October 1, 2016 Recent Legal News


Peer Review and Employment





US v Macasaet Jr.

Romy Macasaet Jr. of Homewood, Illinois, admitted paying kickbacks for referrals to his company Howe Bound Healthcare.  He paid money to 20 medical directors as a bribe to send patients to his place.  He agreed to pay the feds $6.8 million to resolve civil allegations but will be sentenced for the criminal actions.  He also resigned his employment with Home Bound and to divest all ownership interest. 

US v North American Health Care

The skilled nursing home company agreed to pay $28.5 million to settle allegations that they billed fraudulently for rehab therapy services that were not needed.  Also the board chair agreed to personally $1 million and the senior vice president of reimbursement analysis has agreed to pay $500,000.  The company also entered into a five year CIA as well.

US v Mahmood 

Dr. Taiq Mahmood of Cedar Hill, Texas, was found guilty in a jury trial of health care fraud for fudging codes in hospitals he owned.  He was sentenced but appealed and now was re-sentenced to 135 month in federal prison and ordered to repay $145,000.

US v Midwest Family Practice

The Warren, Michigan, physician owner of the practice Dr. Hussein Awada agreed to pay $200,000 to settle allegations that he wrote prescriptions for oxycodone without medical reason and billed for the services.  The allegations also say that he gave patients unnecessary monthly x-rays to cover up his fraud.  He plead guilty in a related criminal action and was sentenced to 84 months in prison and to pay $2.3 million in restitution.  He was also ordered to forfeit assets.  The civil case was a whistleblower one where the receptionist will get $36,000.

US v Malik

Five people have been indicted in a scheme to defraud.  The feds allege that Drs. Sandeep Sherlekar and Atif Makik of Germantown, Maryland conspired with Muhammad Kahn, Mubtagha Syad and Konstantin Bas to use kickbacks for the needed urine tests and DME prior to and for pain treatment.  The feds also allege the two physician lied about both being present for epidurals so higher charges could be made.

US v Kindred Health

Kindred Health was under a CIA and did not comply with it.  They were fined just over $3 million for their lapses.

Peer Review and Employment

Telesford v Maryland Provo-i Med. Services

A white male replaced a black male as medical director of the ED.  Later a white male was promoted to lead PA without advertisement.  The medical director said he was the most qualified.  When questioned he then said the PA was hired by a corporation contracted to provide doctors and PAs.  Then seven black PAs filed a discrimination suit.  The medical director also threatened them with firing if they did not agree to a new fee structure and then took that back and paid them all what they should have been paid.  The court said no retaliation since they had been paid what owed but allowed the racial discrimination suit to go ahead.  This came after a black nursing director stated that the medical director claimed she had green lighted the PA when she had not.  

Rowell v Phoebe Putney Memorial Hospital
Ga Ct App

The female anesthesiologist had an agreement to work on nights and weekends at the hospital via an exclusive provider.  The employer and the VPMA of the hospital met about the care by Rowell.  She was told by her employer to not come to work and if she did she would be suspended.  The employer later called Rowell and told her she was not suspended and she needed to fight the hospital.  Rowell decided to go quietly and collected her final paycheck.  The employer terminated her med mal insurance and she was no longer qualified to be on the hospital staff.  She sued the hospital and VPMA for the usual things and to no one's surprise lost at summary judgment.


Oracle v Oregon

Oracle has agreed to pay the state $100 million to settle the cross suits over the complete foul up of the Ocare startup several years ago.  The website was a dismal failure. The settlement is payment of $25 million to the state and and additional $75 million in software. Oregon paid Oracle $240 million for the failed site. They then went to the federal exchange.  The original filed complaint against Oracle wanted $6 billion for racketeering and all sorts of nonsense.  To date legal costs alone are over the settled $25 million.  It should be interesting in the future how Oregon does with the Oracle software.

BCBS v Vermont
To BE Filed

The insurer says it is due $6.2 million for premiums they did not receive and claims paid after the state cancelled their individual insurance plans.  Last year the state paid $1.2 million to settle the same type claims.  There will be a settlement prior to actually filing a suit.  

