US v Ferris, Dossey,Isbell
Dr. James Ferris along with Katherine Dossey and Sherry Isbell of Oklahoma were sentenced to various months of probation along with Ferris giving up his medical license. They were also required to pay restitution of about $75,000. They had pleaded guilty to illegally prescribing narcotics along with falsely billing for them.
v McKinsey & Company
The consulting company has agreed to pay the states and territories a total of $573 million. It had consulted with Purdue to show them how to market their oxycodone.
v Newton, Waruru
Faith Newton and Winnie Waruru of Massachusetts were indicted for allegedly using a home health scam to falsely bill fed med via Arbor Homecare Services. They are accused of billing for services not performed as well as lying to investigators.
Dr. Mario Rosenberg of Beverly Hills, California, was sentenced to three years probation along with 1000 hours of community service and to pay restitution of $2.9 million. He had plead guilty six years ago but it had taken all this time to work out a deal. He had done along with others unnecessary surgeries on people for money.
Henry McInnis, the former CEO of Merida Group, a group of hospice and home health entities in Texas, was sentenced to 15 years in prison for his part in a scheme to bill for services not needed. He is an electrician by trade with no medical experience but as CEO and de facto chief of nursing directed employees to admit unqualified people to hospice and to keep those people on services for a long time.
Candida Girouard agreed to settle charges that she as Chief Compliance officer of Simple Health enterprise lured customers via deceptive websites to think they were buying comprehensive medical insurance instead of bare bones insurance. She agreed to be permanently banned from the health care business along with being responsible for the $195 million. That was suspended since she could not pay.
US v Behavioral
The North Haven, Connecticut, group agreed to pay $100,000 to settle allegations that they billed for licensed sessions but no licensed person held the sessions.
v Collier Anesthesia Pain LLC
The Fort Myers, Florida, pain clinic paid $1.6 million to settle allegations that they waived copays for surgical facility fees to induce patients to receive injection procedures. They also were alleged to falsely bill.
v Estate of Hunter
The estate of Urologist Dr. Patrick Hunter agreed to pay $1.7 million to settle allegations that he billed for ECWP for kidney stones that were not medially justified. The Florida urologist had an illegal kickback arrangement with the Orlando Center for Outpatient surgery where he agreed to perform his procedures there in exchange for payments from the surgical center.
Denis Mikhlin, the St. Louis owner of "Doctors on the Go" was sentenced to nine years in prison and ordered to repay $4,704,568. He had plead guilty to obtaining oxycodone and other drugs by fraud as well as getting illegal kickbacks from Central Diagnostic Laboratory for medically unnecessary testing.
Bradley Nurkin filed suit against HMA alleging fraud and paying kickbacks. The feds took over the suit and won a settlement of $262 million. Nurkin filed for $12 million in fees but the court reduced that to almost $1 million. The attorneys attempted to charge a contingency fee and the court rejected that. They paid on reasonable billing rates.
v Ferris, Dossey, Isbell
Dr. James Ferris along with Katherine Dossey and Sherry Isbell were all sentenced for fraud and for illegal distribution of controlled substances. Isbell was the owner of Physicians at Home in Wellston, Oklahoma where Dorsey was a pharmacist and Ferris was a physician. Isbell gave Dorsey access to patient records who filled out false prescriptions on presigned blank forms signed by Ferris. Ferris got 42 months probation as long as he agreed not to practice medicine in Oklahoma for three years. Dossey and she got 54 months probation and never practice pharmacy again in the state. Isbell was sentenced to 24 months probation. The three were also required to pay restitution of $53,468 to CMS and an additional $20,301 to Medicaid.
v Secon of New England
Secon Laboratories and Sterling Healthcare or Cordant Health Solutions agreed to pay $845,000 to settle allegations that they unnecessary urine tests were ordered and performed and then billed illegally.
