September 15, 2016 Recent Legal News


Peer Review and Employment





Singer v Progressive Care
ND Ill

The court dismissed a false claims action against the oncology practice by a relator.  Singer alleged that the practice illegally referred patients for PET scans to an offsite firms that they owned an interest in.  Also alleged is that the group illegally administered Procrit to patient as well as padding the bills.  The court said the relator's claims were based on public knowledge and therefore barred. The court acknowledged that his position as COO gave him direct knowledge but did not pleas with particularity as required.  The court allowed a re-filing.

Howes v Yankton Medical Clinic

The court denied a summary judgment motion by the Clinic to dismiss.  This case stems from a med mal case filed by a plaintiff earlier for widespread med mal from an ortho doing unnecessary spine surgeries.  The plaintiff then saw a pulmonologist at the clinic for sleep apnea.  He missed some follow up appointments that were required for the use of CPAP.  The pulmonologist refused to see the patient unless the entire bill was paid in full even though he had Medicare and had agreed to a  monthly payment plan.  The patient died.  The wife sued saying the pulmonologist used an intimidation factor because of the prior law suit for the ortho.  She satisfied the interstate requirement by showing that other plaintiffs in the ortho case were form other states and the clinic accepted Medicare.  

US v Rouzaud

Robert Rouzaud , DDS of Cleveland was sentenced to one year in prison and repaying $344,000 to Medicaid for billing for more work than authorized or for work never done.

US v US Healthcare Supply

US Healthcare Supply and Oxford Diabetic Supply Company agreed to pay over $12.2 million for violations of the FCA.  They made cold calls to sell DME to patients thereby billing for unneeded equipment.  These calls are against the law.

US v Stubblefield 

Ph.Ds Beverly Stubblefield of Slidell, La. and John Teal of Jackson, Miss. pleaded guilty of health care fraud.  The administered psychological tests to nursing home residents in several states that were not medically necessary.

Hockenberry v OhioHealth
SD Ohio

A physician sued the system for having physician employees enter false notes into patient charges.  However, he could not provide patient names, dates or anything else due to HIPAA .  The court said hard taffy and dismissed the case.  He could have used initials or get a protective order but did nothing.

US v Carroll

The feds indicted 16 people including physicians in another South Florida fraud ring.  This one was to the tune of $175 million.  Call centers solicited potential patients for compounded creams that cost up to $31,000 per tube.  

Grason v Burwell
7th Circuit

Dr. Grason was investigated for alleged billing fraud.  He was found to enter a patient apartment building and leave in 15 minutes after which he billed for five different patients with medium to high complexity visits.  CMS revoked his billing privileges and a ALJ upheld the decision.  The district court also upheld the decision and the appeal to the 7th Circuit yielded no different decision.   

US v Westlake Convalescent Hospital

 The hospital and Dr. Jasvant Modi and Meera Modi along with Jasvant's wife have agreed to pay $3.5 million to settle allegations they paid illegal kickbacks for skid row people to be sent to Westlake.  They then allegedly sent false claims into the feds for medically unnecessary services.  The whistleblower will get over $500,000 for turning them in.   

US v Kaplan
9th Circuit

Dr. Michael Kaplan, urologist, used one time only prostate biopsy needles several times on different patients.  He was accused and convicted of adulteration by the FDA in a jury trial, a felony conviction.  He appealed and thank God lost.   Top

Peer Review and Employment

Moore v Grady Memorial Hospital
11th Circuit

A surgeon sued after he had summary suspension of his privileges.  He sued for racial discrimination.  He was employed by a medical school that had an agreement with the hospital.  The dispute involved whether the surgeries he was doing were barred bariatric surgery or not.  During the dispute he complained that another medical school surgeons were being given more access to OR time than he was.  he then received a letter of his suspension.  The lower court dismissed the surgeon's claims but the appellate court said the issue of discrimination needs to be re-examined and allowed the suit to continue for now.        Top


Yarbrough v NW Memorial Hospital
Ill App Ct

A pregnant woman received care from a federally funded clinic not affiliated with the hospital but was told that she would deliver at the hospital.  She delivered at 26 weeks and the child had many complications.  She sued many people and entities.  The attorney said the hospital should be sued since they had apparent authority.  The hospital logically disagreed.  The court disagreed since the hospital advertises itself as a community hospital that collaborated with neighborhood centers including the center where the mother had her prenatal care.  There was an affiliation agreement between the two entities and the agreement called for a hospital representative to sit on the clinic board.

