New York v Gajewski
William Gajewski, of Amherst, New York, was convicted of embezzlement and sentenced to six month in jail. He was the office manager of Buffalo Rheumatology and Medicine. He has paid restitution. He also must pay $10,000 in fines and serve 1000 hours of community service. Top
US v William Beaumont Hospital
The Detroit area system agreed to pay the feds $84.5 million to resolve allegations that it had improper relationships with eight physicians resulting in false claims. They provided office space for below market value in order to get referrals. This was a qui tam suit by four individuals. They will get good money for their filing suits. In an interesting turn, three physicians Drs. Joel Kahn, Dineth Shah and Renato Ramos have hired lawyers to fight charges that they were improperly paid. The three cardiologists denied any illegal acts.
US v Yi
Young Yi, a citizen of South Korea, was convicted of health care fraud . She did unnecessary sleep tests on legitimate patients referred to her Virginia sleep center. She did not have the results sent to the patient's physicians and told the patients they did not have co-pays when they did. For this she obtained about $83 million and lowered her taxes by $900,000 in one year alone. She also used her business accounts to purchase lavish goods and real estate for personal use. She was convicted by a federal jury and will be sentenced at a later time.
US v Early Autism Project
The largest provider of behavioral therapy for autistic children in South Carolina has agreed to pay $8.8 million to settle allegations that it billed falsely for services not performed.
US v Ritter
Drs. Michelle Ritter and Charise Valentine of the Detroit area were arrested along with others for prescribing controlled substances to patients who did not have a legitimate need. The drugs would then be resold at street value.
US v Voudouris
Dr. Apostolos Voudouris of Somerset, New Jersey, was sentenced to 20 months in prison for billing the VA for services never performed. He had pleaded guilty previously. He will also pay $476,460 in a fine as well as restitution of $238,230 and a fine of $7500.. He is a cardiologist and electrophysiologist. He had billed the VA for these never performed procedures.
US v Prime Health Care
Prime and Dr. Prem Reddy have agreed to pay the feds $65 million to settle allegations that the 14 California hospitals both admitted patients that should have been outpatients and upcoded. The whistleblower, a former Director of Performance Improvement at Alvarado Hospital will get over $17 million.
US v Vaid
Mustak Vaid, a physician in Brooklyn, was sentenced to 18 months in prison for health care fraud. He posed as an owner of a medical clinic and claimed he had examined and treated patients he never saw. He had previously plead guilty. He is one of many indicted or convicted in the scheme.
US v Insys
Insys agreed to pay the feds $150 million to settle allegations that former employees inappropriately sold controlled substances. This will be paid over five years.
US v Wiseth
Stephen Wiseth, Chiropractor, has been indicted for wire fraud and identity theft. The Thief Falls, Minnesota (great name for this case) chiropractor is accused of having free promotional events and then billing insurances for treatment of those attending. He also is accused of stocking his waiting room with "wobble chairs" and then billing for treatments for the time the patients were waiting.
US v Northwest ENT
The Georgia ENT group agreed to pay almost $2 million to settle allegations that they billed for dilating the patient's sinus with a single use balloon but reused the balloons. The group accepted responsibility for its actions.
Shaffer v Perez
In a federal filing the plaintiff has alleged that Jorge Perez of Miami and the VP of Hospital Partners Inc. took control of a 10 hospital group in Kansas and Missouri and intentionally stripped it of its assets leaving the shareholders without value. The hospitals were then used to run a scheme for billing for drug testing according to the suit.
US v Esformes
Overzealous prosecutors give all a bad name. In this case a judge tossed key evidence against Philip Esformes, a Miami executive due to the feds took away records protected under client attorney privilege. This gives a huge advantage to the defense trying to get their client either acquittal or a lesser sentence. Esformes has been under arrest and detained for the past two years. He was accused of fleecing the public by billing for services never performed in his chain of nursing homes.
