US v Hills
Edward Hills, the former COO of MetroHealth and three others were arrested for receiving kickbacks from dentists he supervised for giving them bonuses and allowing them to work privately while receiving full time salaries. The others arrested were all dentists. They are Sari Alqsous, Yuazan Al-Madani and Tariq Sayegh. They have been accused of RICO violations.
US v Cox III
Ralph Cox III, the former CEO of Toumey Health, was found guilty will be excluded for four years from any participation in any federal programs and will pay $1 million. This along with Toumey paying $72.4 million settles the allegations of paying illegal compensation at Toumey to physicians for referring patients. Toumey was also sold to Palmetto Health as part of the agreement.
US v Vibra Health
Vibra agreed to pay almost $33 million to settle claims for billing for medically unnecessary procedures. The allegations say they admitted patients to its long term care facilities that did not need admission. This is a qui tam case with a former coder getting at least $4 million.
US v Destasio
Dr. Vincent Destasio of Toms River, New Jersey, was sentenced to 12 months and one day in federal prison for accepting money for referrals to two lab companies.
US v Delia
Dr. Steven Delia of Tulsa was found guilty of fraud for filing false claims for medical services not rendered by a qualified medical profession. He pre-signed 9000 blank prescriptions for his staff to use while he was deployed in Afghanistan.
US v Orthopedic Associates of
The clinics agreed to pay almost $3 million for billing for illegally imported meds for treatment of osteoarthritis. This is a qui tam case and the by a Sanofi manager.
US v Tenet
The system will pay over $513 million to settle allegations that they paid kickbacks for referrals. The hospitals are accused of paying bribes and kickbacks for undocumented females to deliver at the hospitals. This is another whistleblower suit with the blower getting $84 million.
US v Gamuzza
Dr. Vincent Gamuzza of Hazelet, New Jersey, has been accused of fraud for billing for services not rendered.
US v Kibert
Dr. Leonard Kibert of Houston was sentenced to 63 months in jail and ordered to pay restitution of $2.89 million. Others have already been sentenced or will be sentenced soon. The physician illegally billed for recruited patients to get unneeded or never performed diagnostic testing. His license had previously been revoked for this offense.
US v O'Brien
Dr. William O'Brien III of Philadelphia was sentenced to 30 years in prison for illegal distribution of oxy. He is also ordered to pay restitution of $342,000 and another special assessment of $12,300. He was convicted of running a pill mill with others. He received $250 cash for the first visit of a fake patient and $200 per visit thereafter.
US v Yavapai Regional Medical
The community health system agreed to pay $5.85 million to resolve allegations that they lied on the time sheets of its employees to get more money from the feds. This qui tam case means the blower will get $1.17 million.
US v DeWeese
Paul DeWeese, MD, of Hold, Michign, was sentenced to three years probation and a $5,000 fine for ordering others to make false declarations to Blue Cross. He was a two term state representative and the CEO of of a chain of medical clinics that treated peripheral neuropathy with nerve blocks. He did not supervise nurse practitioners as he was supposed to and allowed his signature to be used illegally. he also lost his DEA license, paid $172,000 in restitution. He had surrendered his medical license as well.
US v Hudson Valley Associates
The Heme-Onc clinic in New York paid $5.31 million to settle allegations of fraud for routinely waiving co-pays and billing for them as well as billing for services it did not provide or not permitted. The clinic agreed that they did this. This was a qui tam case.
US v Ganji
Dr. Pramela Ganki of Harahan, Louisiana, and Elaine Davis of New Orleans were sentenced to prison for health fraud. They billed for home health services not needed. Ganji was the medical director and she claimed that the people who he had never seen were qualified for the services.
US v Omnicare
Omnicare has agreed to pay over $28 million to resolve allegations that it solicited and received kickbacks from Abbott Labs to promote Depakote. Abbott had already paid $1.5 billion to settle this allegation. This qui tam case give $3 million to a former Abbott employee.
US v LifeCare Centers of America
The Center and its owner Forrest Preston agreed to pay $145 million to resolve allegations of false claims for rehab not needed. The company was accused of placing many patient in the "Ultra High" category for rehab for greater payments. This qui tam case results in $29 million for the two former employees.
US v Windsor
Dr. Robert Windsor of Atlanta was sentenced to prison for billing for surgical monitoring that he did not perform. He was supposed to monitor surgical patients nerve and spinal cord activity during surgery and communicate any problems as well as give a formal report at the conclusion of the surgery. He had unqualified assistants do the monitoring. He was sentenced to three years in jail and ordered to pay $1,169,000 in restitution. Top
Billeaudeau v Opelousas General
The state high court ruled that a claim for negligent credentialing against a hospital for care by an independent contractor was not covered by the state med mal act and therefore there was no cap. The ED physician was credentialed even though he did not have at least a year of full time practice in an emergency department as required in the by-laws. Since negligent credentialing is an administrative not medical cause of action no med mal was inferred and therefore not subject to the state's med mal act.
Togba v Abbott Northwestern
The patient was injured by a replacement nurse at the hospital. She was injected with adrenaline in a way that was against physician's orders. This caused heart problems and a visit to the ICU. Medicare has investigated and agreed to a plan of action so no sanctions against the hospital.
