v Multiple People
The DEA raided and indicted 345 people including over 100 physicians, nurses or other medical professionals for fraud regarding telehealth, sober homes and opiod treatment. The accusation state that telemedicine execs paid physicians to order unnecessary DME along with genetic and other testing for patients they have never met or only telephonic conversations. The sober home was the same of paying illegal fees for referrals and then billing for same.
Dr. Chambless Johnston of the Knoxville, Tennessee area agreed to pay $530,000 to settle allegations that he billed for individual and group psychotherapy session done by unlicensed people as well as upcoding and providing illegal case management services.
David Mora, OD of the Laredo, Texas, area agreed to pay $3.23 million to settle allegation that he billed for medically unnecessary procedures.
US v Zamora
Roberto Zamora and his wife Carmen Donminguez were indicted on health care fraud for causing the submission of fraudulent claims for non-invasive cardiac studies. He is a CV tech and she is a biller for Cardiology Medical Group in Puerto Rico. The tests were alleged to by medically unnecessary and not reviewed by any cardiologist.
Dr. Franco Sicuro of Chesterfield, Missouri and Carlos Hunter of Baton Rouge, Louisiana , his business partner were indicted for billing for lab tests never performed. The allegedly billed for genetic and urine drug tests but did not have the equipment to perform those tests. They also unbundled tests and billed separately it is alleged.
US v Advanced Imaging of Port
The company has agreed to pay $500,000 to settle allegations that they billed for dye injection scans without direct physician supervision as required by law.
Abbas Mohammadi, DDS the owner of Columbia Dental agreed to pay $300,000 to settle allegations that he did dental restorations that were not needed and billed for x-ray done by non-certified people. A former employee filed the suit.
Hector Okwuosa, a licensed Alcohol and Drug Counselor in Connecticut, agreed to pay $230,000 to settle allegations that he billed for services by an unlicensed individual.
Monroe, Louisiana's George Fluitt III was indicted for allegedly paying bribes and kickbacks resulting in improper billings.
US v Klurfeld
Alex and Diana Kurfeld own Williamsburg Physical Therapy and Euro Physical Therapy in New York state. They have agreed to pay $4 million to settle allegations that hey billed for physical therapy services supervised by someone not eligible to supervise.
v Advanced Pain Management
The company agreed to pay $1 million to settle allegations that they paid stock to referring providers to refer unnecessary lab testing to them.
US v Pham
The San Diego owner of Phamatech, Tuan Pham, has agreed to pay $3 million to settle allegations that they submitted false claims for lab services for service induced by illegal payments.
Wansa Makki along with her brother Mahmoud Makki and her husband Hossam Tanana were indicted for allegedly billing for meds not dispensed. They oversaw two closed door pharmacies that only filled meds from various care facilities.
Hatem Behiry of New York state was sentenced to 2 years in prison for billing for physical therapy services not performed.
US v La Parl
Nathan LaParl, Talia Alexandre and Stefanie Hirsch were indicted allegedly illegally obtaining patient information and using that to illegally bill for unnecessary DME. Top
Luther King community Hospital v Anthem
The hospital sued the insurer for payment and won. The insurer covered an Ohio ERISA plan and about 75 patients visited the ED of the out of network hospital. The hospital billed but the insurer paid the patients and not the hospital. The patients deposited the money into their own accounts and did not pay the hospital. The lower court and now the 9th Circuit ruled for the hospital. The contract forbid the beneficiaries from assigning benefits to others excerpt providers.
Torres v Texas Children's Hosptal
The child was found face down in a bathtub and was declared brain dead. The parents filed suit to keep their child on the respirator and for $1 million. The EEG apparently shows complete cessation of brain activity. The lower court denied the parent's injunction and the Court of Appeals is now to decide.
Baltimore med mal attorney Stephen Snyder has been indicted by the feds for attempting to extort $25 million from the University of Maryland Medical System. It is alleged that the attorney threatened to do an online and media campaign stating the University had transplanted diseased organs into patients without telling them unless they paid him a ton of money as a sham consulting fee. Top
US v Parker
Jeffery Parker of Georgia was found guilty of making a false statement by attempting to accuse a former female lover of sending graphic photos of patients.
