November 1, 2017 Recent Legal News

Criminal

Fraud

Healthcare

HIPAA

Insurers

Malpractice

Peer Review and Employment

Physicians

Criminal

New York v Abdel-Sayed
Arrested

Mamdough Abdel-Sayed, a tenured biology lecturer at Medgar Evers College was arrested for selling healthcare certification completion certificates after teaching unauthorized courses.  He pocketed the money.  

Massachusetts v Chin
Jury

Glenn Chin was the owner of the New England Compounding Center who meds killed 76 people by giving them meningitis.  He was up for murder but not convicted.  He was convicted of mail fraud and racketeering.   

New Jersey v Singh
Arrested

Paramjit Singh of Hackettstown, New Jersey, was arrested for practicing medicine without a license.  He had been doing this for many years since his license was suspended in Ohio and West Virginia and his NJ license had been suspended.  The founder of Medical Care Associates where Singh worked, Parminderjeet Sandu, was also arrested.

Florida v Ramirez
Arrested

Yet another fake physician has been arrested.  Jose Ramirez of Doral was the CEO of a medical clinic and said he was a physician.  He was not.  He also wrote prescriptions.        Top

Fraud

US v Haq
Guilty

Dr. Abdul Haq of Ypsilanti, Michigan, pleaded guilty of fraud for conspiring with the owner of the Tri-County Network, Mashiyat Rashid to prescribe unnecessary controlled substances.  If the patients wanted the prescriptions they had to undergo unnecessary facet joint injections.  Haj then referred patients to home health agencies, labs and diagnostic providers for unnecessary procedures.  

US v HCA
Settlement

Four Houston hospitals all affiliated with HCA agreed to pay a total of $8.6 million to settle allegations that they received kickbacks from ambulance companies to get the rights to service the hospitals.  The hospitals are Bayshore Medical Center, Clear Lake Regional Medical Center, West Houston Medical Center and East Houston Regional Medical Center.  

US v New York Spine an Wellness Center
Settlement

The medical practice agreed to pay $1,941,850.29 to settle allegations that it billed for moderate sedation when the practitioner spent less than the mandated 16 minutes face time with the patient.

US v Vardumyan
Sentenced

Knarik Vardumyan of Burbank, California, was sentenced to 37 months in prison for her part in a Medicare fraud.  She billed Medicare for unnecessary visits and tests in her medical clinic.

US v Johnson
Arrested

Dr. David Johnson of Macomb, Michigan, was arrested in the Dominican Republic after he fled the country to avoid trial for illegally billing Medicaid for procedures.  

US v Peltan
Indicted

Dr. Harold Peltan, a Cleveland, Mississippi, ophalmologist, was indicted for billing Medicaid for unnecessary procedures.

Massachusetts v Insys
Settlement

The state AG has settled against the company by alleging they directed their sales people to sell Subsys for any chronic pain even though it was only authorized for cancer pain.  The problem is not how the physician used the drug but how it was marketed.  They won $500,000.

New Jersey v Insys
Filed

The state AG has filed suit against the company by dutifully following Massachusetts and other states. The AG, as someone who is looking for publicity does, uses hyperbole to describe the company's action.  He is probably trying to top the settlement that Illinois received of $4.5 million.  

US v Samadi
Investigation

The feds are investigation Dr. David Samadi, the chief of Urology of Lenox Hill Hospital in New York, for doing simultaneous surgeries.  Federal law does not allow billing for cases unless the attending surgeon is present for all critical parts, whatever that is.

US v Fingerhut
Sentenced

Gary Fingerhut, the former director of Cleveland Clinic's Innovations plead guilty to fraud and agreed to serve prison time for his part in a $2.7 million scheme.  

US v Rizk 
Arrested

As part of the same Cleveland Clinic fraud case Wisam Rizk has been charged with 27 counts of wire fraud.

US v Williams
Arrested

David Williams of Fort Worth was arrested and charged with submitting over $25 million in false and fraudulent claims for medical services.  He registered as a health care provider but was not.  

US v First Coast Cardiovascular Institute
Settlement

The Florida corporation refused to repay the feds $175,000 in overpayments.  They now will pay $440,000 instead.  The dummies deserve this.

Arizona v Foster
Arrested

Globe, Arizona, surgeon Jamison Mark Foster was indicted for forging prescription for narcotic self use.