Navid Vahedi or Brentwood in Southern California, pleaded guilty to healthcare fraud. He and his business Fusion Rx Compounding Pharmacy paid kickbacks for prescriptions. They provided physicians with preprinted prescription pads that had check the box options. They also did not collect the co-pays on these prescriptions. They then billed for the illegal prescriptions.
Kelly Wolfe of Indian Rocks Beach, Florida, pleaded guilty and she and her company Regency, Inc. have agreed to pay over $20 million to resolve allegations that they falsified documents to bill for DME as well as paying kickbacks. She used straw owners to set up fake DME companies in order to bill illegally. She also lied on her tax returns claiming personal items were business expenses. The was a qui tam case and the former employee who sued originally will get 23% of the civil recovery.
v Berberian and Lytle
John Berberian of Atlanta, and Christopher Lytle of Desoto, Texas, were charged with conspiracy to pay kickbacks and bribes for referrals for DNA samples sent to labs. It is alleged that they paid kickbacks to Ark Laboratory Network for obtaining samples to send to Personalized Genetic Lab in New Jersey. Top
v Geisinger and Evangelical Community Hospital
Three nurses have filed suit in federal court against the facilities for conspiring on a "n0-pouch agreement". They say this artificially kept down wages. This comes after a law suit by the Justice department to block Geisinger from partially acquiring Evangelical. Top
v Leon Medical Centers and Nocona General Hospital
The hackers posted the patient information of tens of thousands of people from the two Florida hospitals on line in order to extort money from the hospitals. In January Leon announced it was hacked in November but had no idea how many people's information was hacked. They are probably negligent for allowing the hack and for their follow-up.
In yet another hospital system to not have adequate security UPMC was hacked in April of last year. They just found out at 36,000 patients information was compromised.
Nebraska Medical Center
The University of Nebraska Medical Center and the Nebraska Medical Center have just found they were hacked last year and that patient's information was exposed.
v Renown Health
Renown has agreed to pay $75,000 for not providing timely the medical records and billing records requested by a patient. They will also have two years of monitoring.
OCR v Sharp
Sharp joins Renown and others in paying for not dleivering timely health records requested by patients. Sharp's negligence will cost them $70,000. Top
Borman went to Dr. Tara Brown for treatment of a droopy eyelid. She ws told that she could be treated by one of two procedures and one was covered by insurance but the other one wasn't. She chose the covered procedure but it failed to correct the problem. She contacted a second physician who said the correct procedure was the one she did not choose and it is covered by insurance. She then sued Dr. brown for negligence, lack of informed consent, fraud and battery. The trial court granted defendant's motion for summary judgment on the fraud and deceit charge and the jury went for the defense on the other charges. the appellate court reversed the summary judgment stating the she could still be tried for negligent misrepresentation.
Flores went to Dr. Carson Liu for treatment for morbid obesity. He explained the three procedures to her and performed a lap band surgery which failed due to the patient's continued eating. He then performed a sleeve procedure but it also failed for the same reason. He then redid the sleeve operation and although performed competently the post-op period was marred by a leak which required prolonged hospitalization. He had told the patient that the re-sleeve had a 5% chance of complications as he said the original sleeve had as well. This was not true as the original had a lower complication rate. She sued and of course lost. On appeal the verdict was affirmed and the lawyer lost even more money.
Morris sued the surgeon Carlota as well as the scrub nurse employed by HH Health Systems-Athens Limestone for a retained sponge. the court ruled the plaintiff did not need an expert for something that was commonly understood by a lay person and that the precedent case did not apply only to physicians since the nurses had settled pre-trial. the case against all goes forward. Top
Elder v Tenet Healthcare
Drs. Amir Kaki and Mahir Elder were fired from their positions and did an arbitration where they prevailed and were awarded $10.6 million and reinstatement of their medical privileges. The hospital went to court to overturn the arbitration and the court said the only legitimate cause of action was whether or not the arbiter overstepped her authority. It ruled she did not. Tenet is now appealing to the Circuit court and will lose there as well. 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.