States v Anthem
Anthem agreed to pay $39.5 million to settle state AG claims regarding its lack of security in the 2015 hack of the information of 79 million people.
US v Liriano
Richard Liriano, a computer information tech of a New York hospital, inserted malware into co-workers computers allowing him to steal information of people coming to the hospital. He was found guilty and sentenced to 30 month in prison.
US v Dignity Health
Dignity has agreed to pay $160,000 to settle a case in which Dignity did not send the records to a patient's mother who had requested them.
States AG v CHS/ Community Health
Twenty eight state attorney generals sued the company and got a $5 million judgment for the company's handling of a data breach that affected over 6 million people. The 2014 data breach was due to the lax security systems by the hospitals and system. Top
Evans v UPMC Susquehanna
Evans was severely burned when his face caught fire while in the OR having surgery t remove basal cell carcinomas. He sued not only for med mal but also sued the hospital for fraud in advertising. the hospital used significant phrases in their advertising and he is say this is fraud,. The hospital says it is puffery and they can not be sued for this.
Prisma Heath v SC OBGYN
The medical group has quit Prisma and joined a rival hospital. Prisma is suing them for over $300,000plus attorney fees for breaking their leas. The medical group in answering said the reason they are leaving is due to th abysmal care received by the patients at Prisma. The hospital accused the physicians of leaving for more money from their rival but they state they will be getting less.
Alborzi v University of Southern California
Dr. Arash Alborzi was on the ID call panel at Verdugo Hills Hospital and had complained to the higher-ups about patient safety issues due to an illegal referral and kickback scheme by other ID physicians. He alleges that after that the panel was dismissed and the hospital no longer referred any cases to him. He sued for retaliation and the lower court dismissed for not first getting a writ of mandate. The appellate court said that was not necessary since it was not a quasi judicial decision but retaliation. The court ruled the case was to proceed. Top
Kennelly v Mid Coast Hospital
The estate of Carol Kennelly sued Mid Coast Hospital for med mal under the vicarious liability theory. Hospital employee Dr. Mia Marietta was accused of a gallbladder surgery that was under the standard of care. They wanted redacted operative reports of 25 cases prior to and another 25 post the surgery on this patient. The trial court ordered the production of the records and this court vacated that order. They ruled the cases post were not relevant and not discoverable. The pre cases were non party and protected under the state and federal privacy laws. Top
Tayefeh v Kern Medical Center
Dr. Farzin Tayefeh, applied for and was given temporary privileges at the hospital in Anesthesiology. Shortly after the Medical Board of California notified the hospital that an accusation was filed against him. He was summarily dismissed for failure to report the accusation within the required time. He sued saying that the hospital was required to give him notice and a hearing. A jury said no and he appealed. The higher court agreed with the doctor as his expert was not allowed to testify about the common meaning in the peer review industry of "medical disciplinary cause or reason". A new trial. It would have easier to just give him the hearing. Now the hospital lost and will go again to trial and then probably lose and then have to give him a hearing. More money than sense. Top
Milner v Team Health
Dr. Jeffery Milner was an employee of Team Health and worked in several hospital. He was often reassigned after filing complaints against coworkers or the hospitals regarding EMTALA and racial harassment. He lost his job and then compounded his errors by hiring an attorney that filed a terrible complaint using shotgun accusations. That cased the complaint to be dismissed. Top
Alexander v Hackensack Meridian
Dr. Frederick Alexander, a board certified pediatric surgeon, was terminated from the hospital. He had undergone internal hearing and then sued that his termination violated bylaws and due to anticompetitive grounds. The hospital moved to dismiss and lost. They failed to show the proceeding were quasi-judicial. Alexander argued the proceedings were against the bylaws and that the panel agreed that his privileges should not be terminated. The court also found that HCQIA would not apply due to the malice of the hospital. The reports to the NPDB were also still up for grabs under the trade libel statute. Bad hospital and executive committee controlled by the hospital. 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.