US v Geisinger Community Health
The facilities have agreed to pay $18 million to settle allegations that they submitted claims for hospice and home health that did not have physician certification of terminal illness.
Massachusetts v Health Insurance Innovations
The Florida insurance company has agreed to pay Massachusetts clients a total of $515,000 along with a fine of $100,000 and and additional $10,000 to cover the cost of the investigation. The reason is that they sold policies that were deceptive.
US v Osella, Matos
Lorena Osella and Juan Matos of southern Florida plead guilty of health care fraud. They paid Medicaid beneficiaries $400 per month for their receiving psychosocial rehab services at Lighthouse Community Center in Doral, Florida.
US v Access Hospital Dayton, Johnson
The Ohio facility and its owner dr. John Johnson agreed to pay the feds $374,780 and the state $50,19 to settle allegations that they knowingly submitted false claims for tests of prolactin and ammonia that were not necessary.
US v RehabAuthority, LLC
The Minnesota physical therapy company agreed to pay $4 million to settle allegations that they billed for one on one physicial therapy that did not exist.
US v Great Lakes Therapy Housecalls, PC, Harvey
The Traverse City, Michigan company agreed to pay $450,000 to settle allegations that they submitted false claims for physical therapy sessions never provided.
US v Fleyshmakher
Igor Fleyshmakhler, the owner of Union city, New Jersey, Prime Aid Pharmacies was sentenced to 41 months in prison. He had plead guilty of kickback violations and tax evasion. They paid bribes to physicians and physician employees to steer prescriptions to their stores. He was also order to pay restitution of $5.8 million and a $100,000 fine.
US v Moffett
Mark Mofffett of Springfield, Illinois, was sentenced to 54 months in prison. He had as a pharmaceutical rep stole patient identifications, falsified medical documents and convinced physicians to order a very expensive anti-cholesterol med Juxtapid where it was not indicated.
US v Wittbrodt
Patrick Wittbrodt of Grand Blac, Michigan was sentenced to 48 months in prison for going to UAW meetings and touting "free" pain creams. They got the people's medical insurance information then had a Dr. April Tyler write the prescriptions with out seeing the patients. Along with the prison he was ordered to pay to Blue Cross of Michigan $7,317,173 and $902,387 to Medicare.
US v Infectious Disease Consultants of Georgia
The Macon, Georgia group agreed topay $325,000 to settle allegations that they billed for infusion services provided by unlicensed personnel.
US v Markovich, Markovich
Two South Florida brothers Jonathan and Daniel Markovich were convicted of fraud and paying kickbacks in their addiction centers. They billed for services never received and nor medically necessary. They also paid patients for coming to their centers and for their medical information.
US v Taylor
Billy Joe Taylor of Lavaca, Arkansas, was indicted and accused of faking the need for urine drug tests in the multiple labs he controlled.
US v Kaleo Inc.
The pharmaceutical manufacturer has agreed to pay $12.7 million to settle allegations that they submitted false claims for the drug Evzio, an injectable naloxone. Kaleo directed physicians to send the prescriptions to certain pharmacies if they prescriptions were not completely kosher. The case is a qui tam and the whistleblower will ger about $2.5 million.
US v Ambulatory Anesthesia of Atlanta, Northside
The entities agreed to pay $28 million in a qui tam case for paying surgical centers with free staffing along with paying for drugs etc to become their exclusive provider. The whistleblower and her husband were killed in a plane crash prior to the settlement. The WB and her medical practice got almost $5 million.
US v Nolan, Epstein
Michael Nolan of Tampa, Florida and Richard Epstein of Aurora, Colorado, were sentenced to 6.5 years and 63 months respectively for their telemarketing company targeting elders for DME not needed. They are also to pay $2.1 million and $3 million respectively along with jointly and severally along with others $29 million.
US v Defonte, Cirri Truglia
Nicholas Defonte and Chritpher Cirri of Toms River, New Jersey, and Pat Truglia of Parkland, Florida, pleaded guilty to fraud and kickbacks. The DME companies were secretly owned by the three and the companies paid kickbacks to the three. The same was true for call centers they owned.
US v Covington, et al
Lee Covington and his wife and sisters all of Raeford, North Carolina were sentenced various prison time and repayment of $3.65 million. They had plead guilty of falsifying crisis intervention and being grossly overpaid.
US v Palatnik
Leonel Paltnik of Adventura, Florida, was sentenced to 82 months in prison for his role in the billing for unnecessary cancer and cardiovascular genetic testing orders.
US v Smiley
Norman Smiley of Boca Raton, Florida, plead guilty for giving and receiving kickbacks in the use of unnecessary genetic testing.
US v Arthrex
Arthrex, a medical device company, agreed to pay $16 million to settle allegations that they paid royalties to a Colorado surgeon for his contribution to the the devices but it was really for using the product.
US v Brown
Sikirat Brown of Upper Marlboro, Maryland, was sentenced to 13 months in prison for providing false timesheets to Medicaid for services she did not do while working as a personal care aide. She was also ordered to pay $343,539 in restitution and $201,640 in a forfeiture bond money.