Cunningham v Colorado

In a ACLA led lawsuit Colorado has been accused of denying treatment to him because he has government insurance.  Colorado now covers the treatment only for people whose livers have reached stage two scarring due to hepatitis.  Private insurance cover the drug treatment regardless of how far its advanced.  Colorado Medicaid says it cannot spend that much money on one disease.  The stage 2 was only started this month.  Prior it was stage 3.  Also all who are drug or alcohol abusers will need to enroll in counseling at least one month before receiving the regime.  The suit says that the withholding of the drug to any one is illegal.  

B. E. v Teeter

In the Washington state case a similar suit as the one above has been filed.  Interestingly here Gilead, the drug manufacturer of the Hepatitis regime has donated hundreds of thousand dollars to the people who helped bring this case.  They get the money back if Medicaid pays for the medicine.  It should be noted that Gilead's rivals have also contributed to the case.  

Moran v Prime Healthcare
Ca Ct App

The patient went to a hospital ED on three occasions as self pay, signed a financial liability contract and charged over $10,000.  Prior to getting a bill he contacted the hospital to tell them he was uninsured and out of work and asking for relief.  No response.  He then sued stating self pay are charged more than insured and that is discrimination and against the UCL and the CLRA.  The patient lost on the discrimination and CLRA as variable pricing is allowed and he failed to show that he relied on the a misrepresentation by the hospital that he would be charged the same as all other patients.  He won summary judgment on the UCL claim that the financial liability contract is unconscionable.  Those that need medical care are at a disadvantage and must sign to get care and be charged much more than the actual cost of care.  

Rollins v Dignity Health
US Supreme Court

Rollins sued her employer in 2013 for failure to comply with ERISA.  She claimed that Dignity did not fully insure and fund their pension plan.  Dignity claimed they were a religious entity and exempt for that requirement.  Justice Kennedy has issued a temporary stay from Dignity having to comply with the 9th Circuit ruling that they are not exempt.  The high court will later decide whether or not to take up the appeal.

Nicodemus v St. Francis Memorial Hospital
Ca Ct App

A class action suit was filed stating that the hospital charged more for attorney medical record requests than was allowed.  The lower court refused to certify the class but the appeals court ordered them to certify.  


Patients v University of Washington Medical Center
To Be Filed

Two patients have died from Legionnaire's Disease and another is sick with it.  An investigation has showed the source of the Legionnaire's to be a ice machine and two sinks in the cardiac unit.  The bacteria was also found in devices used to heat and cool patients during heart surgery.  This was also true in the outbreaks recently in Pennsylvania.  The water in the machines do not come into contact with the patient's blood there is a possibility of the bacteria to enter other parts of the device or be transmitted via the air says the FDA.

Lemmons v Sonoma County

Lemmons was a homeless man jailed in December for sleeping outside a grocery store.  He was in his cell, he states, for two days without medical treatment for pain in his feet.  He was taken to Kaiser prior to his booking and diagnosed with hypothermia. He could not see a doctor until his first court appearance and a judge ordered immediate treatment for his black toes and purple legs.  He was sent back to Kaiser, found to have gangrene and had his feed and part of his right leg amputated.  He does not seem to be suing Kaiser for the original diagnosis and their cleared for custody letter.

Morales-Ramos v Hosp. Episcpal San Lucas Guayama

 Puerto Rico finally found a hospital that was really dumb enough to get caught in EMTALA.  They did enough to show they may have not followed protocol in a pregnant female who they transferred.  The protocol is to put a fetal monitor on all pregnant females for 100 minutes.  They could only show half that.  They also failed to document vital signs and did not follow proper pre-transfer protocol to see lab tests prior to deciding on transfer.  Since the court retained EMTLA jurisdiction they also kept jurisdiction on the state based med mal complaints.



Patients v Geisinger Health Plan
To Be Filed

A processing error had erroneous invoices mailed to about 2900 incorrect recipients.  Again, no security in place.  


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.