on the face of the prosecution.
US v Raval
Dr. Pramod Raval and several others were found guilty for conspiracy to commit fraud by soliciting and accepting money for referring patients for PT and home health.
US v CVS
CVS Pharmacy has agreed to pay $5 million to settle allegations that they falsified to Medicare their drug prices.
US v Patel
In the continuing saga of Orange (New Jersey) MRI the medical director said that he paid bribes to physicians to send patients to the unit. Chirag Patel is the ninth person to plead guilty in this fiasco. Patel agreed to give up $90,000 gain from the deal.
Whistleblowers v Florida Hospital
Two whistleblowers, including one physician radiologist, is suing Adventist Florida Hospitals for Medicare fraud. They state that the hospital billed for imaging that was not in place at the time of the billing as well as for more MRI injection material than what was actually given. Now they have added additional fraud accusations regarding the Florida Hospital emergency rooms.
Friedman v Sebelius
Three former Purdue Frederick execs had been convicted of misdemeanor relating to fraud. The three had been banned from Medicare for 12 years. They sued stating that they had not been convicted of fraud but the court disagreed. The court did say the 12 years was arbitrary and remanded the case for another look at the length of time. HHS must justify it's reasons for the long length of time.
FDA v 1-800-GET- THIN
The feds and state of California have now filed criminal charges against the debunked practice. The suit includes the Omidi brothers who are the head of the program. Federal agents also arrested a LPN for attempting to extort money for patient records who died post surgery at the clinic.
US v Westchester Medical Center
The feds announced a suit and a simultaneous $7 million settlement against the Westchester (NY) Medical Center. The hospital billed for millions of dollars of undocumented mental health services to Medicaid. The settlement also makes the hospital return it's share of money paid paid from the state. Top
Patients v Physicians
The same law firm that filed medical malpractice charges against Dr. Mark Midei and St. Joseph Hospital in Baltimore has found 39 more patients to file claims against 8 more Cardiologists and the hospital for placing unnecessary stents. This round of charges include the physicians that measured the amount of blockage that allowed the cardiologist to place the stent. After three years this case is as open as the day it was filed.
Monk v O'Connell
A plaintiff sued the physician and the locum tenens company that hired him and placed him in the hospital. The trial court gave summary judgment to the locum company but this was reversed by the court of appeals. The high court applied the tests for the definition of employer employee and found that this fit into the classification.
Baker v Hedstrom
The court ruled that physicians practicing under a corporate or LLC protection are entitled to the provisions of the New Mexico Malpractice Act.
Patients v Blount Hospital
Blount Hospital in Tennessee has had a laptop stolen with the medical records of 27,000 patients. The computer was in the residence of an employee and was stolen during a break-in. The hospital is now, three months post break-in , notifying patients of their potential problems.
Braun v Lewis
Braun had multiple colostomies by the defendant and eventually died 2 1/2 years after the last colonoscopy. The physician was sued for medical malpractice but the court said the statute of limitations had passed. However the court on its own said this could be simple negligence and wrongful death and sent the case back for trial on these grounds. Apparently the physician never told the patient the results of the biopsies. Top
v Webber Hospital
A radiologist who provided services to the hospital sued the hospital and the new provider for discrimination and tortious interference. The hospital and new provider went for summary judgment but lost since the radiologist had pled enough facts and comments by the groups to overcome the summary judgment on both counts due to potential age discrimination.
v Avera Marshall Hospital
The hospital unilaterally changed the bylaws and the medical staff sued. The court originally ruled that the staff could not sue but individual physicians may. The court now ruled that there can be no breach of contract since medical staff bylaws are not contracts. The physicians are considering appeal. Again, I mention that Avera is very anti-physician and physicians should not go to those hospitals.
v Clinch Valley Medical Center
Horne, a nurse was fired for what the hospital said was not using the chain of command for complaints about a ED physician. She said it was for age and disease disability. The court tossed the age case since she was replaced by someone just a little younger but kept the disability in place. The hospital must have the dumbest administrator in history as he kept a list of 14 employees all with disabilities that look like they are targeted for dismissal.
v Tri-City Healthcare District
A cardiac surgeon was suspended for being disruptive ( I know, I can't believe it either). He went through the usual hearings and lost in all. While he was waiting for the appeal to the Board he did it again (how unusual) and was terminated. He filed a writ of mandamus for reinstatement due to not getting fair treatment. The hospital filed an Anti-SLAPP motion saying the peer review was protected speech (the Act allows a motion to strike down claims based on free speech or right to petition). The court tossed the hospital claim for summary judgment stating that the hospital's decision was not free speech.
US v Monroe
Florida Hospital employee Monroe worked in ED registration. He stole patient identification and sold it to chiropractors and attorneys. He also pled guilty. Top
The feds have agreed to increase Medicare coverage to those whose conditions have not improved. The feds have always not allowed coverage for patients whose treatments do not cause improvement. Now Medicare will continue to pay for services in a nursing home or other site regardless of the progress. It would pay for OT for keeping conditions from getting worse as well as improving. It is interesting that the improvement standard was written into the Medicare handbook even though it had never been written into the law.
Thomas v Tenet Health
Thomas filed a class action suit against Tenet for their undisclosed facility fees charged to patients seen in physician offices. This causes the patient who sees a physician affiliated with Tenet to pay much more than one who sees a physician in the next office for the identical problem. A recent report showed that Wexner Medical Center affiliated with Ohio State collects about $17 million per year in facility fees. This is a process that must stop. 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.