Consumer Watchdog v Anthem Blue
The organization has filed a class action suit against the insurer for bait and switch tactics. The suit claims that consumers were failed to be warned adequately that in 2017 they were to be switched to a new stripped down plan. The people were moved from a PPO to a EPO and were told the coverage was the same. They are not. EPO plans do not pay out of network costs costing some people thousands of dollars more a year and may have different physicians. They received notices that if they do nothing they will be automatically enrolled in similar coverage and lose the right to shop around by doing nothing.
CCS Oncology v Independent Health
The New York group is suing to keep the insurer from dropping them fro its network. They are seeing about 500 cancer patients insured by Independent. About 22 oncologists are being dropped but another 51 non-oncologists are being allowed to stay in the network. The insurer says that CCS cost for lung and breast cancer treatment is 50% more than at its competitors. CCS wants to see the data but the insurer is not allowing that. Top
Humboldt County Adult Protective
Services v Superior Ct.
The case involves the agency filing an ex parte petition without notice seeing to revoke a dying patient's valid advance directive. He had agreed to to accept palliative care only. The agency sort of forgot to mention this and other things when they filed the suit. The trial court, unaware of the palliative aspect, granted the agency a TRO. When the wife found out she hired an attorney and moved to dismiss. The agency then withdrew its suit and the court vacated the order. She wanted attorney fees but the court denied that so she appealed. The appellate court reversed due to the shenanigans of the agency and she got her fees.
Physicians v CMS
Twenty one physicians in Tennessee have filed suit against the fed for their asking for a clawback from the physicians for money given to them several years ago for treating Medicaid patients. The agency claims the physicians were never qualified for the money that was paid at Medicare rates to see the Medicaid patients. The physicians were not board certified or two thirds of their claims had to be for E and M claims, not lab fees or imaging. The suit said the discrimination of non board certified physicians is arbitrary and capricious. The physicians are rural and therefore do their own labs and x-rays so did not meet the 66% threshold. The physicians assumed that the 66% rule applied to costs and not number of claims. Top
Patients v Medtronic
The company has stated that two more patients have died after using the SynchroMed II infusion pump for pain control. Over a dozen deaths have been reported.
Fewins v Granbury Hospital
A child went to the ER for leg pain after a fall a week prior. He had triage and an exam. He was discharged but the next day was seen at a different ER and had MRSA. He was hospitalized for months and had several surgeries. The parent sued the first hospital for EMTALA for an inappropriate screening. The trial court and the circuit court said hard cheese since no evidence of disparate treatment. Since the physician did not have knowledge or perceive that the child had an emergency condition there was no duty to stabilize. Why would an attorney take this case??
Watkins v Good Samaritan Hospital
The parents sued the hospital for a baby case and in discovery wanted certain personnel records that the hospital claimed were privileged. The hospital showed they had a peer review committee and the records were within the scope of the committee. The records should not have been compelled to be shown but should have had an in camera exam. The court ordered the exam.
Drexler v Petersen
The plaintiff saw tow physicians who diagnosed him with tension headaches. He went elsewhere and was found to have a brain tumor but it had grown so removing it caused significant problems. He sued the initial physicians for med mal but the trial court rejected the case due to the lack of filing within three years of the date of injury or one year after the patient discovers, or through the use of reasonable diligence should have discovered, the injury, whichever comes first. The appellate court overruled stating that in missed diagnosis cases there is no injury until the patient first experiences appreciable harm due to the missed diagnosis. The one year does not start until the patient discovers or should have discovered both the injury and the negligent cause.
Friedrich v City Hospital
The patient went to an urgent care facility with chest pains. He was diagnosed with acid reflux and sent home to die the next day from a MI. The facility was sued under EMTALA for failing to screen and stabilize. The facility filed for summary judgment since it was not an ED. The court said nope. It held itself out as a place for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment.
Fewins v Granbury Hospital
The plaintiff fell and several days later went to an ED for pain and discharged. A week later he went to the defendant ED with fever and pain. He was seen and treated by a physician and found only a muscle strain. The following day he was in another ED where he was hospitalized for a severe infection and has permanent bone damage. A suit followed where the hospital said no EMTALA since the screening was adequate and the physician found no emergency medical condition. The patient said the screen was inadequate but in fact the patient had lab tests, an extensive exam and several consults. There was no disparate screening and the appeals court found the attorney had completely screwed up as the case should sound in tort but they had abandoned any negligence claim so summary judgment was appropriate.