US v Haar
Sandra Haar, the CEO of Horisons Unlimited in Merced, California, pleaded guilty of health care fraud. She billed for services not rendered nor medically necessary. Top
Highmark v UPMC
The lower court said thee was no end to the contract between the two but this was reversed. the end is now 12/31/18 with a six month runout after that. The Attorney General didn't like the end of a contract but he is a loser in the 6-0 vote.
Santa Rosa Memorial Hospital v Kent
The hospital was one of many that sued the state after legislation reduced Medicaid reimbursement. The lower and the court of appeal both said that it had no jurisdiction to hear the hospital's charge since CMS approved the rates the sole remedy is administrative proceedings against the CMS.
Flack v Wisconsin Dept. of Health Services
The court issued an injunction against the state so they must pay for gender reassignment surgery. Wisconsin Medicaid specifically excludes coverage for this and for medically prescribed drugs for transsexual surgery. The court found the two with gender dysphonia and proved they would have irreparable harm if the surgery was not done and paid for.
North Cyprus Medical Center v Cigna
The Houston hospital sued Cigna for allegedly underpaying of claims. The insurer did this after it learned that the hospital which is out of network was charging patients less than what they owe or fee forgiving. Cigna alleges this is fraudulent. The court ruled for Cigna.
Crane v Lifemark Hospitals
Crane,, who is deaf, sued Palmetto General and the parent for failure to provide him with an ASL interpreter. Instead his physician communicated via routine sign language and written notes. The lower court said the hospital deserved summary judgment since Crane was provided with sufficient aids of effective communication. The 11th reversed based on both effective communication and deliberate indifference. They said there was a a genuine issue of material fact so summary judgment was wrong.
Patients v Colorado
In a case of stupidity that mimics the one above (Crane v Lifemark Hospitals), the state is paying $1 million to be shared with 20 patients of the Pueblo Regional Center for the severely intellectually disabled. The idiots at the Department of Health stating it was for the good of the patient did an unconsented to strip search of the patients. The Department refuses to admit their idiocy stating that it was for the good of the patient as there had been allegations of sexual abuse in the past.
In Re: Mister Y
In a victory for patients the high court said that patients no longer have to the Court of Protection would no longer need to intervene in discontinuing artificial life support when physicians have agreed to its necessity in persistent vegetative state patients. There is apparently no law requiring taking all end of life decisions before judges. This is good for England and Wales.
Patients v UnityPoint
Iowa's UnityPoint has notified 1,400,000 patients of the potential for a breach of their medical records. This was a phising scheme that employees fell for. This is the second one this year. The other was in April and 16,400 were affected. They deserve a huge fine from the feds. In the meantime a shyster has filed a class action suit against the hospital which will probably never go to trial. The lead plaintiff said she noticed an increase of robocalls and spam emails and experiences daily anger and sleep disruption due to the data breach. Poor baby.
Patients v MedSpring Urgent Care
The urgent care had a phishing scam in an email resulting in unauthorized access to thousands of people. Poor training. Top
Mota v Tri-City Medical Center
Delfina Mota has filed suit against the Oceanside hospital as well as her surgeon and anesthesiologist for performing a C-Section on her while awake. She states that she was over 41 weeks pregnant upon admission and the staff could not detect a fetal heart tome. This mad the surgery emergent. The anesthesiologist could not get there on time and the surgery was started. The anesthesiologist arrived during the surgery. The husband was outside in the hallway and heard the screams. The patient states she passed out from the pain.
Tunac v US
Randy Tumac had blood tests showing renal failure at the VA. The VA took 3 months to schedule the renal biopsy which confirmed the diagnosis. The scheduled his first dialysis appointment a month later but he died prior. The wife saw a report regarding the VA problems over four years later and under one year later filed an administrative claim which was denied. The lower court said they had jurisdiction but denied for untimeliness. The 9th affirmed.
Doe v Syervud
Jane Doe was taken to the ED of the University of Virginia on an emergency custody order after a suicide attempt. The ED physician and other personnel are accused of violating her 4th and 14th Amendment rights by forcibly taking blood and urine samples as well as giving her psychoactive and anti-anxiety drugs. She apparently was combative and required both physical and pharmacy restraint. Let us hope the attorney not only loses the suit but also a lot of money.