US v Sells
Sentenced

John Sells of St. Peters, Missouri, was sentenced to 41 months in jail for stealing funds at Benchmark Healthcare when he was the CEO.  The residents of the long term care facility were fed almost nothing and not given their prescriptions.  He is also to repay $667,201.

US v Baumiller
Guilty

Dallas pharmacist Andrew Baumiller pleaded guilty to health care fraud.  He conspired with doctors and others to defraud Tricare out of more than $50 million.  He paid kickbacks to physicians who wrote for expensive compounded meds and vitamin supplements.  Also charged but not yet convicted were two physicians and others.  Now others were indicted.  Susan Perry, NP of Grand bay, Alabama, Albert Diaz MD of Ocean Springs, Mississippi and Peter Eodice of Webster, New York were all indicted in the scheme to defraud Tricare and the Blues.

US v Dynamic Visions
USDC DC

The company was ordered to pay the feds $1.98 million for falsifying records to obtain funds from Medicaid.  The original damages were $489,744 which the judge trebled and also added an $11,000 civil penalty for each of the 47 invoices submitted.  He did this because the company was uncooperative and obstructive.

US v Rosenberg
Guilty

Dr. Jerrold Rosenberg of Rhode Island plead guilty of obtaining kickbacks for prescribing Subsys, a fentanyl cancer medicine by Insys.  He was to receive $188,000 in speaker's fees for prescribing the med.  He agreed to pay restitution of $754,736 to insurance programs and will be sentenced later.

US v Catholic Health
Settlement

The company agreed to pay the feds a lot of money to settle their false claims case.  Details are not available.        Top

Healthcare

Conway v Great Britain
Supreme Court

Noel Conway had sued to allow physicians to help him take his own life.  The three person court denied him as this would be against the European Convention on Human Rights.  Conway has a motor neuron disease and has less than six months to live.  The next step is to have Parliament pass a law to allow assisted suicide as Switzerland does.

Jane Doe v US
DC Ct App.

In an interesting legal drama a Central American illegal alien teenager is pregnant.  She wants an abortion and wants the taxpayers to pay for it.  A San Francisco federal judge says that she can get an abortion but refused to order the feds to pay for it.  A different federal court says the teen must be allowed to get an abortion.  The ACLU wants to muck up the waters by making this into not an individual suit but a class action suit so that all can enter the country and get abortions on demand.  The DC Court of Appeals panel ruled that the illegal can not get an abortion until they consider the case in full.  The feds state that even if no fed funds are used in the abortion they would still be used for staff to be sent with her and for follow-up which is against federal law.  The full court of appeal ruled 6-3 on political division that Doe could receive an abortion.  Doe got her abortion.  Her case against the US is now moot but the class action will continue.

States v United States
DC 

Multiple blue state Attorney Generals sued to block Trump's stopping of the Ocare subsidies as illegal.  The Obama appointed judge not only denied the injunction he blasted the states for the suit.  He rightly said that the states had the time to plan for this and they should not be in court for an emergency injunction.  Watch for an appeal.

Batista v Ohio
Ohio Supreme Court

Orlando Batista was convicted under Ohio law for giving his girlfriend HIV and not telling her of his status prior to having sex.  The opinion and sentence was upheld unanimously.  This is expected to be appealed to the US Supreme Court.        Top

HIPAA

Jane Doe v Aetna
Filed

The shysters have seen the payday.  A class action suit has been filed against the deep pocket Aetna for inadvertently allowing HIV status to be visible through an envelope.   This is the second suit over this filed.  She has also filed a second suit on the same facts but against different defendants and for punitive damages.  

Oregonian Publishing v Oregon Health and Sciences
Oregon Supreme Court

The newspaper wanted information from the hospital regarding tort claims.  These contained patient names and information and so the request was denied by the high court after the trial court allowed the information to be divulged and the appeals court refused.         Top 

Insurers

YDM Management v Sharp Medical Group
Ca Ap Ct.

An urgent care facility assigned its accounts receivable to YDM who sued the IPA for more money for ED services the facility had given to Sharp managed care people .  California requires IPAs to reimburse out of network the full reasonable charges.  Sharp requested and was granted summary judgment because the codes billed were not emergency codes.  The appellate court agreed.