Patients v Nurse Assist
About one hundred people have been infected with B. cepacia in New Jersey, New York, Pennsylvania Maryland and Delaware that seem to be from a saline flush syringe made by Nurse Assist in Texas. To date, six people have died but not necessarily of the infection. Top
Levitin v Northeast Community
Dr. Levitin, an independent contract physician on the staff of the hospital sued for Title VII for a hostile work environment. The underlying was said to be allegedly sham peer review. She attempted to get her cause before the court even though she was an independent practitioner by stating she got compensation via a PHO and subjected to hospital policies. She lost as she was not covered under an employment situation. She could have been on as many hospital staffs as she liked so was a true independent contractor.
Casillas v Central California
Faculty Medical Group
The plaintiff was a respiratory therapist for the group. She refused to perform duties outside of her scope of practice and complained to Medicare about billing practices of the group. She was terminated and sued. She won a verdict of over $600,000 for being retaliated against as a whistleblower. The group said that Casillas illegally made referrals to a DME to benefit her husband. Sounds like the company needs better legal oversight.
Novotny v Sacred Heart Health
The patient sought production of documents from the hospital and the hospital said they were protected by the state peer review statute. The patient challenged the statute as unconstitutional. The lower court agreed but only if a crime fraud exception applied. The court said the patient had presented enough evidence of fraud. The Supreme Court disagreed. The information was generated by and for a peer review committee and should be protected. The Supreme Court also did not allow the crime fraud exception as the patient could get information from independent sources to show fraud.
Sharda v Sunrise Hospital
A physician sued for a TRO relating to the suspension of his privileges. He claimed his 14th Amendment rights were violated by the hospital not scheduling a hearing on his request for reinstatement of privileges. The court said no since the hospital was private and not state the 14th Amendment did not apply. No TRO. Top
FTC v Advocate Health
The court unanimously reversed a lower court decision to refuse to enjoin the merger between two large healthcare systems. The FTC's injunction against the merger is now in effect until after an appeal is heard and decided. The geographic market is the deciding factor.
American Health Care Association v
The judge blocked CMS from implementing a new rule until it gets challenged in court. The rule would have blocked arbitration in nursing home contracts that accept any federal money. The court ruled the administration again overstepped its authority as this is a legislative issue. Top
New York v Moschetto
Dr. Anthony Moschetto, a Long Island cardiologist, pled guilty to arson of a fellow physician's office and hiring people to beat him up. He wanted to put him out of business to obtain his patients. The two had practiced together for twenty years but split two years ago. He is to be sentenced to five years in jail in December. Top
US v Reddy
Dr. Duttala Reddy, a Springfield, Illinois, psychiatrist, paid $908,000 for allegations of Medicare fraud. He was accused of billing for nursing home visits never provided. He has also been removed from billing fed med for 10 years and has been permanently banned from participation in the Illinois Medical Assistance Program. He denied the allegations.
US v Solarin
Dr. Oiuwatoyin Solarin of Atlanta pleaded guilty of fraud for billing for dental services by back dating claims due to the patients Medicaid eligibility being expired. As part of a plea agreement she agreed to not only repay all the money and forfeit her interest in over a dozen real estate properties she purchased with the ill gotten gains.
US v Riachi
Dr. Labib Riachi, an OB in New Jersey practicing Urogynecology, agreed to be dropped from fed med for 20 years and pay $5.25 million while denying liability. He was accused of submitting thousands of claims for Pelvic Floor Therapy which were never needed or never performed. He failed to supervise the personally the services although he implied he did. Top
Patients v Carolina Cardiology
About 2500 patients of the medical group are affected by a breach of a business associate ScottCare from a thumb drive.
Patients v Integrity Transitional
The Denton, Texas hospital was hacked and patient information was breached. The hack was in August but just recently found. One wonders about the security of the hospital.
Patients v Broward Health
The worst hospitals in the country again have shown the way. Broward Health of South Florida, already renowned for their fraud problems and inability of their Board or administration to fix any problem, now has announced that six months ago personal patient information was found in a individual's home. This was told to the system by a law enforcement organization. They never knew it. The information was on stolen hospital facesheets. The actual removal occurred several years prior and affected 120 patients. They are now reviewing their safeguards, years after the problem. The thieves used the information to get phony tax refunds from the IRS. Back in 2013 they had another data breach with 960 patients involved with stolen facesheets and then they said they were going to fix their system. Right! 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.