Trahan v Clayton Dublier &
Zelda Trahan sued because her daughter was transported to Harbor Hospital instead of a closer one in violation of EMTALA. Wrong! EMTALA applies only to hospital with emergency departments. No EMTALA claim.
Cynamon v Mount Sinai Hospital
The plaintiff sued two docs and the hospital after it was found during surgery that the original planned could not be completed and a different one was done. They also claim no antibiotics were done so she had problems and needed another surgery. The hospital was dismissed as the doctors were independent practitioners and it is the duty of the physician and not the hospital to get informed consent.
Brugaletta v Chilton Memorial
The state high court reaffirmed that a hospital's self critical analysis is not discoverable under the state's Patient Safety Act. The plaintiff was admitted to the hospital and had multiple surgeries and sued for doing less than the standard of care. The trial court said the findings were discoverable The appeals court reversed an the supreme court affirmed the appellate court.
Bean v Jackson Memorial
In an interesting case the plaintiff Latoya Bean had preeclampsia and the newborn died. The issue is that the physicians were University of Miami physicians working at Jackson Memorial. In Florida there is sovereign immunity for government agencies. This case now allows that immunity to be transferred to private entities that have an agreement with a state agency.
Johnson v Monsanto
Don't you love a jury of your peers? A San Francisco federal jury found Monsanto guilty of causing the plaintiff's Hodgkin's Lymphoma from their "Roundup". There are virtually no scientific studies that show any relationship to the active ingredient glyphosate. He was awarded $39 million in damages and another $250 million in punis. Johns on will never see this money and I doubt his family will either as the appeals will take forever. Top
Carter v Appledore Medical Group,
HCA, Portsmouth Regional Hospital
Dr. Peter Carter has filed suit against the above and others for age discrimination. He contends that he was forced out of his job and was then defamed by a letter stating he retired. He was employed by Appledore and after seven years noted his referrals were falling. He was told that it was due to preference for female surgeons in breast surgery. He was then told his position was being eliminated due to loss of referrals and he could resign or accept a 90 day notice for his job to end. He says Appledore sent the letter that he retired although it was never authorized to do so.
Scarabelli v VCU
Dr. Tiziano Scarabelli has filed suit against VCU physician group and four colleagues for defamation. He says he was retaliated against for raising concerns regarding insufficient heart care for chemo patients. He says that colleagues resisted the common sense idea to monitor patients for chemo toxicity in real time not just prior to therapy due to insurance concerns. He claims that the decision ws made to get rid of him and then information was actively solicited about he doing sexual harassment, which he alleges is not true. He says an investigation proved he had no complaints and he was absolved of problems. He was then fired.
Pinter-Brown v UCLA
After she won a $13 million suit against UCLA for discrimination she went back to court and won an additional $1.8 million for attorney fees. I have to agree with UCLA on this one. $1100 per hour is a ridiculous sum for attorney fees.
Kim v Wyoming Medical Center
Dr. Anje Kim is suing for a breach of her employment contract and being barred from practicing any type of medicine in much of Wyoming. She argues the noncompete clause is too broad and unenforceable. She claims that she was removed from the staff due to failure to obtain or maintain without restriction clinical privileges at WMC. She says her agreement only stated that she needed to maintain clinical privileges at Mountain View Regional Hospital and she was not required to apply for privileges at WMC. Her contract was acquired by WMC. This is part of an ongoing spat between WMC and neurosurgeons. Mountain View was founded by neurosurgeons who wanted their own OR team. After WMC purchased Mountain View they closed the hospital ED and made it into another campus. Top
Dr. Jay Joshi is suing another of the same name. The suit claims he used the plaintiffs name and reputation to turn his small practice into a pill mill. The defendant in this case has already pleaded guilty to illegal distribution of illegal substances. The imitator used all the plaintiffs reputation to give fake interviews etc. 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.