Pham v Texas Health Presbyterian
Nurse Nina Pham, the first person to contract Ebola in the US, settled her lawsuit against her employer. The terms were not revealed. The suit claimed that the hospital did not train nor protect its staff who were treating the patient from Liberia who died from the disease. She also claimed a violation of privacy by the hospital. She had been kept on the payroll although not returned to work.
Hogans v J&J
In spite of no known link proved between the use of talcum powder for feminine hygiene and ovarian cancer a third jury found J&J guilty of causing the cancer and failure to warn. The jury awarded this person $70 million. All are being appealed.
Patients v Stockert
The CDC has found via fingerprinting that patients who had cardiac bypass and were on the Stockert 3T heater-cooler device may have been exposed to non-tuberculosis mycobacterium and have after the procedure the disease. They found evidence of a single source contamination with resultant disease and deaths.
Nava v Saddleback Memorial Med
The patient fell from a gurney and was injured. He sued after two years and was denied due to the one year statute of limitations on med mal. The court affirmed since the care was related to medical care.
Markow v Rosner
The patient sued Dr. Rosner and Cedar's Sinai for making him a quad after he performed a nerve root block. He had seen him many times prior to the last injection where he signed the forms stating Rosner was an independent contractor. Therefore he could not sue Cedar's now for Rosner being an ostensible agent. This is after a jury had awarded 40% of the blame to Cedars.
Nicodemus v Saint Francis Hospital
The plaintiff filed a class action against the hospital and HealthPort Technologies for charging for producing records to attorneys for review. The trial court refused the class action but he higher court reversed and ordered a class certification.
Krieg v UPMC
The hospital got its fourth suit for med mal for mold infection killing patients post transplant. This will be settled.
Ontario v Wettlaufer
A 47 year old nurse has been arrested for first degree murder for killing eight people via drug injection.
US v Caesar
Dr. Shannon Caesar of Metairie, Louisiana, was indicted for prescribing narcotics without a legitimate medical purpose and threatening to kill officers for performing their duties.
New York v Rho
A prosecutor who obviously wants to make his bones has filed a criminal case for manslaughter against a physician who's patient died post abortion. He had performed over 40,000 abortions in his career. He is accused of not helping her and letting her bleed to death. The Medical Examiner said the death was an accident and she died from injuries to the cervix, uterus and the uterine artery. Top
LA v Gardens Regional Hospital
The hospital agreed to pay the city $450,000 to settle a suit against it for dumping a homeless woman on skid row with no discharge plan. The hospital admitted no wrongdoing.
Mendez v Hampton Court Nursing
The Florida high court ruled that a patient in a nursing home who did not sign the contract could not be held to an arbitration agreement in the contract. In this case the son signed the contract but there is no evidence that the patient authorized him to do so.
CarePoint Health v Horizon Blue
The New Jersey health system sued in federal court for money owed by the insurer. They are for profit hospitals and are out of network and are suing for $76 million.
St. Vincent Health v US
The hospital system sued for reimbursement by Medicare for a interest expense on a loan for a new hospital. The court ruled the loan was to a related party and non reimbursable.
Moran v Prime Healthcare
An uninsured patient sued as a class action against Prime for grossly excessive charges and price discrimination against self pay patients. He had been seen in the ED of a hospital and signed that he would be responsible for payment. The trial court tossed the case. On appeal the court said that most of the claims were unsupportable but the charges may be unconscionable since the contracts needed to be signed prior to any treatment, even emergency ones. The price discrimination and fraud claims were tossed. Top
AAPS v California
The physician group has filed suit against the state for enacting a law restricting out of network payments to physicians to 125% of Medicare. The organization believes that this is a violation of the constitution. Top
Patients v Baystate Health
About 13,000 patients had their information potentially compromised when employees opened a scam email and gave hackers access to a data base. They would then use that information to send emails to the patients to get their information. Baystate had problems in the past. Earlier this year they had problems with patients being potentially infected from dirty colonoscopes and last year they had problems at a dialysis center where they failed to follow protocol and may have exposed patients to diseases.
Patients v Florida Hospital
The hospital lost boxes containing patient information during a move from one vendor to another. This is an unusual breach since it is of paper records.
Patients v Rainbow Children's
The clinic had a ransomware attack and lost the data of over 33,000 patients. They are being notified.
OCR v St. Joseph Health
The California system has agreed to pay a fine of $2 million to settle allegations that it left patient information on a new computer server open to the world. There risk management was also faulty.
OCR v Care New England
The hospital system agreed to pay $400,000 for not having an up to date business plan between it and one of the hospitals. This is besides the $150,000 payment made by one of its hospitals, Women & Infants Hospital to Massachusetts. This all comes from a data breach on lost and backup tapes affecting about 14,000.
Patients v Banner Health
The unloved Banner Health to date have had 10 suits filed against it for a cyberattack compromising the records of over 3 million patients. They have been accused of failing to protect patient data and credit card fraud for identity theft secondary to the hack. Top
Alliance Defending Freedom v
The Circuit Court ruled that pregnancy centers are required to refer patient to publicly funded contraception and abortion services even if that violates their moral and religious beliefs. The California law AB 775 stating this does not violate First Amendment rights. The court rejected a preliminary injunction. 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.