Kansas v Henson
Dr. Steven Henson of Wichita was sentenced to life in prison for the death of a patient who he prescribed an opiates. He had been convicted of writing unneeded prescriptions for opiates and money laundering. Top
US v Vanguard Healthcare
The company in Tennessee agreed to pay the feds $18 million to resolve allegations that they provided substandard care in their nursing homes. The feds claimed the services rendered were so substandard as to be worthless. They also were alleged to have submitted false signature cards. Since some of the facilities are in bankruptcy the total collection is expected to by only $6 million.
US v Skyline Urology
The Maryland group agreed to pay the feds $1.8 million to resolve allegations that it submitted improper EM codes. They billed for EM codes done on the same day as procedures, an non-allowed occurrence. They improperly used the -25 codes.
Pacific Alliance Medical Center v
National Union fire Insurance Company
A qui tam person sued the hospital under the False Claims Act and the feds opened a criminal complaint investigation. they sent the hospital a letter saying to keep it quiet and get the feds permission before disclosing the criminal complaint. The hospital complied and after it lost $42 million court case in the FCA they sued their insurance company for the money. the insurers won since the hospital did not inform them of the suit within the time period. the hospital said it couldn't because of the letter from the feds but the letter only said they need to tell the feds before they disclose not that they could not disclose.
US v MedStar (R1 RCA Inc)
A qui tam plaintiff sued and the US intervened in this case against the hospital in Illinois and a company the hospital hired to review physician decisions. The Relator filed suit claiming the defendant entered into uniform contracts with over 250 hospitals for fees for recommendations. This is to justify inpatient and not outpatient stays. The hospital agreed to pay $200 per review. This case was determined on whether or not there was a public disclosure prior to the relator filing his suit. The court said the case could go forward.
NY v Lewis
Wendell Lewis was indicted for stealing from two hospitals, Interfaith Medical Center and Brooklyn Methodist Hospital. Lewis worked in payroll and diverted funds to false identities which he controlled.
US v Medtronic
Medtronic's Covidian has agreed to pay the feds $20 million to settle allegations that they employed kickback arrangements with physicians so they would use the CloseFast device. This was a whistleblower case where it was alleged Covidien provided free or discounted services to physicians to use the product.
New York v Hussain
The state is accusing Aftab Hussain, the owner of multiple pharmacies in the state, of money laundering. The AG wants to attach over $26 million of his assets. He is accused also of paying Medicaid patients to get their prescriptions filled at his stores, opening stores and purchasing some meds fro legitimate wholesalers and more form illegal sources and billing for all to Medicaid and then change the name of the pharmacy or sell it.
New York City v Feygin
Dr. Lazar Feygin of Brooklyn has plead guilty of selling oxy to defraud Medicaid. This is a plea deal where he is expected to get 5 years and lose his license. He paid patients to get medical tests that he billed to insurers with oxy prescriptions.
US v Brooks
Harris Brooks, the former CEO of Palo Pinto General Hospital in Texas, has plead guilty of health fraud. He submitted claims to insurance companies for allergy and genetic testing at the hospital. the hospital did not have the equipment to do these tests.
US v Advanced Pain Diagnostic
The pain clinic and the owner Dr. Kayvan Haddadan of Sacramento had no solution for billing for care provided by a nuse that was excluded from Medicare and Medicaid. They paid a settlement of $866,000. Top
Panaggio v New Hampshire
Compensation Appeals Board
The state high court ruled that the patient's could be reimbursed for his cost of medical marijuana. The insurer denied his claim and the appeals board also denied the claim stating that medical marijuana was against federal law and could expose the carrier to federal prosecution. The high court said the Board cited no legal authority for its position and remanded the case back to the Board.
Patients v United Behavioral
The federal judge blistered the United Health subsidy for creating internal policies to discriminate against mental health patients for money saving reasons. This may cost million and millions of dollars to the firm in the next phase of the trial.
Planned Parenthood of Greater Ohio
Planned Parenthood challenged the Ohio law that deprived it of state funding due to performing abortions. The full court voted 11-6 that the withholding of funds was proper since Planned Parenthood has no due process rights to perform abortions and there is no proof that the ban posed an undue burden on a woman's right to abortion, which belongs to women not Planned Parenthood.
Beal v Iowa Department of Human
Iowa was sued to get Medicaid to pay for transgender surgery. The Supreme Court ruled unanimously that payment is due for the medically necessary surgery.
Parents v Rockland County
The parents of unvaccinated children sued to get their precious little ones back into school. They were told they could not get them back until they were vaccinated. Good on the judge.
Patients v Wolverine Solutions
Potentially many hundreds of thousands of patients may be affected by the EMR breach after a ransomware attack on the Group. In the old days several files may be stolen if an office was broken into. Now with computers it is millions of files per year.
US v Kalina
Linda Kalina of butler, Pennsylvania, pleaded guilty of wrongly disclosing health information. She worked at UPMC and improperly accessed 111 patient records and told personal gyne information to case embarrassment and mental distress.
Edgar v VA
Joseph Edgar filed a whistleblower suit against his boss DeAnne Seekins for retaliation, harassment, defamation and creating an inappropriate working environment. While working against Edgar he has claimed other senior VA members who report directly to Seekins accessed his medical records inappropriately.
Patients v Arizona
The Arizona Medicaid program sent personal health information of over 3000 people to the wrong addresses.
Patients v Emerson Hospital
An employee of a third party that helped the hospital collect billings sent information to another who was not authorized to receive it. As a result another over 3000 patients had their health information compromised. this was a year ago and they are now getting around to telling the people. Top
Kemp v Capital Regional Medical
Stephanie Kemp was visiting a friend at the hospital when she slipped on a wet floor when the hospital violated its own policies regarding same. She had $100,000 in medical bills and was awarded $1 million. Top
Webster v CDI
Webster had a CT scan provided by a CDI facility and read by an independent contractor radiologist. He missed a cancer and it had metastasized when found two years later. At trial Webster won $15 million in federal court on diversity jurisdiction. There were no caps as provided by Indiana law as CDI had negligently failed to register as a state qualified health care provider. The court allowed the verdict to stand as they would not allow corporate arrangements to profit the companies from their liability.
Leavitt v J&J
An Oakland California jury has ruled that the company must pay the plaintiff $29 million for having their powder cause the plaintiff's mesothelioma. The patient will not see this money as the case will be tied up in the courts for many many years. Top
Grafilo v Cohanshohet
In an interesting case the California Medical Board believed that Dr. Cohanshohet was prescribing narcotics without a good faith exam and wanted the patient records. The patients refused to give permission and so did the physician. The board sued to force the production of the records and the trial court backed the Board. On appeal it was reversed saying that in order to overcome the privacy the Board must show good cause and here the Board never presented evidence except for the CURES report that the physician failed to properly diagnose or examine the patients. Top
Talley v Christiana care health
Yet another physician wastes money trying to reverse the removal of privileges. Here, Dr. Lynn Talley, an OB had her privileges terminated and then she sued the hospital and individual physicians for both tort and contract claims. She originally sued for tort misrepresentation claims and then added tortious interference claims. She lost both. 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.