Laster v Henry Ford health
Mich Ct App

The patient came to the ED with a history of Crohn's and abdominal pain and vomiting.  The surgeon examined the patient and diagnosed appendicitis.  She required the patient to sign a paper stating she was not an employee of the hospital.  After the procedure the patient had complications and eventually it was found she had a perforated bowel due to Crohn's.  The [patient sued the surgeon and the hospital on the basis of apparent agency since the surgeon came via a hospital on call system.  The court said the hospital had no control over the surgeon and the appellate court sent the case back to grant the summary judgment.

Scott v Memorial Health
6th Circuit

A patient came to the ED with slurred speech and a facial droop.  The patient was diagnosed with Bell's.  Two hours later he developed other symptoms which showed a stroke and he was transferred to another hospital.  The patient died eight months later after a second stroke.  The wife sued for EMTALA violations.  The court said no expert testimony showing the harm was the direct result of the violations and tossed out the case.

Slagle v UPMC

The young lady died after a heart transplant due to mold infection at the hospital.  This is one of many transplant patients to die in this hospital due to mold.  Her family got $1.3 million.  Previously the hospital settled with another patient's family for $1.3 million.

Genthner v Clovis Community Hospital
ED Cal

Yet another bogus EMTLA claim goes to rest.  The patient went to the ED complaining of a badly burning mouth.  She says she waited four hours for no exam or treatment.  Her own submissions said her statements were false as she was seen and determined her condition was non-urgent.  She also eloped before treatment.  This is a state law case not federal.  Hope either the attorney or the patient lost major dollars on this case.

Young v UC Health
Ohio Ct App

It pays to appeal dumb trial court decisions.  In this case the patient sued the surgeon and hospitals for alleged back problems.  However, he sued after the statute of limitations of four years.  The lower court said the statute was unconstitutional and of course was overridden by the court of appeals.  The case was dismissed.

Casares v Mercy St. Vincent Med Center
Ohio Ct App

The patient fractured his cervical spine while swimming and went to a hospital locally and then transferred to another hospital.  He became quadriplegic and sued both hospitals.  The lower court granted summary judgment to the health center.  The appellate court overruled and said the doctrine of respondeat superior held.  The patient was unconscious and therefore unable to know the independent contractor physician was not a hospital employee.   

Patients v Children's Dental Group
To Be Filed

Seven children were hospitalized for oral cellulitis after having pulpotomies at the clinic.  They are looking at potential water sources.   Top


Patients v Medical College of Wisconsin
To Be filed

An unauthorized third party accessed an email account which contained patient information.  There were about 3200 patients information involved.  They are now going to take steps to minimize this in the future.  They should have done it before the hack.

Patients v Planned Parenthood
To Be Filed

The organization in Greater Washington and North Idaho sent an email erroneously to some organization or someone not entitled to the information.  This error affected 10,700 patients.  They are considering additional safeguards in the future.   Whoopie Doo.  

Patients v Decatur Health 
To Be Filed

The log of patients who received CT scans since May 2102 went missing at the hospital.  Negligence versus theft???  Better ways of keeping the data ate now being explored.  Another hospital living in the dark ages and negligent in their record keeping and security.    

Patients v CHI Franciscan Health Medical Center
To Be Filed

The medical center had a vendor leave patient information accessible via the internet.  The affects over 18,000 people.  Free credit monitoring is offered.      Top


Dev v Blue Shield of California
Ca App Ct

Dr. Vishva Dev treated three patients of the defendant without a contract.  He billed Blue Shield for thousand sof dollars for emergency work and got paid about 10% of billed charges.  He appealed and got a pittance on one patient.  He sued but over two years after the internal appeals were completed.  Blue got summary judgment for untimely filing. 

Lee Memorial v Florida Blue 

The suit is for underpayment for services rendered to out of network Ocare policy holders.  They want $2.5 million for ER care of 150 patients.  

ConnectiCare v Connecticut

The Ocare insurer is suing the state Insurance Department for an injunction for denying their proposed premium increases for this year.  The state reduced the proposed raise from 27.1% to 17.4%.  By not approving the rate increase the insurance company can not offer insurance in the state.  The court several days later ruled against ConnectiCare.  The day following the ruling the insurer said it will stop writing policies leaving about 50,000 without insurance next year.  In then another flip flop the insurer said it will continue to write insurance in the state. They also withdrew their appeal of the state's denial of their raise in rates.  If they had gone through with their quitting, the state would have had only one insurer.       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.