Italy v Physicians
Eight Italian physicians have been jailed by the government for doing over 80 unnecessary surgeries at the Santa Rita Clinic in Milan. These included breast and lung removals. The chief thoracic consultant was given a sentence of 15 years. At least five patients died post operative.
US v Simi Valley Hosp
Simi Valley Hospital in Southern California has agreed to pay almost $6 million in a whistleblower suit for Medicare fraud. The claims were that the hospital filed false claims for overnight stays that were not necessary and they paid a medical director $12,000 to oversee a non-existent post traumatic stress disorder program.
US v St. Joseph Med Ctr
Last newsletter in this section was a report of a law suit by Dr. Midei for defamation against this hospital for stating he had done unnecessary cardiac procedures on patients. Now the hospital, without admitting guilt, has agreed to pay the government $22 million for an illegal ten year kickback scheme with MidAtlantic Cardiovascular Associates. There are also about 100 med mal claims against the hospital for unnecessary cardiac procedures. Dr. Medei's attorney stresses that this settlement is about the hospital actions and has nothing to do with Dr. Midei. Top
Papciak v US
Mrs. Papciak was in a nursing home for a broken hip post surgery. The home wanted to discharge her and Medicare agreed since she was not making any further recovery. The patient sued and won. Medicare must cover those who need nursing home and home health care even if their condition is not likely to improve. If the patient need the home to maintain a person's ability to perform routine activities of daily living or to prevent deterioration of a person's condition the person may get the benefit. The person no longer has to prove that they are improving.
States v US
The 20 states that are suing the feds over the Obamacare tax are asking for a summary judgment. They believe that there are no facts that are in dispute and the law is unconstitutional on its face. The administration has until the end of the month to respond.
Also the AHA has asked to enter this suit. They want to tell the court the problems of furnishing uninsured care.
Pacific Justice Institute v US
The US Supreme Court including Justice Kagan, former Obama Solicitor General, have refused to hear the case from California whether or not the healthcare tax is constitutional. The rational is correct. The case has not been heard by any Court of Appeal. Top
Indiana v WellPoint
Indiana has sued the insurer for not promptly notifying patients of privacy breaches, a state law. In the case at issue is a 129 day delay in notification. The state is looking for $300,000 in civil penalties. Top
Rowell v Valleycare Health
Raymond Rowell, a FP at the hospital, was dismissed for illegally distributing Oxycontin. He did not get his due process as required by the bylaws and sued for failure to follow HCQIA, antitrust and the usual panoply of state claims. They were all dismissed. His attorney obviously did not know that one can not sue under HCQIA for money. He probably felt that since HCQIA was not followed he could sue for money. The court felt that was erroneous and dismissed the claim with prejudice. The antitrust claim fared no better since the attorney stated the Chief of Staff was a employee of the hospital, there could be no conspiracy. The State claims were summarily dismissed and may be filed in state court.
Pierson v Orlando Health
Dr. Pierson was no staff of the hospital and on the ED and Trauma panels. Due to quality concerns he was removed from the two panels but his other privileges remained intact. He had a peer review hearing and then sued when he lost the hearing. The court gave summary judgment to the hospital since they were protected under HCQIA and the Florida law.
Cole v St. James Healthcare
Dr. Jesse Cole, Radiologist, was economic credentialed off the staff of the hospital. He sued and recently won $4 million in a non confidential settlement. This case cost Dr. Cole over $350,000 of his own money. He is also still on the staff but can not work there and no reports were made to any regulators. This suit did cause the CEO to lose his job. The judge did blast the CEO and COS Dr. Sharon Heckler for going after Dr. Cole and also the parent of the hospital the out of state Sisters of Charity of Leavenworth. The court decision of an injunction against the hospital was upheld by the Montana Supreme Court which led to the settlement. The hospital is making good money (almost $250 million last year) and is laying off staff as well as asking the community to contribute to the hospital. Top
Woodward v VA
An 87 year old male has accepted a $250,000 settlement of a mistake of the Palo Alto VA in the treatment of glaucoma. Eight vets were treated erroneously and this patient is the first to file suit. Top
California v Anthem Blue Cross
Anthem has agreed to pay hospitals what they did not pay due to their changing rules on the Stop loss provisions of over utilizing. They will pay what they did not pay plus penalties and interest. 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.