Kendall v Scripps Health
Ca Ct App

Kendall was uninsured sued for a class action for Scripps billing emergency services according to Charge Master.  He lost in trial court on the class action as the court said he had not demonstrated the class was ascertainable.  The upper court agreed that common issues did not predominate.  Each individual would need to be asked what their damages were.        Top

Malpractice

Konrad v AbbVie
ND Ill

A federal jury has order AbbVie to pay Konrad $140 million for allegedly causing him to have a heart attack after using AndroGel.  This is the second trial lost by AbbVie in the Chicago court which has consolidated over 6000 such cases..  The damages will be appealed and a settlement will be reached for all claimants.  

Fox v J&J
Mo App Ct

The appellate court tossed a case where a woman won $72 million for J&J allegedly not warning about the dangers of using baby powder potentially causing ovarian cancer.  There has been no definitive proof of this to date.  This was tossed due to venue shopping which is against a US Supreme Court ruling.

Echeverria v J&J
Reversal

J&J won a JNOV in a LA case where a woman claimed talc caused her ovarian cancer.  The judge overruled the jury who had awarded the plaintiff $417 million since he said the company had no duty to warn if they do not manufacture nor market the product.  The first study linking the cancer to talc (tenuous at best) was in 1982 after J&J had stopped making the baby powder.  The judge also found there was no malice and therefore no punitive damage.  The plaintiff attorney said the obvious, he will appeal.

Wise v J&J
England High Court

Barbara Wise is suing J&J for injuries due to vaginal mesh. She sued J&J and the surgeon in 2014 and that suit was dismissed.  It was reopened this year.  Many women are suing the NHS and J&J with the same symptoms. 

Stewart v Superior Court
Ca App Ct

The court overruled a trial court that gave a summary judgment for the hospital in a  case where the hospital did not listen to the legitimate holder of a power of attorney.  St. Mary's Hospital wanted to do a pacemaker on a patient who the custodian said the patient did not want.  They held a closed ethics committee meeting and voided the power of attorney.  They now have to answer in court.  Seems like the hospital needs a new attorney if the current one allowed this.

Stewart v Parkview Hospital
ND Ind

Stewart sued under the ADA and EMTALA after coming to Parkview for a perceived medical emergency and being transferred to a nearby hospital for treatment.  Parkview is a psychiatric hospital who does not keep an ED.  Stewart came to the hospital for suicidal thoughts and was sent to a nearby hospital but drove to his apartment for a suicide attempt.  He lost the ADA on summary judgment because the hospital had all, not related to disability, sent to the nearby hospital.  He won the EMTALA claim since it is disputed whether the hospital has an emergency room and whether Stewart is a patient.    

Newell v Swedish Health
Judgment Confirmed

A judge has confirmed the arbitration award to Dr. David Newell of $17.5 million for firing him after he raised concerns about another surgeon who eventually lost his license.  The judge also added an additional $665,000 for attorney fees and costs.  Swedish says they will appeal which means a settlement.      Top

Peer Review and Employment

Yerra v Mercy Springfield
SD MO Ct App

Dr. Shanti Yerra sued the hospital for wrongful termination in 2016 and won $751,000.  The appellate court reversed the decision 2-1 stating she did not make a submissible whistleblower case.  She had claimed Mercy did false billing for Medicare.  The majority ruled that since an internal hospital investigation showed a gallbladder patient referral to a cardiologist pre-op was legitimate and no wrongdoing to Yerra was proven therefore no whistle blowing.  This will go to the state Supreme Court.

Acklen v Spectrum Health
Filed

Michelle Acklen, a black nurse at the system, filed suit against the system for allowing patients to choose not to be care for by a black individual.  She worked at the system in Michigan through 2016 via a staffing agency.  Her attorney has a habit of filing these cases.  She got a $200,000 settlement from Hurley Medical Center in Flint.  In another suit that actually went to trial the nurse lost as she could not show she has suffered an adverse employment decision.  

Claycomb v Kentucky
Superior Ct.

A superior court judge ruled that Kentucky's malpractice law mandating a medical review panel review a case prior to court filings.  The judge wrongly ruled that this would stop the people from pursuing their cases which is not true.  The law does require the losing side in the three person panel to pay the costs of the panel. The result of the panel may be entered in court.  

Russell v Dimensions Health
Maryland Superior Ct.

 A licensed physician used a phony name and SSN when he applied for and was granted privileges at a hospital.  Two patients sued for a class action saying they had harm since he did not use his real name but they do not allege malpractice.   Top

Physicians

Kidzcare v North Carolina
Superior Ct

Kidzcare and eight others sued the state for underpaying for children's vaccinations.  They were supposed to get under law $20.45 per vaccine but only received $13.71.  This may cost the state a bundle.        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.