US v Gazi
Dr. Mukaram Gazi of Marlboro, New Jersey, has been indicted for accepting bribes to write prescriptions for Fentanyl. The urologist prescribed Subsys for patients for which it was not necessary and received money for from Insys for doing so but paid as educational presentations.
US v Hertel & Brown Physical and Aquatic Therapy,
The owners Aaron Hertel and Michael Brown and the employees of the Erie, Pennsylvania, PT were all indicted to commit fraud. They are accused of billing for treatment by an unlicensed technician and billing as if performed by a licensed physical therapist. Top
Physicians v VA
In a class action suit the VA has been ordered to pay $160 million to 3207 NPs and physicians who worked overtime to update patients EHRs and respond to patient notifications in the VA EMR. The court found that the staffers ere entitled to overtime if they worked over eight hours a day not weekly overtime. Each class member will get about $50,000.
Louisiana v OSHA
The court stopped the Biden administration plan to require all employers with over 100 workers prove the vaccinations against Covid or wear masks and get weekly testing.
Warren v County of Sacramento
The plaintiffs sued the county EMS for their policies governing where ambulances take patients. They wish to be taken to a hospital where their provider has privileges not the nearest hospital. They say this violates their privacy and informed consent doctrine. The trial court ruled against the Warrens and the appellate court affirmed. They said neither state nor federal privacy laws were applicable and said the policy was rationally related to legitimate governmental purpose.
Long Beach Memorial Medical Center
The hospitals had no contract with Kaiser and billed full rate for seeing their patients. They were paid about 53% of billed charges and sued for the remainder. A jury found for Kaiser. The hospitals appealed and the finding was affirmed. There is no tort duty of avoid paying less than the reasonable and customary value of emergency services. Top
Patients v UNC Health
The Chapel Hill, North Carolina organization found on audit that 946 patient billing records were accessed by someone not authorized to see the records. Top
Counties v Drug Manufacturers
The trial court judge said that the local California counties did not prove that the manufacturers of opioids used deceptive marketing to increase opioid prescriptions and create a public nuisance.
Mitchell v Los Robles regional
Stacey Mitchell took an overdose of Naproxen and went to the ED of the hospital. She was examined and had no sensory or motor deficits. She walked to the toilet assisted by her husband but later walked back unassisted and fell injuring herself. She was admitted and released several days later. She sued the hospital for negligence and premises liability over one year later. the case was tossed since MICRA say the statute for med mal is one year. Legal malpractice?
Cardinale v California Center for Reproductive
The Cardinale's gave birth via IVF to a normal child but the father had doubts. In view of those doubts the Cardinale's had DNA tests done and found they were not the biological parents of the child. The eggs had been mixed up with another's during retrieval. The babies are now with the correct parents but the Cardinale's are suing the center and Dr. Mor for breach of contract, med mal and negligence. They had been told the whole process was in-house but in fact the Center outsourced that handling of the embryos to VitroTech labs. The other couple is expected to also file suit soon.
Oklahoma v J&J
The trial court had awarded $9.3 Billion to the state under the public nuisance law stating the company used deceptive marking to fuel the opiod crisis. The Supreme Court saw thing differently and overturned the verdict. This follows a similar case and result in California. The court said this particular law could not apply to this case. Top
Avva, Gold, Reichard v Hackensack
Drs. Usha Avva, Nina Gold and Kathleen Reichard all emergency pediatric physicians were terminated from their positions the claim due to age discrimination. They were the three oldest in their department and the hospital kept three younger physicians with an average age of 36. The three fired physicians were also the board certified ones and making the most money. The hospital said they were fired due to business reasons due to decreased patient volume related to Covid. However, the hospital has already hired two more young physicians to care for a rising patient volume. How large is the hospital's checkbook?
Ramalingam v Robert Packer
Hospital/Guthrie Medical Systems
Dr. Saravanan Ramalingam was a certified surgeon in India but needed a US residency to become board certified in the US. The ABS allowed him to start as a 4th year resident and he was admitted to the program at Robert Packer Hospital. The director of the program advised him to apply for a fellowship but is was to start three months prior to the end of his residency. He applied to the ACS and then was accepted into the fellowship program. However the Robert Packer Promotion Committee would not allow him to graduate. He sued that this deprived him of his fellowship and therefore could not get as good a job as he would if he got the fellowship. The hospital defended under HCQIA stating expert testimony was needed. The court said that if he could show the Committee's medical basis were unsound or that there was a separate impermissible primary reason for the action the the law would not apply. The court also said the hospital could not limit damages under the claim nor did it dismiss the claim for punitive damages.
Wessner v Aetna
Carol Wessner, RN, was hired by Aetna as a quality management consultant in 2013. She was tasked with finding out why many children were not being screened for their health. She found that Aetna's network contained many physicians no longer in practice or were not pediatricians. The children were assigned to providers not contracted with Aetna. This allowed Aetna to get paid for many more children than it actually provided care for. At Crozier-Keystone Health network almost 97% of Aetna's children wre not screened and assigned to vascular surgeons or gyne for care. She says she reported this and was told not to put it in writing and to stop reporting her findings. She was then terminated from her job. She sued and the US decided not to intervene. 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.